53 “Human Sexuality—What Children Need to Know and When,” http://www.plannedparenthood.org/parents/human-sexuality-what-children-need-know-when-they-need-know-it-4421.htm.
54 “Growth and Development, Ages Six to Eight—What Parents Need to Know,” http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=154&Itemid=206.
55 “How to Talk With Your Children About Sex,” http://www.plannedparenthood.org/parents/how-talk-your-child-about-sex-4422.htm.
56 Selma H. Fraiberg, The Magic Years: Understanding and Handling the Problems of Early Childhood (New York: Charles Scribner’s Sons, 1959).
57 Calvin A. Colarusso, Child and Adult Development: A Psychoanalytic Introduction for Clinicians (New York: Plenum Press, 1992).
58 See Anne C. Bernstein, Flight of the Stork: What Children Think (and When) about Sex and Family Building (Indianapolis, IN: Perspectives Press, 1994).
59 Ibid., 29
60 “How to Talk with Your Children About Sex,” http://www.plannedparenthood.org/parents/how-talk-your-child-about-sex-4422.htm.
61 Ronald F. Moglia and Jon Knowles, A Family Resource on Sex and Sexuality (New York: Three Rivers Press, 1997), 12–15.
62 “Wardell Pomeroy: Kinsey Coauthor Speaks Out” Chic Magazine, February 1981.
63 George Leonard (1983) The End of Sex, JP Tarcher, Inc. Los Angeles, p 89.
64 SIECUS Newsletter Vol 7, No 4, April 1972
65 Online program for 2008 Annual Meeting of The Society for the Scientific Study of Sexuality (SSSS), San Juan, Peurto Rico November 5-9, 2008, available at http://www.sexscience.org.
66 Barbara Defoe Whitehead, “The Failure of Sex Education,” The Atlantic Monthly, 274.n4 (Oct 1994)
Chapter 2
1 All the stories in this book are true. In order to protect the confidentiality of my patients, I’ve changed their names and some details about their lives.
2 Sexuality Information and Education Council for the United States (SIECUS), Guidelines for Comprehensive Sexuality Education (2004), http://www.siecus.org/pubs/guidelines/guidelines.pdf.
3 Some readers might ask why I focus only on Kayla. What about David? I focus on Kayla because in over twenty years of psychiatric work, I have yet to see a man hurting or confused from casual sexual encounters. When a boy or man experiences pain within a relationship, he describes a serious situation in which he has invested time and emotion.
4 Sexuality Information and Education Council for the United States (SIECUS), Guidelines for Comprehensive Sexuality Education (2004), http://www.siecus.org/pubs/guidelines/guidelines.pdf.
5 Ibid., 50.
6 Ibid., 20.
7 Ibid., 71.
8 A belief is not a stereotype.
9 Estrogen, progesterone, and oxytocin.
10 All except her mature red blood cells.
11 Louann Brizendine, The Female Brain (New York: Random House, 2006), 3.
12 George Preti, Charles J. Wysocki, Kurt T. Barnhart, Steven J. Sondheimer, James J. Leyden, “Male Axillary Extracts Contain Pheromones that Affect Pulsatile Secretion of Luteinizing Hormone and Mood in Women Recipients,” Biology of Reproduction 68 (2003): 2107–13.
13 Personal communication with George Preti, Ph.D. of the Monell Chemical Senses Center and the Department of Dermatology, University of Pennsylvania School of Medicine, April 7, 2008.
14 Menstrual synchrony between women living in close quarters is thought to occur via a similar mechanism. The original study was by M. J. Russell, et al, “Olfactory Influences on the human menstrual cycle,” Pharmacology, biochemistry, and behavior 13, no.5 (November 1980): 737–38.
15 Starting in adolescence, female sensitivity to this male pheromone is much higher than male. See Thomas Hummel, Franziska Krone, Johan N. Lundstrom, Oliver Bartsch, “Androstadienone odor thresholds in adolescents,” Hormones and Behavior 47, no.3 (March 2005): 306–10.
16 Suma Jacob and Martha K. McClintock, “Psychological state and mood effects of steroidal chemosignals in women and men,” Hormones and Behavior 37, no.1 (February 2000): 57–78.
17 Brizendine, The Female Brain, 13–16.
18 J. Cameron, “Interrelationships between hormones, behavior and affect during adolescence: understanding hormonal, physical, and brain changes occurring in association with pubertal activation of the reproductive axis,” Annals New York Academy of Sciences 1021 (2004):1-22.
19 Brizendine, The Female Brain, 38.
20 Ibid., 39.
21 Ibid., 48.
22 Ibid., 38.
23 Ibid., 68.
24 Ibid., 3.
25 Ibid., 2.
26 Ibid., preface.
27 Carol Milano, “The physiological and the psychological: how women and men are different,” Yale Medicine 42, no.2 (Winter 2008): 41–42.
28 I have often been asked why I focus on the actions of oxytocin in young women. This hormone exists in men too, in addition to the hormone vasopressin, which differs by only one amino acid in its structure, and plays a role in the formation of social bonds in males. These are the reasons: estrogen is critical to oxytocin control, and it increases production and the number of receptors in the brain. In certain areas, the increase can be rapid (72 hours) and profound (300 percent increase in binding). See Thomas R. Insel, “A Neurobiological Basis of Social Attachment,” American Journal of Psychiatry 154, no.6 (June 1997): 731. Women appear to be more sensitive to oxytocin, (see Grewen, 2005, 537) and they have more of it. Men have more vasopressin, but young men also have raging levels of testosterone, which Drives lust, not attachment. The saturation of the female brain with estrogen and oxytocin, especially at mid-cycle, creates a neuro-chemical environment ripe for intense interpersonal bonding. There does not appear to be a corresponding situation for men. Everyday observations and common sense also support this position; in fact, a study of 16,288 people across ten major world regions, examining the desire for sexual variety and the likelihood of consenting to sex quickly, demonstrated “universal sex differences” (David P. Schmitt, “Universal Sex Differences in the Desire for Sexual Variety: Tests from 52 Nations, 6 Continents, and 13 Islands,” Journal of Personality and Social Psychology 85, no.1 (2003): 85–104).
29 Thomas R. Insel, “A Neurobiological Basis of Social Attachment,” American Journal of Psychiatry 154, no.6 (June 1997): 726–35.
30 Ibid., 727.
31 Ibid., 728.
32 Our knowledge of the actions of vasopressin in the brains of human males is limited. In both humans and voles, there is a gene that controls the number and type of vasopressin receptors in the brain. Having more of a particular receptor means higher sensitivity to the pair-bonding effects of the hormone. So scientists speculate that where a human male’s behaviors fall on the spectrum of totally polygamist to totally monogamous may be somewhat predetermined and passed down genetically (Louann Brizendine, The Female Brain, 73–74).
33 Meissner corpuscles.
34 John P. Aggleton and Andrew W. Young, “The enigma of the amygdala: on its contribution to human emotion.” In R. D. Lane and L. Nadel, eds., Cognitive Neuroscience of Emotion (New York: Oxford University Press, 2000); R. Adolps, Peter Kirsch, et al, “Oxytocin Modulates Neural Circuitry for Social Cognition and Fear in Humans,” The Journal of Neuroscience 24, no.49 (December 2005): 11489–493; R. Adolphs, D. Tranel, A. R. Damasio, “The human amygdala in social judgment,” Nature 393 (4 June 1998): 470–74.
35 Adam J. Guastella, Philip B. Mitchell, and Mark R. Dadds, “Oxytocin Increases Gaze to the Eye Region of Human Faces,” Biological Psychiatry 63, no.1 (January 2008): 3–5.
36 The same thing happens in maternal love. See Andreas Bartels and Semir Zeki, “The neural correlates of maternal and romantic love,” NeuroImage 21, no.3 (March 2004): 1155–66.
37 Michael Kosfeld, Marcus Heinrichs, Paul J. Zac, Urs Fischbacher, and Ernest Fehr, “Oxytocin increases trust in humans,” Nature 435 (2 June 2005): 673.
38 Science has confirmed the existence of “beer goggles”—when a p
erson seems more attractive to you after you’ve had a few drinks. In a British study, eighty college students rated photos of unfamiliar faces of men and women their age; alcohol consumption significantly raised the scores given to photos of the opposite sex. Drinking affects the nucleus accumbens, the area of the brain used to determine facial attractiveness. (Barry T. Jones et al, “Alcohol consumption increases attractiveness ratings of opposite-sex faces: a possible third route to risky sex,” Addiction 98 (2003): 1069–75.
39 Reuters, “ ‘Trust me’ says cuddle hormone,” ABC News Online (2 June 2005), http://www.abc.net.au/news/newsitems/200506/s1382513.htm.
40 Associated Press, “Scientists study ‘trust in a bottle,’ ” MSNBC Mental Health, June 1, 2005; available at: http://www.msnbc.msn.com/id/8059069/.
41 Planned Parenthood, SIECUS, Advocates for Youth.
42 Ruth Bell’s book mentions it in context of abortion.
43 “The question of ‘What does it mean?’—in other words what does a particular sex act signify and communicate—is centrally important to the female sexual experience, before, during, and after. For men, by contrast, the different possible meanings matter less, and sex might often be a perfectly fine experience even if it hardly means anything at all.” (R. F. Baumeister, “Gender Differences in Erotic Plasticity: The Female Sex Drive as Socially Flexible and Responsive,” Psychological Bulletin 126, no.3 (2000): 371).
44 A phrase borrowed from Institute for American Values’ Hardwired to Connect: The New Scientific Case for Authoritative Communities, 2003.
45 SIECUS, Guidelines, 54; available at: http://www.siecus.org/pubs/guidelines/guidelines.pdf.
46 David P. Schmitt, “Universal Sex Differences in the Desire for Sexual Variety: Tests from 52 Nations, 6 Continents, and 13 Islands,” Journal of Personality and Social Psychology 85, no.1 (July 2003): 85-104.
47 Johan N. Lundstrom, Miguel Goncalves, Francisco Esteves, and Mats J. Olsson, “Psychological effects of subthreshold exposure to the putative human pheromone 416-androstadien-3-one,” Hormones and Behavior 44, no.5 (December 2003): 395–401.
48 Aron Weller, “Human pheromones: Communication through body odour,” Nature 392 (12 March 1998): 126–27.
49 The vomero-nasal organ.
50 Caroline M. Larsen, Ilona C. Kokay, and David R. Grattan, “Male pheromones initiate prolactin-induced neurogenesis and advance maternal behavior in female mice,” Hormones and Behavior 53, no.4 (April 2008): 509–17.
51 H. Gelez and C. Fabre-Nys, “The ‘male effect’ in sheep and goats: a review of the respective roles of the two olfactory systems,” Hormones and Behavior 46, no.3 (September 2004): 257-71.
52 M. T. Mendonca and D. Crews, “Control of Attractivity and Receptivity in Female Red-Sided Garter Snakes,” Hormones and Behavior 40, no.1 (August 2001): 43–50.
53 Peter W. Sorensen, Norman E. Stacey, and Katherine J. Chamberlain, “Differing behavioral and endocrinological effects of two female sex pheromones on male goldfish,” Hormones and Behavior 23, no.3 (1989): 317–32.
54 Christopher A. Pearl, Misty Cervantes, Monica Chan, Uyen Ho, Rane Shoji, and Eric O. Thomas, “Evidence for a Mate-Attracting Chemosignal in the Dwarf African Clawed Frog Hymenochirus,” Hormones and Behavior 38, no.1 (August 2000): 67–74.
55 Bruce Alexander Schulte, Elizabeth Watson Freeman, Thomas Elton Good-win, Julie Hollister-Smith, and L. Elizabeth Little Rasmussen, “Honest signaling through chemicals by elephants with applications for care and conservation,” Applied Animal Behaviour Science 102, nos.3-4 (February 2007): 344–63.
56 Kathleen Stern and Martha K. McClintock, “Regulation of ovulation by human pheromones,” Nature 392 (12 March 1998): 177–79.
57 Martha K. McClintock, Susan Bullivant, Suma Jacob, Natasha Spencer, Bethanne Zelano, and Carole Ober, “Human Body Scents: Conscious Perceptions and Biological Effects,” Chemical Senses 30, suppl. 1 (2005): i135–i137.
58 Martha K. McClintock, “Pheromones, Odors, and Vanna: The Neuroendocrinology of Social Chemosignals in Humans and Animals,” in Hormones, Brain and Behavior, Vol.1, ed. D. W. Pfaff (Academic Press, 2002), 797–870.
59 H. Varendi and R. H. Porter, “Breast odour as the only maternal stimulus elicits crawling towards the odour source,” Acta Paediaticar 90, no.4 (2001): 372–75.
60 Bruce J. Ellis, “Timing of Pubertal Maturation in Girls: An Integrated Life History Approach,” Psychological Bulletin 130, no.6 (Nov 2004): 920–58.
61 Kerstin Uvnas Moberg, The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing (New York: Da Capo Press, 2003).
Chapter 3
1 Zogby International, “2004 Survey on Parental Opinions of Character or Relationship-based Abstinence Education vs. Comprehensive (or Abstinence-First, Then Condoms) Sex Education,” January 28, 2004. Retrieved on 4/28/2008 from www.citizenlink.org.
2 Margo Adler, Wade F. Horn, and James Wagoner, “Abstinence-Only Education,” Justice Talking, July 9, 2007. Downloaded from http://www.justicetalking.org/ShowPage.aspx?ShowID=426.
3 Perhaps the interviewer thought she was being balanced by also having on the executive director of the National Abstinence Education Association, Valerie Huber.
4 “Young people explore their sexuality as part of a process of achieving sexual maturity; adolescents are capable of expressing their sexuality in healthy, responsible ways.” See for example: “We Believe,” Planned Parenthood of Indiana, http://www.ppin.org/values.aspx.
5 Debra W. Haffner, “Sexual Health for America’s Adolescents,” Journal of School Health 66, no. 4 (1998): 151–2. This report was a statement of the National Commission on Adolescent Sexual Health, consisting of 21 of the nation’s leading medical, psychological, education, and youth-serving professionals. The Commission’s report was based on a Consensus Statement on Adolescent Sexual Health, “endorsed by more than 50 national organizations.”
6 “The Commission felt strongly that intercourse is developmentally disadvantageous for the youngest adolescents because they do not have the cognitive or emotional maturity for involvement in intimate sexual behaviors, especially intercourse.”
7 “Health Education: Sex—safer and satisfying,” Planned Parenthood, available at: http://www.pposbc.org/education/safeSex.asp.
8 “Pro sex,” available at: http://www.positive.org/JustSayYes/prosex.html.
9 Similar guidance is found on www.GoAskAlice.com, www.positive.org, www.iwannaknow.org, www.scarleteen.com, and many other resources.
10 Elisa Klein, “Am I Ready?” Planned Parenthood; available at: http://www.plannedparenthood.org/teen-talk/sex-masturbation/teens-virginity/am-ready-25396.htm
11 Most girls feel they were too young at time of first intercourse (see Susan Rosenthal et al, “Heterosexual Romantic Relationships and Sexual Behaviors of Young Adolescent Girls,” Journal of Adolescent Health 21 (1997):238–43.)
12 In a Planned Parenthood classroom activity for young adults, students examine the ways they would feel comfortable being intimate, and where they would draw the line. Possible activities to suggest to students include: skinny dipping, sleeping together without sex, showering, and massage (www.plannedparenthood.org/resources/lesson-plans/wheres-your-line.htm).
13 “Q & A with Dr. Cullins,” available at http://www.plannedparenthood.org/health-topics/ask-dr-cullins-6602.htm
14 “Ask Dr. Cullins: Birth Control,” http://www.plannedparenthood.org/health-topics/ask-dr-cullins/ask-dr-cullins-birth-control-5472.htm. Q: My daughter is 12. I’ve talked with her about menstruation and sex. She hasn’t started her period yet. Should I take her to my gynecologist for an exam when she starts? If not, what age should she go? Is it appropriate for me to start her on some type of birth control when she starts having her period? I had her at the age of 16, and I’m scared to death of her going through the same thing!
A: Gynecological exams are not necessary as soon as a young woman starts having her period. We now recommend that young women start having pelvic exams with Pap tes
ts within three years of starting vaginal intercourse. If a young woman has not had first vaginal intercourse by age 21, then she should have a pelvic exam when she becomes 21—even though she has not had vaginal intercourse. Of course, gynecologic visits are a very good idea if sexual or reproductive health concerns or problems arise earlier than within three years of starting vaginal intercourse or age 21.
Young women should be counseled about their birth control options before they become sexually active. They may want to consider taking regular, ongoing, highly effective hormonal prescription methods before beginning vaginal intercourse because of the health benefits of some methods. After they have been used for a few months, combined hormone methods such as the pill and the patch offer health benefits, including lighter periods, less bleeding during periods, less pain with periods, more regular periods, and reduced acne. Combined hormone methods also offer advanced protection against pregnancy as a woman reaches the point in her life when she decides to have vaginal intercourse.
When it comes to sexual and reproductive health, young women are often more comfortable with health care providers who are not also their parent’s providers. Even young women who talk with their parents about sex and sexuality may be more trusting and confident with their own providers. Ask your daughter whether she wants her own personal clinician—a clinician different from her pediatrician, your family-medicine doctor or nurse practitioner, or your gynecologist—to take care of her now that she is older. Respect whatever decision she makes, and help her to find a caring provider if she chooses to change providers. Regardless of the provider they choose, young people should be encouraged to have their visits in private—by themselves. They should also be given every assurance that their confidences will be respected.
15 Stedman’s Online Medical Dictionary, http://www.stedmans.com/section.cfm/45.
16 Society for Adolescent Medicine, “Guidelines for Adolescent Health Research: A Position Paper of the Society for Adolescent Medicine,” Journal of Adolescent Health 33 (2003): 396–409. Available from http://www.adolescenthealth.org/PositionPaper_Guidelines_for_Adolescent_Health_Research.pdf.
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