Sexual Culture Norms
Western sexual, relationship, and gender norms have evolved with the turn of the 21st century. The Western world, which encompasses Europe, North America, and South America, has been influenced in the past several centuries first by the Roman Catholic Church and more recently by Victorian England. Due to British colonization, India, parts of Africa, and Australia may also fall under the sexual culture and mores of the Western world. Both the Roman Catholic religion and the British Empire embraced, at least on the surface, attitudes of repression and restriction regarding sexual behavior (Koch, P., Weis, D., & Francoeur, R., 1999). There is little scientific data that can confirm the sexual norms prior to the 20th century, and what we know about sexual attitudes is extrapolated through writings, stories, and the analysis of religious doctrine and other social institutions (Francoeur, et al., 1999). From this, we can extrapolate through religious teachings and literature of the times that there was a very socially conservative view of relationships and sexuality during the early centuries of the United States. However, with the cultural shifts noted throughout this manual, there is a clinical need to start using science as a tool to frame some of our views on sexuality and relationships.
We know that relationship and sexual norms change with social institutional changes. Francoeur et al. 1999 report that Jerry G. Pankhurst and Sharon K. Houseknecht (1983) identified 5 major social influences that affect the concepts of relationship and sexual norms in American culture prior to the 21st century:
2. A shift from a family being economically producing to a consumer purchasing
3. The entry of men and women into the labor force
4. Expansion of education to minorities and women
In addition, we must also consider the increase of the lifespan and lower infant mortality rates, due to medical and hygiene advancements as influences to relationship and sexual norms, as life expectancy does influence sexuality and relationships.
Evolution of Sex Culture
The 20th century has brought about scores of significant changes in our social institutions due to two major world wars, technology and medical advancement, and globalization (Francoeur, et al., 1999). Some of these social institution changes include an increase of life expectancy, the role of women as a wage earner vs. a homemaker, and the transparency of sexuality that technology offers. We have seen a radical shift in sexual and relationship attitudes. According to popular culture, the 1960’s and 70’s in America were branded as the sexual revolution (Cohen, 2012:Watson, n.d.: Kohn, 2015). History tells us that following revolutions comes periods of restoration and enlightenment. With the dawning of the 21st Century, it appears American culture may be entering a sexual renaissance and as a result there has been a development of alternative sexual, gender, and relationship communities that have created a new sexuality subculture (Dykeman, et al.). Ethnography, a qualitative form of research often used in the areas of anthropology and sociology, is the study and systematic recording of cultures. There are thousands of ethnographic studies, art, literature, and historical documentation which validate that alternative sexuality, gender, and relationship expression have been a part of human existence since the dawn of man; however, until recently, Western culture has negatively viewed sexual, gender, and relationship diversity which, in turn, kept these proposed subcultures in hiding. Gayle S. Rubin (1994) notes:
To some, sexuality may seem to be an unimportant topic, a frivolous diversion from the most critical problems of poverty, war, disease, racism, famine, or nuclear annihilation. But it is precisely at times such as these, when we live with the possibility of unthinkable destruction, that people are likely to become dangerously crazy about sexuality. (p. 143)
The “millennial generation,” the generation reaching adulthood in the early 21st century, being raised on social networking, unlimited availability of Internet pornography, and open sexual expression propagated by the media and popular culture, have shown that they are far more tolerant to alternative relationship, gender, and sexual expressions. We can see evidence of this through examination of popular culture icons and the increase in these alternative lifestyle roles displayed more vividly in entertainment media. Radical changes in our very social institutions such as the legalization of gay marriage, the increase in the number of celebrities publicly acknowledging their sexual, gender, and relationship differences, and the popularity of entertainment media which highlight sexual content have shown that the sexual norms in our culture are starting to shift. Also, as popular culture and the entertainment industry continue to desensitize viewers to sexual behaviors previously termed deviant, there has been a reduction in shame surrounding sexuality.
This trend signifies the importance of modern sex education being incorporated into the current training systems for our healthcare professionals. Without the proper knowledge of these sexual and relationship dynamics, mental health and medical providers can potentially harm their patients. As healthcare providers, we also need to educate our patients so they do not harm themselves.
Multicultural competence for our mental health providers is an important part of the core education and ethics for the profession. For the purposes of this manual, “Kink” is defined as the practice alternative sexual and romantic relationships, outside what is considered “normal” within western culture. We also include the alternative gender identity group in this subculture due to its intimate participation in these communities. As with any subculture, Kink comes with its own emotional and physical health challenges of which healthcare professionals need to be aware so that they may provide the appropriate standard of care for these patients. In spite of trends in our culture to be more sexually and diversity enlightened, those who are considered sexual minorities continue to report discrimination and persecution due to negative stereotypes that are encouraged by the media, uninformed professionals, and religious political extremists.
According to several studies, a significant number of individuals report feeling discriminated against by their healthcare providers. The National Coalition for Sexual Freedom’s (NCSF) 1998 Violence & Discrimination Survey found that of the 3,058 respondents who identified as Kinky, 48.8% report that they received discrimination from medical providers and 39.3% report that they were discriminated against by their mental health provider directly due to their choice of sexual expression (National Coalition for Sexual Freedom [NCSF], 2008). One example of discrimination from a mental health professional involves a client of mine who identifies as both a submissive and as polyamorous (please see the Appendix A for definitions). Approximately six years ago, she reached out to seek help for her Bipolar and chronically ill partner because their relationship had become violent. She reported to me that when she called one therapist and explained the situation, including the domestic violence, and the therapist promptly told her never to call again and that they were crazy. Her partner committed suicide two months later.
It is important to note that self-reporting does not state definitively that there was discrimination, which is a limitation of this study. It does, however, denote that the patient felt this way and this alone can undermine the patient/physician relationship, which is important for effective treatment. If a patient is not comfortable being open and honest with his mental health or medical provider, then it could set the provider up for a potential liability when treating the patient, as there may be treatments that are contraindicated or even dangerous for patients who participate in some alternative sexual practices. This discrimination shows the lack of understanding and ignorance that some medical providers have about these kinds of patients. Chances are that as a medical or mental health provider they will have these individuals as patients, whether they are aware of it or not. This means it is important that healthcare providers have a functional understanding of the Kink culture and the common issues for which they seek help.
Cohen, N. (2012). How the sexual revolution changed America forever. Counterpoint Press: Retrieved from http://www.alternet.org/story/153969/how_the_sexual_revolution_changed_america_forever
Dykeman, K., Duncan, D., Irvin, K., King, A. (2006). Perceptions of sexuality in American culture. Future Leaders Summit 2006, 40-42.
Koch, P., Weis, D., & Francoeur, R. (1999). Sexuality in America: Understanding our sexual values and behavior. New York, NY: Bloomsbury Academic.
National Coalition for Sexual Freedom. (2015). How many people engage in SM?. Retrieved from https://ncsfreedom.org/key-programs/education-outreach/what-is-sm/item/364-what-is-sm-how-many-people-engage-in-sm?.html
National Coalition for Sexual Freedom. (2015). NCSF mission statement. Retrieved from https://ncsfreedom.org/who-we-are/about-ncsf/ncsf-mission-statement.html
National Coalition for Sexual Freedom. (2016). BDSM the state of the law. Retrieved from http://www.criminology.su.se/polopoly_fs/1.177159.1399989295!/menu/standard/file/2013c_Fredriksson_Tea.pdf
Rubin, G. (1984). Thinking sex: Notes for a radical theory of the politics of sexuality. InC. Vance(Ed.). Pleasure and danger: Exploring female sexuality. New York, NY: Routledge.