Sexual law is a highly political issue. Some argue for more restrictive sexual laws and harsher enforcement. Others argue for more personal freedom. The sexual laws currently being debated across America include laws about:

• marriage and domestic partnerships

• divorce, child custody, and child support

• sexual health and safer sex

• sexuality education in the schools

• teenage pregnancy

• abortion and contraception

• civil rights for people who are gay, lesbian, bisexual, or trans-gender

• sexual assault

• sexual abuse of children

• sexual harassment

• pornography

• HIV/AIDS discrimination

Marriage and Domestic Partnerships

Each of our states has its own marriage laws. Each can decide who can marry, set the legal age for marriage, and state requirements for blood tests and marriage licenses. As of this writing, marriage can be legalized only between a man and a woman.

Bigamy

Bigamy—to have more than one spouse—is against the law in all states. There are two forms of bigamy. “Polygamy” or “Polygyny” means having more than one wife. “Polyandry” means having more than one husband. Polygamy is legal in some societies. Polyandry is no longer legal anywhere.

Domestic Partnerships

In the past, many states considered women and men who lived together for a significant period of time (different time requirements in different states) and who publicly described themselves as “husband and wife” to be common-law spouses. This gave them certain benefits held by other couples who had been married in an official way.

There are now more single people in our country than at any other time in history. Many never marry. Many divorce and do not remarry. Many singles live together in long-term, sexual relationships. This is called cohabitation. Increasing numbers of cities, states, corporations, and insurance carriers recognize these relationships and confer on couples some of the benefits otherwise available only to couples who are legally married. In some cases, same-sex couples also receive these benefits. These relationships, when recognized in this way, are sometimes called domestic partnerships.

Gay Marriage

In 1967, the U.S. Supreme Court overthrew all miscegenation laws in its decision Loving v. the Commonwealth of Virginia. The Supreme Court ruled that laws against marriage between persons of different races violated the right of equal protection. As we go to press, similar arguments are being used in the state of Hawaii, where legalized gay marriage is being debated. So many people are against gay marriage, however, that the U.S. Congress recently passed a new law, the Defense of Marriage Act, that allows states to disregard gay marriages recognized in other states. Some people think this law is a violation of the full faith and credit clause of the U.S. Constitution—which makes the official acts of one state valid in all states.

The Defense of Marriage Act also allows the government to withhold certain federal benefits from the spouses of gay marriages. These benefits include Social Security, veterans benefits, and federal pensions. President Bill Clinton signed this law in 1996.

Many states already ban same-sex marriage, and other states are considering similar laws.

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Men who report being sexually assaulted by women were pressured by guilt or threat of breakup. Some described being too drunk or incapacitated to be able to control the situation. Others report being threatened with physical violence, blackmail, or demotion.

Sexual assault against men by women is much less common than sexual assault against women. There are more than 9,000 cases of sexual assault by women against men reported each year, but sexual assault against men is often unreported. Men encounter disbelief when reporting a woman as a rapist. They may fear public and private humiliation. They may feel that they have failed to be masculine enough to defend themselves. Some fear they will be perceived as effeminate or homosexual.

The emotional effects of sexual assault for men are anger, fear, shame, guilt, and disruptions in sexual, social, and family relationships, as well as in sleeping and eating. Professional counseling can help relieve these effects. Rape-crisis centers assist men as well as women.

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Adolescence in American society is generally viewed as a period of change, friction, and problems. It is a period during which the individual is no longer a child and yet not quite an adult. The adolescent is encouraged to be independent and to be assertive, but with regard to sexual expression there are varying degrees of prohibition depending on gender and social status. More restrictive sexual standards are applied to women than to men, blacks are more sexually permissive than whites, and lower social class people are generally more permissive than other social groups. The sexual restrictions imposed by society on adolescents at a stage when the physiological need for sexual expression increases creates many conflicts. The period of conflicts is now longer than it ever has been, because there has been a prolongation of adolescence both biologically and socially. The mean age at menarche in the Western European populations declined from about age sixteen in 1870 to age fourteen by around 1930 and went down to about age thirteen years during the 1950s. The present mean age at menarche in the United States is about age twelve. Socially, there have been changes in the life cycle. The median age at marriage for United States women increased from 20.3 years in 1960 to 21.6 years in 1977, and the proportion of unmarried adolescent women has increased dramatically. In 1960, 60 percent of nineteen-year-old women were single compared to 74 percent in 1977 (Current Population Reports). Also, adolescents are exposed to sex to a much greater degree than ever before, both through the mass media and through personal experiences. Under these circumstances, the restrictive standards of society with respect to sexual behavior are likely to be violated. There seems to be a greater tolerance now of the violators of the sexual code than there was a few decades ago, but this tolerance is not usually extended to the young woman who becomes pregnant before marriage. The social, psychological, and economic consequences of an out-of-wedlock birth are grim for both the young mother and her child.

Most earlier studies on adolescent sexual behavior have dealt not with the consequences of sexual behavior but with different types of sexual outlets in the context of sexual standards, interpersonal relationships, attainment of orgasm, and marital happiness. For example, Kinsey studied the correlation between premarital patterns of various types of sexual behavior and subsequent sexual adjustments in marriage, based on the sexual histories of females of all ages; Reiss analyzed premarital sexual standards and premarital sexual permissiveness: Ehrmann examined premarital sexual behavior in terms of sex codes of conduct and the love relationship; Burgess and Wallin analyzed factors influencing engagement and marriage adjustments; Kirkendall studied premarital intercourse and interpersonal relationships based on experiences of 200 college-level males; and Locke dealt with premarital sexual intercourse and marital sexual adjustment among 525 divorced and 404 happily married persons.

We will examine adolescent sexual behavior from the viewpoint of the consequences of sexual behavior, for example, out-of-wedlock pregnancy. Our focus will be on premarital sexual behavior and more particularly on the social aspects of premarital intercourse (heterosexual coitus) among women fifteen to nineteen years of age. Our findings are based largely on data from two national surveys of women aged fifteen to nineteen. In the first study, conducted in the spring and early summer of 1971, interviews were obtained from a national probability sample of 4,611 adolescent women fifteen to nineteen years of age living in households and in college dormitories in the continental United States. The sampled population included young women of all marital statuses and races (Zelnik). A similar but independent study was carried out in the spring and summer of 1976, with a national probability sample of 2,193 adolescent women fifteen to nineteen years of age, who lived in households in the continental United States. Again, the sampled population covered women of all marital statuses and races (Zelnik).

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Affectional-sexual development, in comparison with other aspects of development, motor and language, for example, has been more often repressed than encouraged by most families in the United States and throughout most of the Western world. In the United States, sex is seldom treated as a strong and healthy force in the positive development of personality. Infant sexual behavior, in the eyes of many, is negative, perverse, and destructive. Some see infant sexual-affectional potential as related to excesses—addictions that control the individual and weaken reason. That infants have erotic capacity has been pointedly ignored or overlooked. After an asexual infancy and childhood, sex is supposed to burst out in full bloom at puberty or, better, later. Sexual innocence has been assumed to be normal and appropriate. Still earlier, infants were considered depraved if they masturbated, asked sex-related questions, or showed any sexual interest or curiosity. Ignorance was and is deemed best to keep dormant any precocious sexual feelings. It has been taken for granted that other aspects of physical and mental growth would proceed gradually from birth to full maturity, but knowledge about sexual capacity and interest has been either consciously or unconsciously suppressed even in the community of social and behavioral scientists. This is an enigma, for as early as the turn of the century, Bell, Freud, and Moll were reporting that in infants of suckling age, various parts of the body could give pleasurable sensation and romances did develop in childhood, and it was known that “unscrupulous nurses” had found that they could calm crying babies by stroking their genitals. Freud observed that sexual behavior of the infant and child not only was ignored but “the educators consider all sexual manifestations of the child as an ‘evil’ in the face of which little can be accomplished”. To find sexuality suppressed in the schools is perhaps understandable; to find it largely overlooked in the behavioral and social sciences is more difficult to understand and to accept.

What would be the outcome of a concerted effort to give infants the opportunity to develop fully their capacity for sensory and affectional response? We do not know because we have not wanted to know. Those who argue that the individual, to be fully human, must have the opportunity to develop all his or her capacities argue that this principle should apply to sexual capacity as well as to intellect and motor skills. Those who argue for discipline, self-control, and the curbing of harmful or socially disruptive human tendencies, argue that only the minimum of stimulation and no erotic experience should characterize the personal encounters of infants. Those who opt for restriction of erotic expression in infancy and childhood are in the majority in the United States at the present time.

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In micropenis, the penile corpora are underdeveloped. They may be so small that the penis looks like a clitoris. Unlike a clitoris, however, the micropenis has a median raphe, a covered urethra, a foreskin, and a glans in which the urethral meatus is normally placed. It may or may not be erectile, dependent upon the amount of corpora cavernosa and corpus spongiosum present. The scrotum is present and fused. The testes may be descended or either unilaterally or bilaterally cryptorchid. The etiology of micropenis is unknown.

In the two cases of micropenis compared here, the sex of assignment, rearing, and rehabilitation (surgical and hormonal, as required) was male and female respectively. In the male case, the boy differentiated a masculine gender identity/role, but not without difficulty. As a child, he did not join in rough-and-tumble play. He played more with girls than he did with boys. At the age of ten, he revealed to an interviewer that he had often thought about changing his sex. He already had made up his mind, however, that he would not bother with a change of sex unless he could be guaranteed to have children by his own pregnancies. Despite application in childhood of testosterone cream to his penis and, in adolescence, injections of androgen (given primarily to induce a masculinizing puberty since his testes were vestigial and defective) the micropenis remained excessively minute. Consequently, its use in both heterosexual and homosexual relationships was grossly impaired. Maintenance of intromission was, in fact, impossible.

At the present time, despite surgical and/or hormonal treatments for micropenis, there is no evidence that such treatments produce a fully functioning penis of adult size.

The other micropenis infant was surgically rehabilitated as a girl during the fourth month after birth. This consisted of bilateral gonadectomy and feminization of the external genitalia. At age twelve, feminizing puberty was exogenously induced by means of oral estrogen. Vaginoplasty was performed at age seventeen.

In childhood, this girl played with boys and girls. Although she did prefer outdoor activities, it was not to an intense or one-sided degree. With adolescence, she began to be interested in boys and had experiences with necking and petting at age thirteen, even though girls in her family were not officially permitted to date. At age eighteen and a half, she had intercourse for the first time with her steady boyfriend.

Three years later they married. Her gender identity/role is unquestionably female.

The fact that the testes of the infant assigned and reared male were defective and did not produce pubertal androgen, and that the testes of the infant assigned and reared female were removed before the age of six months, might eventually prove important in relationship to the differentiation of their erotic gender identity/role. In normal XY infants there is an increase in plasma testosterone from birth until the second or third month of life, followed by a gradual decrease. By the seventh month, the level of plasma testosterone diminishes and stays at the low, pre-pubertal level of boyhood. Perhaps the high postnatal level of plasma testosterone is needed to complete the job, initiated prenatally, of setting in the brain thresholds for the release of certain types of sexually dimorphic behavior later in life. This hypothesis is currently only speculative. In any event, the lesson of the matched pair of micropenis individuals teaches the same lesson taught by individuals matched for various diagnoses of hermaphroditism. It is that, in the differentiation of an individual’s gender identity/role, the determinants are prenatal as well as postnatal. It is possible for postnatal determinants to override prenatal ones, just as it is possible for prenatal determinants to intrude on postnatal ones. The various possible permutations and combinations still need to be clarified.

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There are specific treatments for most of the faults and, depending on what the problem is, the success rate varies.

In general, the hormonal problems are treated with hormone therapy, for example if a woman is not ovulating it may be possible to induce ovulation with certain hormones. Some of the physical problems can be dealt with by surgery, for example microsurgery on the fallopian tubes may help to open them up again. Other treatment may be recommended, depending on the cause identified.

There are two specific forms of treatment which warrant explanation: artificial insemination and in-vitro fertilization.

Artificial insemination. This technique involve, fertile semen (either fresh or frozen) being deposited through a woman’s cervix. The semen can be from the woman s partner (AIH-artificial insemination using ‘husband’ semen) or, more commonly, from a .perm donor (this used to be called AID, now known as Dl-donor insemination). There are techniques available to make the sperm more potent, if low sperm count, are the problem. The sperm is placed inside the uterus therefore bypassing the cervix, making it a suitable treatment for people with hostile mucus, etc. Donor semen is a treatment for couples m wh.ch the male partner’s semen is unsuitable, the most common problem in male factor infertility.

Ethical problems caused by donor insemination initially caused a big stir. Could the donor be identified? Did the donor have any legal right to the child produced by the technique? The answers at the moment are both no. There are guidelines laid down to protect donors and recipients of donor sperm. (The legislation regarding this protection, like all legislation, may be subject to review at some stage.) It is a very useful treatment for many couples who otherwise would be unable to have children.

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Frequent urination. This is a symptom of early pregnancy, and is probably due to a combination of the effect of hormones, increasing blood flow to the kidneys, and a slight decrease in the capacity of the bladder, as the uterus sits next to it and is getting bigger. If there are no other symptoms (like burning or pain on weeing, or obvious blood in the wee, which may suggest a urine infection), it is usually simply pregnancy related, and will often become less noticeable after twelve weeks or so, and recur later in the pregnancy when the uterus is bigger. It might cause women to wake in the night to wee, interrupting their sleep. It is also a nuisance at other times.

It is important for women to drink plenty of fluid in pregnancy, and the extra weeing this causes is often a disincentive. It is important to drink, however, despite the inconvenience. Perhaps doing more of the drinking during the day, rather than the evening may help prevent the night-time interruptions.

Swelling. Even in early pregnancy, women may notice fluid retention. This is related to the hormonal and blood vessel changes described already. Slightly swollen ankles, or a bloated feeling, or skirts and pants feeling tighter, or putting on a couple of kilograms in a week, are not that uncommon. In very early pregnancy they are usually related to fluid changes, rather than fat deposition. No specific treatment or action is needed for this.

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What a mouthful. It is pronounced ‘moluskum contay-jee-osum’. They are little bumps in the skin, caused by a virus called the pox virus, and they appear within two to twelve weeks from the time of contact. They are found commonly in children, as well as adults. They may be anywhere on the body, but if they are spread sexually, they are usually on the thighs and abdomen. Sometimes a little bit of waxy stuff can be squeezed out of them. They are not dangerous, a bit annoying, but not dangerous.

Symptoms

Little collections of bumps appear on the skin.

Diagnosis

Usually a doctor will say ‘that looks like molluscum contagiosum’.

Treatment

Some people treat them with liquid nitrogen (freezing), or pop them with a sterile needle. The trend appears to be to leave them alone, if there are not too many of them, because it is likely that within six months they will have disappeared. It depends on how many, and where they are, and how keen you are to get rid of them.

Prevention

This is a common virus in the community, and doesn’t cause any great lasting drama in fit healthy people. It is spread by close contact of many kinds, not only sexual, so it is pretty difficult to avoid it totally if you want to live a normal life.

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Unfortunately there is a fair amount of confusion regarding this little pill, largely because of its name. Many people believe that the lower-dose combined (oestrogen and progesterone) pills are in fact ‘minipills’. Not so.

The true ‘minipill’, or the ‘progesterone-only pill’ (POP) has been used widely as the pill taken for contraception while breastfeeding (lactating). Together with the natural (but not always reliable) contraceptive effect of lactation the POP gives further protection, without interfering with milk production.

Lactation naturally suppresses ovulation. The World Health Organisation has collated research and has stated that if a baby is under six months old and is fully breast fed (with no additional or formula feeding), and the mother is not having periods, then the chance of the woman becoming pregnant is about 2 per cent. When any of these criteria are not fulfilled, the risk of pregnancy increases significantly. (That is why the minipill is handy.)

However, its usefulness extends further than simply with lactation. It can been used by women who, for a variety of reasons, cannot take oestrogens (and therefore can’t take the combined pill).

It acts by increasing the mucus plug at the cervix, making it much more difficult for sperm to penetrate. It also probably slows down the transport mechanisms in the tubes, so the sperm are less likely to find a comfy place to fertilise and settle. It’s a bit like a picket line, and if a strike breaker does happen to get through, the factory is on a ‘go slow’ campaign.

The failure rate of the POP is about two to three per 100 women years, not bad, but not as good as the combined pill (but with fewer serious side-effects). Because it has narrower safety margin it is even more important to take care not to miss any tablets, or to delay taking them. Problems like vomiting and diarrhoea and antibiotic use can interfere with absorption and effectiveness of the POP, as they can for the combined oral contraceptive pill. You should take added precautions (like condoms or abstain from sex) for the time of increased risk, and for at least two (rather than seven) days after, to avoid getting pregnant.

The POP does not have the advantages of cycle control, and in fact spotting, irregular cycles and missed periods can be a problem for some POP-takers. Apart from this, the only other significant side-effect is that some women can experience mood problems (mild depression, PMS-type symptoms) while taking the POP, but this is uncommon as it is such a small dose of progesterone.

However, it is an extremely useful, and probably under-utilised form of contraception. Used alone it provides fairly effective pregnancy prevention (when used properly). It is more effective when combined with another method, like breast feeding or barrier methods.

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Amenorrhoea is the word used to describe the absence of menstruation for three months or more. At times, like before puberty, during pregnancy and breastfeeding, and after menopause, it is perfectly acceptable not to have periods. At other times it is a little unusual, although fairly common. Amenorrhoea can be ‘primary’ (never had a period), or ‘secondary’ (had them before, but they have stopped).

Oligomenorrhoea is related; it is when you have periods, but not very often. Oligomenorrhoea is defined as having a cycle longer than thirty-eight days, but less than three months (because if it was three months between periods, the doctors would call that amenorrhoea, but it’s all a bit academic, really).

Amenorrhoea and oligomenorrhoea are not diseases. They are symptoms, and may have a variety of causes. Oligomenorrhoea may be a ‘normal’ condition for some women who just have long cycles. More often it is due to an alteration in the pattern of the hormones, as is usually the case in secondary amenorrhoea.

Primary amenorrhoea can simply be due to late puberty. If there arc no periods by the time a girl has reached 16 or 17 years of age it is reasonable to go looking for a cause. There are several rare causes, including failure of development of the reproductive organs, chromosome abnormalities, and ovarian abnormalities.

The commonest reasons for amenorrhoea (primary and secondary) arc stress and low body weight which affect hormone levels. This results in what is called ‘anovulation’ (no egg being produced). Stress, either brief or long term, can affect the hormonal system so that the message to produce eggs, and therefore have a period, does not get through. It is not uncommon for women to have no periods while travelling, or changing jobs or schools, when unwell or in a state of emotional turmoil. Some of the hormones involved with ovulation are made in the brain, close to the areas involved with the production of other hormones, including the ‘stress’ hormones. It is not surprising then, that one can affect the other. Recovery is usually spontaneous, and den ling with the stress, if possible, can help.

Deficiencies of certain vitamins and minerals can have dramatic effects like anaemia (low red blood cell count), problems with the nervous system, and many other systems, resulting in the body not functioning as well as it should. Under a certain weight (different for every woman), a woman’s ovaries will not produce eggs. This shows up as not having periods, like the reaction to

stress, it is possible to see a kind of reason behind this. If the body could talk it may say: i make eggs every month in order to reproduce. If I would not be fit enough (because of stress or lack of nutrition) to have a successful pregnancy, I am not going to make an egg. That means I will not have a period’.

This makes sense in an evolutionary way.

Some girls and women do not just diet; some are suffering from a condition called ‘anorexia nervosa’, one of the class of conditions called ‘eating disorders’. This is a psychiatric condition, which involves compulsive dieting, often excessive exercising and, frequently, intentional vomiting (‘bulimia’). There may be many factors contributing to the development of this condition, which presents in the teenage years most commonly. There are varying degrees of severity of anorexia nervosa. With the correct diagnosis and treatment these conditions can be overcome. However, anorexia nervosa can be serious and, in severe cases, may be fatal. If a person is concerned that she may have an eating disorder, or is worried that a friend or family member may have a problem of this kind, it is a good idea to ask for advice from a doctor.

Young women who have prolonged (like a year or more) amenorrhoea may be at risk of developing the side-effects of lacking oestrogen. It has been shown that bone mass thins when there is not much oestrogen around, like after menopause. We build up our bone mass stores from our teens until our early thirties. Lacking oestrogen during this time may limit the ‘peak bone density’ we achieve. This means that there may be greater risk of osteoporosis and bone damage later in life. For this reason it is not uncommon for doctors to recommend that young women with prolonged amenorrhoea should have hormone supplementation, often in the form of the combined oral contraceptive pill.

There are other hormonal treatments which can be used to stimulate ovulation in women who have problems with amenorrhoea, bur these are usually only given if the woman is actively trying to get pregnant.

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