Professional Psychology: Research and Practice
2015, Vol. 46, No. 1, 46 –54
© 2013 American Psychological Association
0735-7028/15/$12.00 http://dx.doi.org/10.1037/a0031824
Clinical Work With Non-Accepting Parents of Sexual Minority Children:
Addressing Causal and Controllability Attributions
Maya S. Shpigel, Yael Belsky, and Gary M. Diamond
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Ben-Gurion University of the Negev
Nonaccepting parents of sexual minority children typically attribute their child’s same-sex orientation to
external causes (e.g., early childhood experiences, peer pressure) and perceive sexual orientation as
mutable and under their child’s control. Using scientific findings to introduce the possibility that sexual
orientation may be, at least to some degree, biologically influenced, not a matter of choice and not under
the child’s control, can reduce blame and anger and elicit empathy among these parents. This article
provides therapists with an abbreviated summary of the extant research findings on the association
between biology and sexual orientation, and on the results of sexual orientation change efforts, written
in easily accessible language of the type we use when working with nonaccepting parents. In addition,
we discuss the clinical issues therapists must consider when deciding how and when to introduce such
information. Finally, we present a case study to illustrate this therapeutic process.
Keywords: gay, lesbian, causal attributions, parents
great majority feel more comfortable with, and supportive of, their
child’s minority sexual orientation with the passing of time (BenAri, 1995; Holtzen & Agresti, 1990; Robinson, Walter, & Skeen,
1989). Likewise, a number of surveys of sexual minority adolescents have found that, on average, parents’ level of acceptance, and
the quality of adolescent-parent relationships, improved over time
(Beals & Peplau, 2006; Cramer & Roach, 1988; Savin-Williams &
Ream, 2003), though one study found no change (D’Augelli et al.,
2010). A recent Internet survey of Israeli sexual minority adolescents found that approximately 40% of parents who were initially
fully or almost fully rejecting became more accepting by one and
one half years (on average) postdisclosure (Samarova, Shilo &
Diamond, under review).
Facilitating increased tolerance or acceptance among initially
rejecting parents is of tremendous import. When parents remain
rejecting, angry, blaming, and invalidating over time, it can undermine the very fabric of the attachment relationship, the adolescent’s or young adult’s self-esteem, and his or her emotional/
psychological well-being. Indeed, research shows that parental
criticism, invalidation, rejection, and abuse increase sexual minority adolescents’ and young adults’ risk for depression and suicidal
ideation (D’Augelli et al., 2005; Remafedi, Farrow, & Deisher,
1991; Ryan, Huebner, Diaz, & Sanchez, 2009). In contrast, parental support buffers against psychopathology (D’Augelli, 2003;
Eisenberg & Resnick, 2006; Evans, Hawton, & Rodham, 2004;
Needham & Austin, 2010; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010). Not surprisingly, when asked directly, sexual minority adolescents explicitly express a desire for improved relationships with their parents (Diamond et al., 2011; Samorova et al.,
under review).
For many parents stuck in nonaccepting stances, their blame,
anger, and criticism rest, in part, on the belief that their child’s
sexual orientation is: caused by situational/environment factors (as
opposed to biological factors); subject to change (i.e., mutable);
and under the control of their child (controllability; Bernstein,
Parents react to their children’s disclosure of a lesbian, gay, or
bisexual (LGB) orientation (i.e., “coming out”) in various ways.
Whereas some respond with understanding, acceptance, love, and
support, others initially react with shock, disbelief, anger, guilt,
shame, hurt, and grief. Indeed, research findings suggest that
upward of 50% of parents initially react with some degree of
negativity, with a small minority exhibiting severe forms of rejection, threatening behavior, and, in extreme cases, physical violence
and/or ejection from the home (D’Augelli et al., 2010; Heatherington & Lavner, 2008; Robinson, Walters & Skeen, 1989; SavinWilliams, 1998, 2001). Very religious parents are more likely to
react with rejection (Heatherington & Lavner, 2008).
Fortunately, many parents who initially react negatively become
more accepting, or at least more tolerant, over time. For example,
studies of parents participating in gay affirmative support groups
(e.g., Parents and Friends of Lesbians and Gays) show that the
This article was published Online First March 11, 2013.
MAYA S. SHPIGEL has an MA in clinical psychology and is currently
completing her PhD dissertation in the Department of Psychology, BenGurion University of the Negev, Israel. She investigates change mechanisms in family therapy, including change processes in family therapy for
homosexual offspring and their parents.
YAEL BELSKY received her MA in clinical psychology from the Department of Psychology, Ben-Gurion University of the Negev, Israel. Her
research interests are family dynamics and family therapy.
GARY M. DIAMOND received his PhD in counseling psychology from
Temple University and completed his post-doctoral training in clinical
psychology at the University of Pennsylvania School of Medicine. He is an
associate professor in the Department of Psychology, Ben-Gurion University of the Negev, Israel. His research interests include the process and
outcome of family-based treatments, emotional processing and lesbian, gay
and bisexual issues in psychotherapy.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Gary
M. Diamond, Department of Psychology, Ben-Gurion University of the
Negev, P.O. Box 653, Beer-Sheva, Israel. E-mail: gdiamond@bgu.ac.il
46
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
NON-ACCEPTING PARENTS
1990). These three dimensions are related but not identical. Typically, nonaccepting parents attribute the onset of their child’s
same-sex orientation to environmental forces such as peer influence, fear of the opposite sex, an absent father, a smothering
mother, the lure of the gay community, and so forth. They use
“evidence” from the past (e.g., a close relationship with a member
of the opposite sex) to “prove” that their child’s sexual orientation
was once heterosexual, and cling to stories they have heard or read
of people who supposedly changed their orientation via pastoral
counseling, conversion therapy, or simple strong will. By believing
that their child was once heterosexual, and that his or her same-sex
orientation was caused by external events, these parents maintain
the hope that with sufficient motivation, effort, and/or the correct
intervention, their child will “revert” to being heterosexual and,
thus, alleviate their (the parents’) fears, conflicts, embarrassment,
shame, loss, and so forth. When their child does not change, these
parents’ frustrations turn to anger.
A number of studies have explored the association between
causal and controllability attributions and attitudes to LGB orientation. In one analogue study asking 356 colleges students to
imagine that they were the parents of a 16-year-old homosexual
boy, findings showed that the more the child’s homosexuality was
perceived as being under his control, the more fury, anger, hate,
and shame emerged. Conversely, the less homosexuality was perceived as under the adolescent’s control, the more affection was
demonstrated (Armesto & Weisman, 2001). In two studies conducted by Haslam and Levy (2006), employing a sample of 487
college students and a sample of 216 adults from the community,
the authors found that tolerance of minority sexual orientation was
associated with the belief that same-sex orientation is immutable,
biologically based, and historically and cross-culturally universal.
In a study of two nationally representative samples of adults,
Haider-Markel and Joslyn (2008) found that perceiving homosexuality as controllable was associated with negative affect toward
homosexuals and perceiving homosexuality as uncontrollable
(e.g., biological, genetic in origin) was associated with positive
affect toward homosexuals.
In our clinical work with nonaccepting parents, we have found
that introducing the possibility that their child’s same-sex orientation may not simply be a choice but is, rather, influenced by
biology and immutable, can lead to a decrease in anger and an
increase in empathy toward their child. In some cases, when
parents realize that they may have been demanding something
from their child that their child cannot provide (i.e., change their
sexual orientation), the enormity of the tragedy sinks in and
sadness and compassion emerge. For some, though not for all, this
realization is momentous and signals the transition from denial and
rejection to the beginning of the acceptance process.
One strategy for introducing the possibility that their children
cannot control their sexual orientation, and therefore are not culpable, is to provide parents with up-to-date, scientifically accurate,
user friendly information regarding what is known about the link
between biology and sexual orientation and about the immutability
of same-sex orientation. A number of good, detailed reviews of
research findings on these topics already exist (cf. Hill, Dawood &
Puts, 2012; Jenkins, 2010). However, such reviews are not necessarily aimed for the consumption of the average parent. The
primary purpose of this article to is to provide clinicians with an
abbreviated, select summary of the most compelling and easily
47
understood findings on the link between biology and sexual orientation and on efforts to change sexual orientation. The summary
is written in accessible language, of the type we typically use when
working with nonaccepting parents. For those clinicians and parents wanting more detailed information about biology and sexual
orientation, we have included a list of relevant references (see
Appendix). In addition, we discuss the clinical issues therapists
must consider when deciding how and when to introduce such
information. Finally, we present a case study to illustrate this
therapeutic process.
Clinically Oriented Summary of Research on Biology
and Sexual Orientation and on Sexual Orientation
Change Efforts
Biology refers to a wide range of factors and processes, including genetic makeup, organ structure, enzyme production, dendritic
growth, and exposure to prenatal hormones, to name a few. Below,
we review findings from the areas of behavioral genetics, prenatal
development, and brain morphology.
Behavioral Genetics
Many parents wonder whether their child’s sexual orientation is
determined by genes. Indeed, genetics have been found to influence many of our physical traits, as well as our psychological
functioning. Researchers typically describe the contribution of
genes in terms of heritability rate—the degree to which individual
differences in the population are explained by our genes. One way
to estimate heritability rates is through family and twin studies.
Fifty years of such research have generated compelling and consistent evidence that lesbians and gay men are more likely than
heterosexual men and women to have gay siblings. For example, in
one study researchers found that approximately one-quarter of gay
men’s brothers also reported being gay—roughly four times the
rate found among brothers of heterosexual men (Pillard & Weinrich, 1986). Moreover, twin studies consistently show that identical twins, who by definition share the same genetic make-ups, are
2 to 4 times more likely to both be gay than nonidentical twins,
who share only half of their genetic makeup. In one recent largescale twin study conducted in Sweden, genetics accounted for up
to 39% of the variation in sexual orientation identity among males
and up to 19% among women (Långström, Rahman, Carlstrom, &
Lichtenstein, 2010). In another recent large-scale study conducted
in Finland, the heritability rate was 45% and 50% for women and
men, respectively (Alanko et al., 2010). In summary, genetics
appear to play an important role in the development of sexual
orientation. While their influence is less than that found in traits
such as height and eye color (with heritability rates of approximately 80%) (Bräuer & Chopra, 1978; Magarey, Boulton, Chatterton, Schultz, & Nordin, 1999), it is substantially higher than that
found in phenomena such as major depression (with a heritability
rate of approximately 34%; Nes et al., 2012). Moreover, the closer
the genetic relation, the greater the likelihood that two related
individuals will be concordant for sexual orientation However,
despite the overwhelming evidence suggesting that genes are to
some degree implicated in the development of sexual orientation,
there is still no reliable evidence indicating exactly which genes
are implicated (Hill, Dawood & Puts, 2012; Jenkins, 2010).
48
SHPIGEL, BELSKY, AND DIAMOND
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Prenatal Development
There is some research suggesting that levels of certain hormones (e.g., testosterone, estrogen), released during pregnancy,
may influence the development of sexual orientation. One approach to investigating the link between such hormones and sexual
orientation is by examining finger length, because these same
hormones are thought to influence finger growth in utero. Perhaps
the most researched phenomenon relates to the relative lengths
of the second and fourth fingers. A number of studies have found
that the ratio of the second finger to fourth finger (2D:4D) is lower
in gay males than it is in heterosexual males. A recent systematic
review of the research on this topic, however, concluded that
although there seems to be evidence that 2D:4D differs between
lesbian and heterosexual women, there does not seem to be a
difference between gay and heterosexual men (Grimbos, Dawood,
Burriss, Zucker, & Puts, 2010; Rahman, & Wilson, 2003).
Another biological marker studied has been “handedness.”
Handedness is thought to be the result of prenatal development of
the brain. A meta-analysis (Lalumière, Blanchard, & Zucker,
2000) of all studies up until the year 2000 found that gay men were
a third more likely than heterosexual men, and lesbians were
almost twice as likely as heterosexual women, to be left-handed or
ambidextrous. Findings from these two lines of research provide
some support for the hypothesis that prenatal hormone levels may
partially determine or influence sexual orientation development
(Hill, Dawood & Puts, 2012).
Brain Morphology
Although the brains of homosexual and heterosexual men, and
lesbian and heterosexual females, are for the most part similar, a
number of studies have found differences between individuals with
same-sex versus other-sex orientations regarding specific brain structures. One such structure is the hypothalamus, which is implicated in
the generation of male typical sexual behavior (LeVay, 1991). Studies
have found that the size and density of neurons in the hypothalamus
differ among homosexual men versus heterosexual men (Byne et al.,
2001; LeVay, 1991; Swaab & Hoffman, 1990). Another such structure is the anterior commissure (AC)—a bundle of nerve fibers
connecting the two cerebral hemispheres. One study found that homosexual males evidenced the largest anterior commissure, followed
by heterosexual women and, in turn, heterosexual men (Allen &
Gorski, 1993), though a later study found no between-gender or
between-orientation differences in the size of the AC (Lasco, Jordan,
Edgar, Petito, & Byne, 2002). Researchers have also found that the
corpus callosum, the primary band of neural fibers connecting the left
and right cerebral hemispheres, is larger in homosexual men than in
heterosexual men (Witelson et al., 2008). In terms of the relative size
of the two cerebral hemispheres, there is evidence that whereas
heterosexual males and homosexual women have slightly larger right
hemispheres than left hemispheres, the two hemispheres of homosexual males and heterosexual women are symmetrical (Savic & Lindstrom, 2008). In addition, the amygdala—that brain structure implicated in the processing of emotional memories—appears to function
differently according to gender and sexual orientation. More specifically, whereas the left amygdala showed greater connectivity to other
brain structures among heterosexual women and homosexual men,
the right amygdala showed greater connectivity among heterosexual
men and homosexual women (Savic & Lindstrom, 2008). Finally,
there are findings suggesting that certain basic cognitive processes,
such as spatial memory, mental rotation, verbal fluency, and recognition of facial expressions of emotion, are different among homosexual men in comparison with heterosexual men. In summary, a
substantial body of research suggests that there are brain differences
between lesbian or gay individuals in comparison with heterosexual
individuals, though much more research is required to understand the
nature of the association between brain structure and sexual orientation (Hill, Dawood & Puts, 2012; Jenkins, 2010).
Environment/Life Experiences
In the past, some have suggested that environmental factors, such
as early parent– child interactions and sexual experiences, could cause
an individual to become homosexual or lesbian (Friedman &
Downey, 2008). To date, however, there is no methodologically
sound research supporting such theories (Frankowski, 2004). In fact,
there is quite a lot of research showing that parental gender, gender
behavior, and attitudes toward homosexuality most likely do not
influence children’s sexual orientation. For example, studies show
that children raised by homosexual or lesbian couples are not more
likely to be homosexuals or lesbians themselves (Allen & Burrell,
1996; Bailey, Bobrow, Wolfe, & Mikach, 1995; Gartrell, Bos, &
Goldberg, 2011; Golombok & Tasker, 1996; Stacey & Biblarz, 2001),
though in one recent study adolescent females raised by lesbian
mothers were more likely to have had same-sex contact and define
themselves as bisexual (Gartrell, Bos, & Goldberg, 2011). With
regard to sexual experiences, research shows that lesbian adolescents
were as likely as heterosexual female adolescents to have experienced
intercourse, suggesting that they were not lesbian because they had
not experienced heterosexual sex (Saewyc, Bearinger, Blum &
Resnick, 1999).
Sexual Orientation Change Efforts (SOCE), Including
Conversion Therapy
What we tell parents about SOCE is derived, primarily, from the
report by the American Psychological Association Task Force on
Appropriate Therapeutic Responses to Sexual Orientation (APA,
2009). We explain that there is a very small amount of rigorous
research on sexual orientation change efforts. A summary of the
findings that are available suggests that enduring change to an individual’s sexual orientation is uncommon and that a very small minority of people in these studies showed any evidence of reduced
same-sex sexual attraction. Likewise, evidence that SOCE increased
sexual behavior with the opposite sex is rare. Counseling and psychotherapy approaches designed to change sexual orientation have not
been rigorously evaluated, and there is no basis for concluding that
they are effective.
Not only is there no evidence that SOCE are effective, there is
evidence to indicate that individuals experience harm from such
efforts. For example, in a study of 202 individuals who had undergone
sexual orientation change efforts, including aversion conditioning,
psychotherapy, and religious counseling, two thirds described the
interventions they received as “harmful only” (38%) or “both harmful
and helpful” (28%) (Shidlo & Schroeder, 2002). Participants of sexual
orientation change efforts describe negative social, emotional, and
spiritual consequences as a result of their experience, including anger,
anxiety, confusion, depression, grief, guilt, hopelessness, deterioration
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NON-ACCEPTING PARENTS
of relationships with family, loss of social support, loss of faith, poor
self-image, social isolation, intimacy difficulties, intrusive imagery,
suicidal ideation, self-hatred, and sexual dysfunction. A minority of
participants did report experiencing benefits, such as relief, happiness,
improved relationship with God, and perceived improvement in mental health status, though some described experiencing these benefits
initially, only to later experience or acknowledge the negative effects
(Morrow & Beckstead, 2004; Shidlo & Schroeder, 2002). It is important to note, however, that we have no way of knowing to what
degree these samples are representative of the entire population of
individuals undergoing SOCE. Nevertheless, because of the lack of
support for SOCE, and because of their potential to cause harm, the
American Psychological Association suggests that mental health professionals avoid telling clients that they can change their sexual
orientation through therapy or other treatment. The APA also suggests
that therapists advise clients to avoid sexual orientation change efforts
that portray homosexuality as pathological and, instead, to seek treatment, social support, and educational services that provide accurate
information about sexual orientation, increase family and school support, and reduce rejection of sexual minority youth (APA, 2009). The
American Psychiatric Association adopted a similar resolution in
2000, stating that the organization opposes therapeutic techniques
intended to change an individual’s sexual orientation from homosexual to heterosexual. The Board of Trustees went on to state that there
is no evidence that so-called reparative therapies have any efficacy
(APA, 2000). Recently, the California State Assembly passed a bill
making it illegal for mental health practitioners to administer treatments intended to change the sexual orientation, romantic attractions,
or gender expression of children and adolescents under the age of 18.
Clinical Issues
Introducing the possibility that sexual orientation may be innate
and/or immutable is a powerful intervention that must be skillfully
and sensitively employed. If the possibility is introduced prematurely,
parents may experience the therapist as allied with their child and as
lacking understanding and empathy for their own suffering and anger.
Along the same lines, if the possibility is introduced too forcefully, as
an unequivocal fact, parents may feel coerced or railroaded into
adopting a position they are not yet ready or able to fully consider.
Both of these negative processes can undermine the therapeutic alliance. For that reason, introducing the possibility that sexual orientation may not be a choice, and may not be controllable, needs to be
done gradually, nonpassionately, and in a manner that accurately
reflects the current state of the science. Only after parents feel that the
therapist understands and empathizes with their own distress, and that
they (they parents) have the freedom and time to weigh all of the
evidence, will they be open to considering alternative causal and
controllability attributions.
When speaking with parents, we always begin by pointing out that,
at this point in time, nobody knows for sure exactly why an individual
expresses a same-sex orientation, though we make it clear that there
is no credible evidence that sexual orientation is attributable, even in
part, to social factors. To date, researchers have yet to identify specific
genes, hormones, or other physiological factors that can be said, with
certainty, to determine or influence the development of sexual orientation. Nevertheless, there are findings from a substantial amount of
studies across a wide range of domains that strongly suggest that
biology plays a role in the development of sexual orientation.
49
Depending on the needs and capacities of the parents, the findings
listed above can be presented in less or more detail. For some parents,
it is enough to hear that there is some research suggesting a link
between genes and sexual orientation. Others may want to know how
much variance genes account for, how many studies have been
conducted, and whether the findings are the same for men and
women. Also, the breadth of information provided at a given moment
varies. In some cases, parents make a general request for information
on the association between biology and sexual orientation and we
respond with a five- to 10-minute psycho-educational summary of the
data appearing above. In other instances, we introduce brief bits of
data as part of our responses to parents’ specific questions or concerns, as they arise. For example, some parents may have questions
about the potential benefits of conversion therapy at the start of
therapy, and only later, after recognizing that their child is not likely
to change their sexual orientation, then have other questions about the
role of genetics in the development of same-sex orientation.
In all cases we are careful to monitor parents’ reactions as we
present them with the data. When parents respond with openness,
curiosity, and in an engaged manner, we proceed to offer additional information and explore the impact the information is having on the parent and on his or her attitudes/feelings toward their
child. On the other hand, when parents respond defensively or
become overwhelmed, we take a step back, empathize with their
distress about how hard the process is for them, and offer support.
Composite Case Example
Yaacov (age 64) and Rivka (age 60) immigrated to Israel from
Yemen as children in the 1950s. Rivka works as clerk in a
government office and Yaacov as a foreman in a factory. Although
they do not identify themselves as being religious, both come from
traditional families. They are parents of 6 children ranging in age
from 20 to 52. Yonni (age 25), their second to youngest son, came
out to them as gay approximately one year ago. They agreed to
participate in our family therapy program after Yonni, with our
encouragement, wrote them a letter explaining how much he cared
about them, how important his relationship with them was, and
how much he wanted them to join him in family treatment.
During the first session, both Rivka and Yaacov described the
shock they experienced when Yonni disclosed his sexual orientation to them.
Rivka: “I thought I didn’t hear him correctly. I had to ask him to
repeat what he said—it was like . . . I couldn’t think or comprehend
for . . . I don’t know how many minutes passed. My heart dropped. He
is the last person in the world I would have thought would be like
that— he was always so manly, liked sports—the girls were all over him.”
Yaacov: “Yes. That’s true. It was like thunder on a clear day. I still
don’t understand. I have asked myself a million times—where did I go
wrong—was I not involved enough with him? Was I too soft with
him?”
Therapist: “I don’t think many parents are fully prepared to hear their
son say, ‘Mom, Dad . . . I am gay.’ Especially when it comes
completely unexpectedly.”
After hearing more about their shock, anger, shame, and fears,
the therapist returned to Yaacov’s questions about his possible role
in the development of Yonni’s sexual orientation.
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50
SHPIGEL, BELSKY, AND DIAMOND
Therapist: “You know, Yaacov, I heard you saying that you wonder
whether something you did or didn’t do, something about your parenting, the way you treated Yonni, is responsible for his being gay.
What exactly do you think you should have done differently?”
Yaacov: “We wanted him to come and speak with our Rabbi—the Rabbi
said he was willing to talk to Yonni. I thought that maybe if I could get
him more involved in the synagogue, in the morning prayer group,
perhaps that might make a difference.”
Yaacov: “I don’t know . . . maybe I should have provided more of a
masculine role model . . . played more sports with him.”
Rivka: “We heard from others that in some cases, it is possible to get
the person back on the ‘right’ track. I even heard one man speak about
how he had overcome his homosexuality and was now living a life
just like everybody else—married, with children.”
Therapist: “I hear what you are saying. For a lot of parents, that is a
natural instinct—to question or blame themselves. We can talk more
about it later if you would like, but I just want you to know right now
that there is no compelling evidence of any kind suggesting a connection between parenting and children’s sexual orientation. There
have been lots of theories about absent fathers, overinvolved mothers,
and so forth but really no data supporting these contentions. Even
among families with two lesbian parents, boys are not more likely to
grow up gay.”
Later in the session, Rivka returns to the question of how her son
came to be gay and the implications.
Rivka: “I don’t understand. What would make him choose that path?
Doesn’t he realize that his life is going to be hell? That our life is
going to be hell?”
Therapist: “I hear how hard this is for you. It also sounds like you are
worried about how hard it is going to be for Yonni—that you are
pained thinking about what he will be up against . . . .”
After spending some time exploring and acknowledging Rivka’s
and Yaacov’s fears about the future, the challenges both they and
Yonni will face, and introducing the possibility of an alternative
narrative—an alternative future that is not dominated by isolation,
shame and loss but rather connection and meaning—the therapist
turns to the question of causality.
Therapist: “Rivka, a few minutes ago you mentioned the word
‘choice’—that you couldn’t understand why Yonni ‘chose’ to be
homosexual. I was wondering whether you had considered that maybe
Yonni didn’t ‘choose’ to be gay, but was perhaps born that way?”
Rivka: “We have heard others say that. What can I say . . . ”
Yaacov: “You know, we have relatives—Rivka’s cousin. They have
two daughters who are both lesbian.”
Rivka: “I feel terrible for them. It was one catastrophe after the other
for them.”
Therapist: “You know, there is quite a bit of research suggesting that
sexual orientation, at least in part, may be related to genetics or other
biological processes and may not be much of a choice, if at all. For
example, there are some findings suggesting that the amount of certain
hormones released during pregnancy may impact upon sexual orientation.”
Yaacov: “Yes, on one hand it makes sense—I can’t think of anything
we did or that was out of the ordinary while he was growing up.”
Finally, near the end of the session, Rivka lamented about
wishing Yonni would change, wishing that he would at least try to
live a “normative” lifestyle, find a woman, start a family.
Rivka: “I just wish he would try . . . to see if he could change himself
back to normal.”
Therapist: “I can certainly understand why you would wish that, somehow, all of this could be different and that Yonni would somehow
transform into being heterosexual, the way you always expected. The
idea of having a gay son, particularly in the beginning, is hard and scary,
and magically ‘changing’ him into a heterosexual would somehow eliminate all of those problems. You know, many have explored whether it is
possible to change one’s sexual orientation. The fact is that reports of
people changing their sexual orientation, particularly when they identify
as exclusively homosexual, are very rare and generally unvalidated.
There have been numerous surveys on people’s experience participating
in all sorts of sexual orientation change efforts, including psychotherapy,
pastoral counseling. Overall, there is no credible evidence that such
efforts change sexual orientation, though there has been very little rigorous research examining this question. For people who report a more fluid
or bisexual orientation, fluctuations in self-defined sexual orientation are
more common. However, in large surveys, a very small percentage of
respondents reporting that they were gay and went to therapy to change
(either because of family or societal pressure or because of internalized
discomfort) reported that they had indeed changed. Just as importantly,
the great majority of people surveyed who underwent sexual orientation
change efforts reported feeling harmed by the effort, including experiencing increased guilt, self-contempt, hopelessness, and suicidal ideation,
among other things.”
Discussion
The primary purpose of this article is to provide therapists working
with nonaccepting parents of LGB individuals with a user-friendly
summary of research findings that they can use to introduce, or better
establish, the possibility that sexual orientation is, at least partially,
attributable to biology and not a choice, and that efforts to change
sexual orientation, particularly coercive efforts, are likely to be unsuccessful and detrimental. Introducing the possibility that sexual
orientation may be biologically determined and immutable is a potentially critical change intervention for nonaccepting parents and, in
turn, their relationship with their child. As mentioned above, there is
a strong link between causal and controllability attributions and attitudes toward homosexuality. Nonaccepting parents who tenaciously
hold onto the belief that their child has “chosen” to be gay, and can
therefore choose to become heterosexual, are less likely to be willing
to work toward acceptance or even tolerance. On the other hand, when
such parents recognize that there is even a small possibility that their
child is not responsible for their same-sex orientation and, in fact, has
suffered in his or her struggle to come to peace with his or her sexual
orientation, parents are likely to become more empathic and supportive and the process of shared acceptance can begin.
Although the potential usefulness of introducing the idea that
biological factors influence sexual orientation is clear, a number of
caveats are warranted. First, for some religious families, the contention that homosexuality may be even partly attributable to biological
factors runs counter to their interpretation of the Bible and, therefore,
holds little traction. They argue that the Bible is unequivocal about
homosexuality being a sin and that God would not have created
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NON-ACCEPTING PARENTS
individuals who were innately gay. Indeed, holding orthodox or
fundamental religious beliefs is one of the more robust predictors of
parental nonacceptance (Heatherington & Lavner, 2008; Newman &
Muzzonigro, 1993; Schope, 2002). To resolve or circumvent this
conflict, some gay friendly clergy have reinterpreted the relevant
biblical verses, emphasized the distinction between sexual orientation
(urges) and actual sexual behavior, highlighted fundamental JudeoChristian values such as acceptance and the importance of not judging
others, focused on the greater good of preserving the parent– child
relationship, and reminded parents that no one can fully understand
God’s intentions and plans (Rodriguez & Ouellette, 2000). With that
said, orthodox religious parents are likely to have a difficult time
integrating biological causal attributions for homosexuality with their
religious beliefs, and introducing them to such research findings may
be ineffective, inappropriate, or even counterproductive in some
cases. With this population, therapists need to be particularly cautious
and carefully monitor parents’ reactions to the information presented
on a moment-to-moment basis.
Second, invoking biological, essentialist causal attributions may be
more challenging with parents of nonheterosexual females, and in
particular bisexual females, than with parents of homosexual males.
Research suggests that sexual orientation is generally more clearly
defined among men, with most men identifying as either homosexual
or heterosexual, and only a few identifying as bisexual (Hammack,
2005). Moreover, men less often report change in their sexual orientation over time (Kinnish, Strassberg & Turner, 2005). These two
related findings are consistent with an essentialist approach: that one’s
physiology is central in determining sexual orientation. In contrast,
female sexual orientation appears to be more varied, with women
reporting a wider range of self-identifications including many who
self-identify as bisexual (Hammack, 2005). Moreover, research suggests that female sexual orientation is more fluid than that of men
(Diamond, 2000, 2003; Kinnish et al., 2005; Savin-Williams & Diamond, 2000; Savin-Williams & Ream, 2007). Such fluidity presents
a challenge to biological, essentialist explanations and, in turn, may
complicate the acceptance process. Indeed, there are research findings
that indicate that fathers have particular difficulty accepting their
lesbian daughters (Heatherington & Lavner, 2008). Also, a recent
study of Israeli sexual minority adolescents suggests that parents had
the most difficulty accepting their bisexual daughters (Samarova,
Shilo, & Diamond, under review).
Third, although a biological causal model is likely to reduce parents’ blame and anger toward their child, it has the potential to
increase parents’ own guilt, and in some cases, even lead one parent
to blame the other. However, it is worth noting (and perhaps reminding parents) that individuals (including themselves) are not responsible for their own genetic makeup or biological functioning. Moreover,
biological causal models alleviate what is generally a greater concern
among parents: that they may have somehow actively, albeit unwittingly, influenced their child’s sexual orientation through their parenting style/choices.
A fourth consideration when invoking biological causal models is
that they can potentially be used to pathologize sexual minority
individuals. He is gay because he has a disease, a genetic deformity,
and so forth. Above and beyond the insult inherent to pathologizing what
is in fact a normal variation of human sexuality, such pathologizing can
quickly lead to stigmatization and, subsequently, to discrimination. Moreover, many fear that pathologizing homosexuality can lead to, or promote,
51
eugenic ideas: provide a rational or justification for biological interventions to eliminate or alter same-sex orientation.
Yet another concern is that the very use of terms such as homosexual, lesbian, bisexual, and heterosexual is offensive to certain
individuals. For many sexual minority individuals aligned with a
“queer” stance, such labels are experienced as artificial, restrictive,
and essentialist in nature—vehicles for defining what is normal,
permissible, and not. Such individuals are more likely to view gender,
gender behavior, sexual orientation and behavior, and selfidentification as varied, fluid, and as socially, historically, culturally,
and politically constructed (Spargo, 1999). They are likely to spurn
both the use of labels and biological causal theories. In such circumstances, the adolescent or adult child him/herself might be averse to
the idea of the therapist invoking biological models when explaining
their sexual orientation to their parents.
An additional concern is that, for some individuals, any discussion
of cause is perceived as “missing the point.” Such individuals take the
position that it doesn’t matter “why” somebody is gay. Instead,
parents should be concerned with accepting and being proud of their
children, regardless of their sexual identity and inclinations. To this
we can only respond with an emphatic, resounding, “Yes. We agree!”
However, for many parents, being affirming, or even just least tolerant, is the end result of a process, not the beginning. Nonaccepting
parents are typically organized by their shame, fears, frustrations, and
anger. Introducing a frame in which no one is to blame can serve to
neutralize or temper such feelings long enough for parents to become
more reflective and allow other feelings and thoughts to arise, such as
their love for their child, concern for his or her emotional welfare, and
the importance of their relationships with him/her. For such parents,
introducing the possibility of biological causes is an instrumental,
strategic intervention useful early in the therapy process. In a study of
parents participating in a gay empowerment parent support group,
Fields (2001) found that most newcomers to the group experienced
the biological argument as comforting. However, with time, most
members eventually rejected the debate on the causes of homosexuality and, instead, focused more on acceptance, affirmation, and
advocacy. Indeed, one of the participants reported that while she
initially found the biological argument comforting, after becoming
more comfortable with her son’s gay identity she now resented
discussions of biological causal models. Most interestingly, long-term
members of the group reported that they themselves were strategic in
their use of biological causal models when speaking with new members. They invoked research supporting such models when addressing
new members who were still consumed by their search for reasons
why their child was gay and who were concerned about the possibility
that they had contributed to their child’s same-sex orientation through
their parenting. For many parents new to the group, “assigning responsibility for homosexuality to natural forces over which they had
no control allowed them to avoid embracing lesbian and gay sexuality
while still accepting their daughters and sons” (Fields, 2001, p. 174).
Finally, some might take the position that working with nonaccepting parents is a useless endeavor or, worse, unethical—that it invalidates children’s (young or adult) legitimate expectations that their
parents fully accept and prize them for who they are, in their entirety,
including their sexuality. They take an all-or-nothing position: Until
parents are able to come to full acceptance, any contact with that
parent is toxic. Unquestionably, ongoing contact with nonaccepting
parents is potentially harmful for their sexual minority offspring. For
parents who are particularly critical and rejecting, even intermittent
SHPIGEL, BELSKY, AND DIAMOND
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52
contact can be destructive. For that reason, as therapists, we place a
premium on helping adolescents and young adults protect themselves
from excessive criticism, humiliation, or abuse. With that said, relationships with parents continue to be important to most individuals
throughout their lives. Consequently, we work individually with nonaccepting parents, sometimes for months, in an effort to help them
articulate, differentiate between, and overcome their fears, anger,
shame, and loss. We help them to focus more on their love for their
child, the welfare of their child, and their deep-seated, instinctual
desire to maintain a relationship with their child. When parents’ fear,
anger, and shame sufficiently subside, and their desire to work on
their relationship comes to the fore, we initiate conjoint sessions
focused on increasing safety and acceptance in the relationship and
deepening the attachment bond. In those cases in which, despite our best
efforts, parents rigidly hold onto their anger and demands that their child
“change,” we are left to grieve, together with the child. However, in light
of the research demonstrating the protective role of parental acceptance
and support, and in light of the deep seated need we all carry to feel that
our parents our proud of us, accept us, and love us, articulating and testing
interventions that can potentially facilitate the acceptance process among
nonaccepting parents is warranted.
Whereas the focus of this article is on conducting psychotherapy
with families with nonaccepting parents, the potential utility of introducing parents to research on biology and sexual orientation extends
beyond the clinic to other settings. For example, many schools and
community centers offer parenting classes for parents of young children and adolescents. In the context of such classes, introducing
same-sex orientation as a common phenomenon influenced, to some
degree, by biology may help moderate the reactions of parents whose
children subsequently “come out” (i.e., primary prevention). Likewise, professionals can present such information to parents concerned
about what they perceive as their child’s atypical gender behavior
(i.e., secondary prevention). Finally, the more such findings are profiled in the mass media, the more likely it is that the general public
will adopt more tolerant, accepting attitudes to sexual minority individuals (Altemeyer, 2002; Haslam & Levy, 2012).
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(Appendix follows)
54
SHPIGEL, BELSKY, AND DIAMOND
Appendix
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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Received August 6, 2012
Revision received December 27, 2012
Accepted January 7, 2013 䡲
Call for Papers: Experimental and Clinical Psychopharmacology
Special Issue for August 2015 on: Sex Differences in Drug Abuse: Etiology
and Implications for Prevention and Treatment
The goal of this special issue is to broadly highlight how males and females differ in their risks for
substance abuse, in their responses to treatments, and in their relapse to substance use after a period
of abstinence. Relevant approaches include (but are not limited to) laboratory behavioral, social
behavior and environmental context, brain development and function, and the role of genetics,
hormones and neuropeptides. Both animal and human methods are appropriate for this issue.
Collaborative manuscripts that bridge animal and human findings are especially valued.
This special issue is intended to showcase the importance of studying sex differences in drug abuse
and how this research might lead to more tailored approaches for prevention and treatment.
Laboratories engaged in research in this area may submit review articles or primary research reports
to Experimental and Clinical Psychopharmacology to be considered for inclusion in this special
issue.
Manuscripts should be submitted as usual through the APA Online Submission Portal
(www.apa.org/pubs/journals/pha/), and the cover letter should indicate that the authors wish the
manuscript to be considered for publication in the special issue on Sex Differences in Drug Abuse.
All submissions will undergo our normal peer review. Manuscripts received no later than March
16, 2015 will be considered for inclusion in the special issue. We strongly encourage individuals to
contact us in advance with their ideas and ideally a draft title and abstract.
Questions or inquiries about the special issue can be directed to the Guest Editor of the issue, Brady
Reynolds, PhD, at brady.reynolds@uky.edu or the Editor, Suzette Evans, PhD at se18@columbia.edu.
The Biology of Sex and Gender
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Sex as a Form of Motivation
Arousal and Satiation
The Role of Testosterone
Brain Structures and Neurotransmitters
Odors, Pheromones, and Sexual Attraction
APPLICATION | Of Love, Bonding, and Empathy
Concept Check
The Biological Determination of Sex
Chromosomes and Hormones
Prenatal Hormones and the Brain
CONCEPT CHECK
Gender-Related Behavioral and Cognitive Differences
Some Demonstrated Male-Female Differences
Origins of Male-Female Differences
IN THE NEWS | GTEx Project Provides New Insight Into the Differences
Between the Sexes
Concept Check
Biological Origins of Gender Identity
Gender Dysphoria
46 XY Difference in Sexual Development
46 XX Difference in Sexual Development
Cognitive and Behavioral Effects
APPLICATION | Sex, Gender, and Sports
Ablatio Penis and Other Natural Experiments
Concept Check
Sexual Orientation
APPLICATION | Who Chooses a Child’s Sex?
The Social Influence Hypothesis
Genetic and Epigenetic Influences
Prenatal Influences on Brain Structure and Function
Social Implications of the Biological Model
Concept Check
In Perspective
Chapter Summary
Study Resources
After reading this chapter, you will be able to:
• Contrast sex with other motivated behaviors.
• Demonstrate the role of hormones and brain structures in sexual behavior.
• Identify hormonal and brain differences between females and males.
• Describe how behavioral differences between males and females are influenced
biology and environment.
• Explain the role of biological influences on gender identity.
• Assess the impact of biological influences on sexual orientation.
by
Bruce Jenner spent his early career as an athlete, playing football at Graceland College until a
knee injury necessitated a change in sport to decathlon in 1968. After years of grueling
training and competition, Jenner won a gold medal in decathlon at the 1976 Summer
Olympics in Montreal and became a hero back home in the United States. Jenner even graced
the cover of Sports Illustrated magazine and became the most widely known athlete to be on
the cover of a Wheaties breakfast cereal box. Leaving athletics behind, he became better
known as a sports commentator and occasional actor in films and television. During this time
he had been married three times and fathered six children. Throughout the successes in
athletics and as an actor, Jenner was struggling with a psychological disorder called gender
dysphoria, which is the distress that people feel when their gender identity does not match
their sex at birth. At times he dressed as a woman, and he was taking female hormones to try
to better match his feelings of being female.
Master the content.
edge.sagepub.com/garrett5e
In April 2015, Jenner made news by coming out as a transgendered woman. Later that year,
Jenner officially adopted her now-permanent feminine identity as Caitlyn Jenner, and in
January 2017, she underwent gender reassignment surgery to replace the penis with a vaginal
opening. Her memoir The Secrets of My Life and the documentary series I Am Cait detailed
her gender transition; in recognition of her outspoken support for LGBT rights and the
strength she demonstrated in discussing her gender identity struggles with the public, she
received the Arthur Ashe Courage Award and Out magazine’s Newsmaker of the Year
award. Quite possibly the most interesting thing about Caitlyn Jenner’s new gender and
identity is that she still finds herself sexually attracted to women, underscoring the fact that
gender identity does not always match a person’s sexual orientation.
Source: Valerie Macon/AFP/Getty Images.
Humans have a great affinity for dichotomies, dividing their world into blacks and whites
with few grays in between. No dichotomy is more significant for human existence than that
of male and female: One’s sex is often the basis for deciding how the person should behave,
what the person can do, and with whom the person should fall in love. Not only are many of
the differences between males and females imposed on them by society, but Caitlyn’s
experience suggests that typing people as male or female may not be as simple or as
appropriate as we think. We will encounter even more puzzling cases later as we take a
critical look at the designation of male versus female and the expectations that go with it. In
the meantime, we need to continue our discussion of motivation by considering how sex is
like and unlike other drives.
Sex as a Form of Motivation
To say that sex is a motivated behavior like hunger may be stating the obvious. But theorists
have had difficulty categorizing sex with other physiological drives because it does not fit the
pattern of a homeostatic tissue need. If you fail to eat or if you cannot maintain body
temperature within reasonable limits, you will die. But no harm will come from forgoing sex;
sex ensures the survival of the species but not of the individual.
There are, however, several similarities with other drives like hunger and thirst. They include
arousal and satiation, the involvement of hormones, and control by specific areas in the brain.
We will explore these similarities as well as some differences in the following pages.
Arousal and Satiation
The cycle of arousal and satiation is the most obvious similarity between sexual motivation
and other motivated behaviors such as hunger and thirst. In the 1960s, William Masters and
Virginia Johnson conducted groundbreaking research on the human sexual response. Until
then, research had been limited to observing sexual behavior in animals or interviewing
humans about their sexual activity. Masters and Johnson (1966) observed 312 men and 382
women and recorded their physiological responses during 10,000 episodes of sexual activity
in the laboratory. This kind of research was unheard of at the time; in fact, the researchers
had trouble finding journals that would publish their work. Their work on human sexual
behavior was the subject of the recent Showtime cable series Masters of Sex.
How is sex like and unlike other drives?
Masters and Johnson identified four phases of sexual response (Figure 7.1). The excitement
phase is a period of arousal and preparation for intercourse. Both sexes experience increased
heart rate, respiration rate, blood pressure, and muscle tension. The male’s penis becomes
engorged with blood and becomes erect. The female’s clitoris becomes erect as well, her
vaginal lips swell and open, the vagina lubricates, her breasts enlarge, and the nipples become
erect.
While hunger is mostly a function of time since the last meal, sexual arousal is more
influenced by opportunity and sexual stimuli such as explicit conversation or the presence of
an attractive person. In contrast to humans, sexual arousal in most mammal species is
triggered by a surge in hormones. Another difference between sex and other drives is that we
usually are motivated to reduce hunger, thirst, and temperature deviations, but we seek sexual
arousal. This difference is not unique, though; for example, we might skip lunch to increase
the enjoyment of a gourmet dinner.
During the plateau phase, the increase in sexual arousal levels off. Arousal is maintained at a
high level for seconds or minutes, though it is possible to prolong this period. The testes rise
in the scrotum in preparation for ejaculation; vaginal lubrication increases and the vaginal
entrance tightens on the penis. During orgasm, rhythmic contractions in the penis are
accompanied by ejaculation of seminal fluid containing sperm into the vagina. Similar
contractions occur in the vagina. This period lasts just a few seconds but involves an intense
experience of pleasure. Orgasm is similar to the pleasure one feels after eating or when
warmed after a deep chill, but it is unique in its intensity; the resolution that follows is
reminiscent of the period of quiet following return to homeostasis with other drives.
After orgasm, males have a refractory phase, during which they are unable to become
aroused or have another orgasm for minutes, hours, or even days, depending on the individual
and the circumstances. Females do not experience a refractory period and can have additional
orgasms anytime during the resolution phase. When comparing the sex drive with other kinds
of motivation, the male refractory period has an interesting parallel with sensory-specific
satiety (see Chapter 6); it is called the Coolidge effect. According to a popular but probably
questionable story, President Coolidge and his wife were touring a farm when Mrs. Coolidge
asked the farmer whether the flurry of sexual activity among the chickens was the work of
one rooster. The farmer answered yes, that the rooster copulated dozens of times each day,
and Mrs. Coolidge said, “You might point that out to Mr. Coolidge.” President Coolidge, so
the story goes, then asked the farmer, “Is it a different hen each time?” The answer again was
yes. “Tell that to Mrs. Coolidge,” the president replied. Whether the story is true or not,
the Coolidge effect—a quicker return to sexual arousal when a new partner is
introduced—has been observed in a wide variety of species. We will visit the subject again
shortly.
Figure 7.1 Phases of the Sexual Response Cycle.
Source: From Psychology: The Adaptive Mind (2nd ed.), by J. S. Nairne, 2000, Wadsworth,
a part of Cengage Learning, Inc.
The Role of Testosterone
As important as sex is to humans, it is ironic that so much of what we know about the topic
comes from the study of other species. One reason is that research into human sexual
behavior was for a long time considered off-limits, and funding was hard to come by.
Another reason is that sexual behavior is more “accessible” in nonhuman animals; rats have
sex as often as 20 times a day and are not at all embarrassed to perform in front of the
experimenter. In addition, we can manipulate their sexual behavior in ways that would be
considered unethical with humans. Hormonal control in particular is more often studied in
animals because hormones have a clearer role in animal sexual behavior.
Castration, or removal of the gonads (testes or ovaries), is one technique used to study
hormonal effects because it removes the major source of sex hormones; castration results in a
loss of sexual motivation in nonhuman mammals of both sexes. Sexual behavior may not
disappear completely, because the adrenal glands continue to produce both male and female
hormones, though at a lesser rate than the gonads. The time course of the decline is also
variable, ranging from a few weeks to five months in male rats (J. M. Davidson, 1966);
across several species, animals who are sexually experienced are impaired the least and
decline the slowest (B. Hart, 1968; Sachs & Meisel, 1994). Humans are less at the mercy of
fluctuating hormone levels than other animals, but when they are castrated (usually for
medical reasons, such as cancer), sexual interest and functioning decrease in both males and
females (Bremer, 1959; Heim, 1981; Sherwin & Gelfand, 1987; Shifren et al., 2000). The
decline takes longer in humans than in rats, but the rate is similarly variable.
Castration has been elected by some male criminals in the hope of controlling aggression or
sexual predation, sometimes in exchange for shorter prison sentences. Castration is an
extreme therapy; drugs that counter the effects of androgens (a class of hormones
responsible for a number of male characteristics and functions) are a more attractive
alternative. Those that block the production of the androgen testosterone, the major sex
hormone in males, have been 80%–100% effective in eliminating deviant sexual behavior
such as exhibitionism and pedophilia (sexual contact with children), along with sexual
fantasies and urges (A. Rösler & Witztum, 1998; Thibaut, Cordier, & Kuhn, 1996). Chemical
castration is either allowed on a voluntary basis or mandated for some offenses in nine states
in the United States (M. Park, 2012) and in several other countries. The effects of castration
indicate that testosterone is necessary for male sexual behavior, but the amount of
testosterone required appears to be minimal; men with very low testosterone levels can be as
sexually active as other men (Raboch & Stárka, 1973).
Frequency of sexual activity does vary with testosterone levels within an individual, but the
testosterone increases appear to be the result of sexual activity rather than the cause. For
example, testosterone levels are high in males at the end of a period in which intercourse
occurred, not necessarily before (J. M. Dabbs & Mohammed, 1992; Kraemer et al., 1976). A
case report (which is anecdotal and does not permit us to draw conclusions) suggests that just
the anticipation of sex can increase the testosterone level. Knowing that beard growth is
related to testosterone level, a researcher working in near isolation on a remote island
weighed the daily clippings from his electric razor. He found that the amount of beard growth
increased just before planned visits to the mainland and the opportunity for sexual activity
(Anonymous, 1970).
Figure 7.2 Female-Initiated Activity During the Menstrual Cycle.
Source: From figure 2 from “Rise in Female-Initiated Sexual Activity at Ovulation and Its
Suppression by Oral Contraceptives,” by D. B. Adams, A. R. Gold, and A. D. Burt, 1978,
New England Journal of Medicine, 299(21), pp. 1145–1150.
In most mammals, females are unwilling to engage in sex except during estrus, a period
when the female is ovulating, sex hormone levels are high, and the animal is said to be
in heat. Human females and females of some other primate species engage in sex throughout
the reproductive cycle. Studies of sexual frequency in women have not shown a clear peak at
the time of ovulation. However, initiation of sex is a better gauge of the female’s sexual
motivation than is her willingness to have sex; women do initiate sexual activity more often
during the middle of the menstrual cycle, which is when ovulation occurs (Figure 7.2; D. B.
Adams, Gold, & Burt, 1978; S. M. Harvey, 1987). The researchers attributed the effect
to estrogen, a class of hormones responsible for a number of female characteristics and
functions. Their reasons were that estrogen peaks at midcycle and the women did not
increase in sexual activity if they were taking birth control pills, which level out estrogen
release over the cycle.
However, testosterone peaks at the same time, and the frequency of intercourse during
midcycle corresponds to the woman’s testosterone level (N. M. Morris, Udry, Khan-Dawood,
& Dawood, 1987). At menopause, when both estrogen and testosterone levels decline,
testosterone levels show the most consistent relationship with intercourse frequency (McCoy
& Davidson, 1985). How to interpret these observations is unclear, because testosterone
increases in women as a result of sexual activity, just as it does in men (Figure 7.3; J. M.
Dabbs & Mohammed, 1992). However, studies in which testosterone level was manipulated
demonstrate that it also contributes to women’s sexual behavior. Giving a dose of
testosterone to women increases their arousal during an erotic film (Tuiten et al., 2000). More
important, in women who had their ovaries removed, testosterone treatment increased sexual
arousal, sexual fantasies, and intercourse frequency, but estrogen treatment did not (Sherwin
& Gelfand, 1987; Shifren et al., 2000).
Figure 7.3 Relationship Between Sexual Behavior and Salivary Testosterone Levels in Men
and Women.
Source: From “Male and Female Salivary Testosterone Concentrations Before and After
Sexual Activity,” by J. M. Dabbs, Jr. and S. Mohammed, Physiology and Behavior, 52, pp.
195–197, Fig. 1. © 1992 Reprinted with permission from Elsevier Science.
Brain Structures and Neurotransmitters
As neuroscientists developed a clearer understanding of the roles of various brain structures,
motivation researchers began to shift their focus from drive as a tissue need to drive as a
condition in particular parts of the brain. Sexual activity, like other drives and behaviors,
involves a network of brain structures. This almost seems inevitable, because sexual activity
involves reaction to a variety of stimuli, activation of several physiological systems, postural
and movement responses, a reward experience, and so on. We do not understand yet how the
sexual network operates as a whole, but we do know something about the functioning of
several of its components. In this section, you will see some familiar terms, the names of
hypothalamic structures you learned about in Chapter 6. This illustrates an important
principle of brain functioning, that a particular brain area, even a very small one, often has
multiple functions.
What is the role of testosterone in sexual behavior?
Two areas are important in sexual behavior in both sexes, the medial preoptic area of the
hypothalamus and the medial amygdala. The medial preoptic area (MPOA) is one of the
more significant brain structures involved in male and female sexual behavior. (Be
careful not to confuse the medial preoptic area with the median preoptic nucleus, discussed
in Chapter 6. They are both in the preoptic area, which you can locate in Figure 6.2.)
Stimulation of the MPOA increases copulation in rats of both sexes (Bloch, Butler, &
Kohlert, 1996; Bloch, Butler, Kohlert, & Bloch, 1993), and the MPOA is active when they
copulate spontaneously (Pfaus, Kleopoulos, Mobbs, Gibbs, & Pfaff, 1993; Shimura &
Shimokochi, 1990). The MPOA appears to be more responsible for performance than for
sexual motivation; when it was destroyed in male monkeys, they no longer tried to copulate,
but instead they would often masturbate in the presence of a female (Slimp, Hart, & Goy,
1978).
What brain structures are involved in sexual behavior?
The medial amygdala also contributes to sexual behavior in rats of both sexes. Located
near the lateral ventricle in each temporal lobe, the amygdala is involved not only in
sexual behavior but also in aggression and emotions. The medial amygdala is active while
rats copulate (Pfaus et al., 1993), and stimulation causes the release of dopamine in the
MPOA (Dominguez & Hull, 2001; Matuszewich, Lorrain, & Hull, 2000). The medial
amygdala’s role apparently is to respond to sexually exciting stimuli, such as the presence of
a potential sex partner (de Jonge, Oldenburger, Louwerse, & Van de Poll, 1992).
Figure 7.4 The Sexually Dimorphic Nuclei of the Rat.
Source: From “The Neuroendocrine Regulation of Sexual Behavior,” by R. A. Gorski, pp. 1–
58, in G. Newton and A. H. Riesen (Eds.) Advances in Psychobiology (Vol. 2), 1974, New
York: Wiley. Reprinted with permission of John Wiley & Sons, Inc.
There are other areas that are involved in sexual behavior but only in the behaviors of a single
sex. Especially significant for males is the sexually dimorphic nucleus (SDN), located in the
preoptic area (de Jonge et al., 1989). The SDN is three to four times larger in male rats
than in females (Figure 7.4; He, Ferguson, Cui, Greenfield, & Paule, 2013), and a male’s
level of sexual activity is related to the size of the SDN, which in turn depends, at least in
part, on protection by testosterone from the cell death that occurs during the pruning stage
shortly after birth (He et al., 2013). Destruction of the SDN reduces male sexual activity (de
Jonge et al., 1989). The SDN’s connections to other sex-related areas of the brain suggest that
it integrates sensory and hormonal information and coordinates behavioral and physiological
responses to sensory cues (Roselli, Larkin, Resko, Stellflug, & Stormshak, 2004). Two other
hypothalamic structures are also important. The paraventricular nucleus (PVN; see Figure
6.2) is important for male sexual performance and, particularly, for penile erections
(Argiolas, 1999). The ventromedial hypothalamusis active in females during copulation
(Pfaus et al., 1993), and its destruction reduces the female’s responsiveness to a male’s
advances(Pfaff & Sakuma, 1979).
Figure 7.5 Dopamine Levels in the Nucleus Accumbens During the Coolidge Effect.
Source: From “Dynamic Changes in Nucleus Accumbens Dopamine Efflux During the
Coolidge Effect in Male Rats,” by D. F. Fiorino, A. Coury, and A. G. Phillips, 1997, Journal
of Neuroscience, 17, p. 4852. © 1997 Society for Neuroscience. Reprinted with permission.
For obvious reasons, we know much less about the brain structures involved in human sexual
behavior. Functional MRI (fMRI) recording during masturbation has confirmed the
involvement of the medial amygdala and PVN in human sexual activity (Komisaruk et al.,
2004). PVN neurons are known to secrete the hormone/neuromodulator oxytocin, which
contributes to male and female orgasm and the intensity of its pleasure(Carmichael,
Warburton, Dixen, & Davidson, 1994). We will see additional results from human research in
the discussion of neurotransmitters. We also know that a few brain structures in humans
differ in size between males and females. Because their contribution to sexual behavior is not
clear and the size differences may also distinguish homosexuals from heterosexuals, we will
defer discussion of these structures until we take up the subject of sexual orientation.
Sexual behavior involves several neurotransmitters, but dopamine has received the most
attention. You saw in Chapter 5 that dopamine level increases in the nucleus accumbens
during sexual activity, and in this chapter that stimulation of the medial amygdala releases
dopamine in the MPOA. Dopamine activity in the MPOA contributes to sexual motivation in
males and females of several species (E. M. Hull et al., 1999). In males, dopamine is critical
for sexual performance: Initially, it stimulates D1 receptors, activating the parasympathetic
system and increasing motivation and erection of sexual tissues; as dopamine level increases,
it activates D2 receptors, which shifts autonomic balance to the sympathetic system, resulting
in orgasm and ejaculation. D2 activity also inhibits erection, which probably accounts in part
for the sexual refractory period in males. Interestingly, dopamine release parallels sexual
behavior during the Coolidge effect. As you can see in Figure 7.5, it increased in the male
rat’s nucleus accumbens in the presence of a female, dropped back to baseline as interest
waned, and then increased again with a new female (Fiorino, Coury, & Phillips, 1997). The
changes occurred even when the male and female were separated by a clear panel, so the
dopamine level reflects the male’s interest rather than the effects of sexual behaviors.
Our knowledge about the role of dopamine in human sexual behavior is less precise but
nevertheless intriguing. Drugs that increase dopamine levels, such as those used in treating
Parkinson’s disease and stimulants, increase sexual activity in humans (Evans, Haney, &
Foltin, 2002; Meston & Frolich, 2000). The dopamine system has been reported to be active
in the ventral tegmental area in males during ejaculation (Holstege et al., 2003) and in the
nucleus accumbens in females during orgasm (Komisaruk et al., 2004). This activity likely
reflects a reward response, but, significantly, the activated areas also have strong motor
output to the pelvic floor muscles, which are important in orgasmic activity. Variations in the
gene for the D4 receptor (DRD4) are associated with sexual arousal and functioning (Ben
Zion et al., 2006), and one variant is correlated with promiscuity and sexual infidelity (Garcia
et al., 2010).
Ejaculation is also accompanied by serotonin increases in the lateral hypothalamus, which
apparently contributes further to the refractory period (E. M. Hull et al., 1999). Injecting a
drug that inhibits serotonin reuptake into the lateral hypothalamus increases the length of
time before male rats will attempt to copulate again and their ability to ejaculate when they
do return to sexual activity. Humans take serotonin reuptake blockers to treat anxiety and
depression, and they often complain that the drugs interfere with their ability to have
orgasms. The antianxiety drug buspirone, by contrast, decreases the release of serotonin and
facilitates orgasms (Komisaruk, Beyer, & Whipple, 2008).
An interesting model for the regulation of gender-related aggressive and bonding behaviors
has been proposed in the steroid/peptide theory of social bonds (van Anders, Goldey, & Kuo,
2011). According to this theory, the balance among testosterone, oxytocin, and vasopressin
determine behaviors such as aggression and intimacy (Figure 7.6). As you probably guessed,
a high testosterone level in either sex increases aggression, but it also impairs the formation
of close social bonds. Oxytocin (involved in muscle contractions of sexual tissue and in
social bonding) and vasopressin (a potent neuromodulator of brain activity) modulate the
form of intimacy and aggression. Antagonistic aggression (which includes social dominance,
partner acquisition, and defense of partners and territory) is seen in those with low levels of
vasopressin, whereas protective aggression (such as defending children or partners) is seen in
those with high levels of vasopressin. Intimacy increases oxytocin, but its interaction with
testosterone levels determines whether that intimacy is sexual (if testosterone is high) or
nurturing (if testosterone is low). Therefore, testosterone levels determine the relative amount
of competitive versus nurturing behaviors an individual expresses, whereas oxytocin
determines the relative amount of social bonding versus social isolation.
Figure 7.6 The Steroid/Peptide Theory of Social Bonds.
Source: From “The Steroid/Peptide Theory of Social Bonds: Integrating testosterone and
peptide responses for classifying social behavioral contexts,” by S. M. van Anders, K. L.
Goldey, & P. X. Kuo. Psychoneuroendocrinology, 36(9). © Elsevier. Reprinted with
permission.
Odors, Pheromones, and Sexual Attraction
Sexual behavior results from the interplay of internal conditions, particularly hormone levels,
with external stimuli. Sexual stimuli can be anything from brightly colored plumage or an
attractive body shape to particular odors. Here we will examine the role of odors and
pheromones in sexual attraction, with emphasis on how important they might be for humans.
Before we launch into this discussion, we need to have a basic understanding of the olfactory
(smell) system. Olfaction is one of the two chemical senses, along with taste. Airborne
odorous materials entering the nasal cavity must dissolve in the mucous layer overlying the
receptor cells; the odorant then stimulates a receptor cell when it comes in contact with
receptor sites on the cell’s dendrites (Figure 7.7). Axons from the olfactory receptors pass
through openings in the base of the skull to enter the olfactory bulbs, which lie over the nasal
cavity. From there, neurons follow the olfactory nerves to the nearby olfactory cortex tucked
into the inner surfaces of the temporal lobes.
Figure 7.7 The Olfactory and Vomeronasal Systems.
By varying the number of components in odor mixtures, researchers have calculated that
humans can distinguish a trillion odors (Bushdid, Magnasco, Vosshall, & Keller, 2014). But
we do not have a different receptor for each odor, and an individual neuron cannot produce
the variety of signals required to distinguish among so many different stimuli. Researchers
have discovered that humans have around 400 different receptor genes that produce an equal
number of receptor types, but additional alleles of some of these genes brings the total to
about 600 (Olender et al., 2012). Variation in these alleles among individuals suggests
considerable variation in what different people can smell. We’re pikers compared with dogs
(800); mice (1,100); and the African elephant, which has 2,000 different receptor genes
(Niimura, Matsui, & Touhara, 2016). Research has shown that elephants can distinguish
people from different tribes by odor and can recognize up to 30 different family members.
There is a good argument to be made for the nose as a sexual organ. The most convincing
evidence comes from the study of pheromones,airborne chemicals released by an animal
that have physiological or behavioral effects on another animal of the same species.
Most pheromones are detected by the vomeronasal organ (VNO), a cluster of receptors
also located in the nasal cavity. The VNO is illustrated in Figure 7.7, although you will
soon see that most researchers believe that it is no longer functional in humans, the victim of
evolution as our ancestors developed color vision and came to rely on visual sexual signals (I.
Rodriguez, 2004). However, a VNO may not be entirely necessary, because some
pheromones and pheromone-like odors can be detected by the olfactory system when an
animal’s VNO has been blocked or eliminated surgically (Wysocki & Preti, 2004). The
VNO’s receptors are produced by a different family of genes, and the VNO and olfactory
systems are separate neurally (P. J. Hines, 1997). Not surprisingly, in animals the VNO’s
pathway leads to the MPOA and the ventromedial nucleus of the hypothalamus, as well as to
the amygdala (Keverne, 1999).
Pheromones can be very powerful, as you know if your yard has ever been besieged by all
the male cats in the neighborhood when your female cat was “in heat.” The female gypsy
moth can attract males from as far as two miles away (Hopson, 1979). Pheromones provide
cues for kin recognition in animals, influence cycling of sexual receptivity in female mice,
initiate aggression in both males and females, and trigger maternal behavior in adults and
suckling in infants (Wysocki & Preti, 2004). In pigs, the boar exudes androstenone, which
elicits sexual posturing and receptivity in sows. In fact, pig farmers use androstenone as an
aid in artificial insemination.
So, do pheromones play a role in human behavior? In spite of the eagerness with which the
media and fragrance industry have embraced the topic, the best answer appears to be “maybe
. . . maybe not.” We certainly don’t see pheromones controlling sexual behavior as
powerfully as they do in animals; in fact, the best candidate for pheromone control of human
behavior is the sucking and searching movements in infants in response to breast odors of a
nursing woman (Wyatt, 2016; Wysocki & Preti, 2004). Early interest in the possibility of
human pheromones was spurred by reports that women living together in dorms tended to
have synchronized menstrual periods and that this was caused by sweat-borne compounds
that altered the frequency of luteinizing hormone release (Preti, Cutler, Garcia, Huggins, &
Lawley, 1986; Preti, Wysocki, Barnhart, Sondheimer, & Leyden, 2003; K. Stern &
McClintock, 1998). Later studies have failed to demonstrate menstrual synchrony almost as
often as they have succeeded, and the results have been questioned on methodological
grounds (Z. Yang & Schank, 2006).
Is there evidence for pheromones in human sexual behavior?
Several other studies have claimed evidence for an influence of pheromones, or at least body
odors, on human behavior. This includes amygdala activation from smelling the sweat of
first-time skydivers (Mujica-Parodi et al., 2009); increased intercourse opportunities when
using aftershave or perfume containing underarm extracts that enhanced the person’s sexcharacteristic body odor (Cutler, Friedman, & McCoy, 1998; McCoy & Pitino, 2002); higher
alcohol consumption and sociability in males after exposure to fertile female odors (Tan &
Goldman, 2015); and men’s higher attractiveness ratings of the scent of women’s T-shirts
when women were ovulating (Kuukasjärvi et al., 2004).
Application: Of Love, Bonding, and Empathy
Source: Todd Ahern/Emory University.
Prairie voles are a rare exception among mammals; they mate for life, and if they lose a mate they rarely take
another partner. The bonding process (as reviewed in L. J. Young & Wang, 2004) begins with the release of
dopamine in reward areas during mating. If dopamine activity is blocked by a receptor antagonist, partner
preference fails to develop. Sexual activity also releases the neuropeptides oxytocin and vasopressin, which are
likewise required for bonding to take place. Either can facilitate bonding in males or females, but oxytocin is
more effective with females and vasopressin with males.
So does any of this apply to humans, who are also monogamous (more or less)? The most apparent parallel
involves oxytocin. Oxytocin not only facilitates bonding but also causes smooth muscle contractions, such as
those involved in orgasm and in milk ejection during breastfeeding. Blood levels of oxytocin increase
dramatically as males and females masturbate to orgasm (M. R. Murphy, Checkley, Seckl, & Lightman, 1990).
Oxytocin also contributes to social recognition, which is necessary for developing mate preferences. Male mice
without the oxytocin gene fail to recognize females from one encounter to the next (J. N. Ferguson et al., 2000),
and human males are better at recognizing previously seen photos of women after receiving oxytocin (Rimmele,
Hediger, Heinrichs, & Klaver, 2009). Men given oxytocin also had more activity in the nucleus accumbens
while viewing photos of their partners, and they increased their ratings of their partners’ attractiveness, but not
of other women they knew (Scheele et al., 2013).
Oxytocin’s bonding effects are not limited to mates and sex partners. Mother-infant bonding is correlated with
oxytocin levels during pregnancy and following birth (Feldman, Weller, Zagoory-Sharon, & Levine, 2007), and
a gene for the oxytocin receptor is related to parenting sensitivity (Bakermans-Kranenburg & van IJzendoorn,
2008). Oxytocin also apparently explains empathetic behavior in prairie voles. Though we can’t speculate about
what the rodents are “feeling,” they respond to a cagemate’s earlier, unobserved stress with increased grooming,
and they match the cagemate’s fear response, anxiety-related behaviors, and corticosterone increase (Burkett et
al., 2016). Consoling behavior did not occur if the animals received an infusion of an oxytocin receptor
antagonist into the lateral ventricles.
But there is no shortage of critics. They point out that no human secretion has been identified
as a pheromone, including the “putative human pheromones” regularly used in research
studies (Wyatt, 2016; Wysocki & Preti, 2004). Although these compounds may have
physiological effects, so do plant odors. Pepper oil, fennel oil, and rose oil can change blood
pressure and catecholamine levels (including adrenaline), and the scent of lemon oil increases
positive mood. In addition, pheromone studies are criticized for their small sample size, lack
of statistical power, lack of replication, and publication bias—the tendency to publish
positive results and shelve negative ones. In spite of these concerns, at least one of the critics
agrees that we’re able to identify family members by odor and that smell may influence our
choice of sexual partner, but he attributes these abilities to a finely tuned sense of smell rather
than pheromones (Wyatt).
In most animals, attraction is fleeting, lasting only through copulation or, at best, till the end
of the mating season. For a few species, though, pair bonding occurs for years or for a
lifetime, as we see in the accompanying Application.
Concept Check
Take a Minute to Check Your Knowledge and Understanding
• What
change in thinking helped researchers see sex as similar to other biological
drives?
• What roles do estrogen and testosterone play in sexual behavior in humans?
• In what ways do sensory stimuli influence sexual behavior?
The Biological Determination of Sex
Now we need to talk about differences between the sexes and the anomalies (exceptions) that
occur. Sex is the term for the biological characteristics that divide humans and other
animals into the categories of male and female. Gender refers to the behavioral
characteristics associated with being male or female. For our purposes, it will be useful to
make two further distinctions: Gender role is the set of behaviors society considers
appropriate for people of a given biological sex, whereas gender identity is the person’s
subjective feeling of being male or female. The term sex cannot be used to refer to all these
concepts, because the characteristics are not always consistent with each other. Thus,
classifying a person as male or female can sometimes be difficult. You might think that the
absolute criterion for identifying a person’s sex would be a matter of chromosomes, but you
will soon see that it is not that simple.
Chromosomes and Hormones
You may remember from Chapter 1 that when cells divide to produce sex cells, the pairs of
chromosomes separate, and each gamete—the sperm or egg—receives only 23 chromosomes.
This means that a sex cell has only one of the two sex chromosomes. In mammals, an egg
will always have an X chromosome, but a sperm may have either an X chromosome ...
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