Positive Sexuality:

A Presentation to
Family Medicine Physicians
by Frederick DocPete Peterson
Sexual Health Program, The Flexman Clinic, Dayton, Ohio

Department of Specialty Medicine

Heritage College of Osteopathic Medicine, Ohio University

Health Promotion & Disease Prevention,

Department of Veterans Affairs
 Positive Sexuality

Overview:

Problem Statement One: The Lack of Communication

Problem Statement Two: Negative Sexuality

Positive News about Sexual Science

Positive News about Female Sexuality
Positive News Male Sexuality
Sexual Satisfaction & Wellness
 Positive Sexuality

Objectives:
At the conclusion of this session, participants will be able to:

Identify at least two components of the definition of

sexual identity

Identify at least two components of the definition of

sexual expression

List at least two measures of

sexual health & wellbeing
 Positive Sexuality
Cautions:
You may blow your mind!

Participants are cautioned to remember that

The empirical study of the human sexuality is relatively new

and therefore is in its infancy as a science

There is much more we dont know about sexual identity,

expression and function than we do know and this is
especially true for female sexuality

The model of the Sexual Hypercube as an explanation of

sexual interaction is one among many
 Positive Sexuality

Problem Statement One

The Lack of Communication

The lack of communication about sex while growing up,

especially the lack of positive communication,
imposes a strong message that sex is not an appropriate
subject for discussion and creates discomfort within people
regarding most things sexual.
(a condition informally referred to as sexophrenia)
 Positive Sexuality

Problem Statement Two

Negative Sexuality

Along with the lack of exposure children have to positive

models of communication about sex, for many people there
is a sense of sex as a necessary negative (evil) in life .

Sex education in schools is less than a few decades old, and

when provided is usually abstinence-based and fear-based
emphasizing prevention of pregnancy & STI
 Before Sexual Science in America

Historical whole-sale pathologizing of women,

people of color, and people with disabilities
which include, but are not limited to:
Eugenics Movement (Galton, Davenport, Goddard, Roosevelt)

Masturbation was a disease leading to disease till mid-20th century

Forced & legalized sterilizations of people of minority status

Mass institutionalization of all forms of substandard people

Pseudo-rationale for racial segregation and miscegenation laws

Repression of sexual rights, especially sexual expression

 The Development of
Sexual Science

Scientific study of sexuality is little more than 100 years old

(Iwan Bloch and Magnus Hirschfeld 1907).

Americans historical focus has been on defining sexuality based

on straight abled-body male WASP identity and obsessively
pathologizing all others via social institutions of law, education,
medicine and religion.
- women
- members of racial/ethnic minorities
- members of the varied disability communities
- LGBT individuals, especially men changing sex status
 The Development of
Sexual Science
Three publications that permanently changed
American consciousness about sexuality:

Sexual Behavior of the American Male

(Kinsey, 1948)
Sexual Behavior of the American Female
(Kinsey, 1953)
Human Sexual Response
(Masters & Johnson, 1966)
 Positivity Sexuality

Ms. Jorgensen is the first

& best known American
who underwent sexual
reassignment (1952).

George W. Jorgensen
was an U.S. Army
WWII veteran.
 The Development of
Sexual Science
Sexual Health

A state of physical, mental and social well-being

in relation to sexuality. It requires a positive and
respectful approach to sexuality and sexual
relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of
coercion, discrimination and violence.
WHO, 2004
 Positive Sexuality

Bill of Sexual Rights

1. Right to Sexual Expression.
2. The Right to privacy.
3. The right to be informed.
4. The right to access to needed sexual services such as contraceptive
counseling, medical care, genetic counseling, and sex counseling.
5. The right to chose ones marital status.
6. The right to have or not have children.
7. The right to make decisions that affect ones life.
8. The right to develop to ones fullest potential.

Sex & Disability Project of George Washington University (Chipouras, S. et al. Who Cares?
A Handbook on Sex Education & Counseling Services for Disabled People (1979).
 Relationship Bill of Rights
I have the right to be treated with dignity and respect.
I have a right to follow my own values and standards
I have the right to say no and not feel guilty.
I have the right to experience and express my feelings.
I have the right to feel safe.
I have the right to take time for myself.
I have the right to change my mind.
I have the right to ask for what I want.
I have the right to ask for information.
I have the right to make mistakes.
I have the right to do less than I am humanly capable of doing.
I have the right to be me and feel good about myself.
I have the right to leave conversations with people who make me feel put down or humiliated
I have the right to act only in ways that will promote my dignity and self-respect.
I have the right to feel scared and say Im afraid.
I have the right to end the relationship.
I have the right not to be responsible for others behavior, actions, feelings, or problems.
I have the right to expect honesty from others
I have the right to all of my feelings
I have the right to make decisions based on my feelings, my judgments, or any reason that I choose.
I have the right to change and grow.
I have the right to be happy.
I have the right to make friends and be myself around people.
I have the right to be angry at someone I love.
I have the right to both experience and let go of fear, guilt, and shame.
Introduction to Sexual Identity
Introduction to Sexual Expression
Introduction to the Sexual Hypercube
 The Search for a Definition:
A Review of College Textbooks
Major college sexuality textbooks were reviewed (N=27)

Eighteen (66 percent) did not include sexual identity in

the index and did not provide a definition of sexual
identity in the body of the text.

Nine texts (33 percent) did have a definition of sexual

identity.

Peterson & Carter, 2010

 The Search for a Definition:
A Review of College Textbooks
This finding was astounding as society looks to college
textbooks as authoritative sources on a given topic.

What we found was the majority of the textbooks did

not define what is considered a core concept of sexuality
(sexual identity).

On the other hand, this is the state of the field as the

scientific study of sexuality has just pasted its centennial.
 Definition of Sexual Identity

Sex Identity is the sense of who one is as a

sexual being and is an overarching sexual health
concept comprised of a person's sex orientation
(male/female continuum), sexual orientation,
and sex role orientation.
Sexual Identity is inclusive of a persons overall sexuality over the
entire lifespan, a central part of their overall identity, and is
influenced by both social-cultural and biological factors.

Heres a quick look at these three components

 Positive Sexuality

Sex Orientation (male/female continuum

sex status) A persons fundamental
status on a male to female continuum,
which is composed of eight factors, both
biological and psychosocial.
 Positive Sexuality

Sexual Orientation (sexual attraction

pattern) This is a personal quality which
determines to whom ones sexual,
affectionate, and/or love interests are
directed.
 Positive Sexuality

Sex Role Orientation (gender role). This

refers to personal qualities and responses
to the role expectations that society
associates with a persons sex designation,
and is manifest in a persons gender-role
attitude and gender-role behavior.
Introduction to Sexual Identity
 Positive Sexuality
Sex Orientation
(male/female continuum sex status)

A fundamental status on a male to female

continuum, which is composed of eight
factors, both biological and psychosocial.

How is a persons sex status designated?

 Sex Orientation
Sex Orientation (male/female continuum)
How is a persons sex status designated?

Estimated Number of Typical and Variant Sexual Development Paths

Biological Psychosocial

Chromosomal Gender Identity

Hormonal Sex Assigned at Birth

prenatal and pubescent

Anatomical Sex Raised As

internal or external organs
 Sex Orientation
Estimated Number of Typical and
Variant Sexual Development Paths
Biological Psychosocial

Chromosomal = 3 Gender Identity = 3

(XX, XY, or variant) (male, female, variant)

Hormonal (x2) = 6 Sex Assigned at Birth = 2

(masculine, feminine, or variant (male or female - variant infants
development at prenatal and pubescent) are often reassigned)

Anatomical (x2) = 6 Sex Raised As = 3

(masculinized, feminized, or variant (male or female, or variant
development of internal or external organs) combined development)
 Sex Orientation (male/female continuum)
How is a persons sex status designated?

Estimated Permutations of Typical and Variant Sexual Development

Separated into Biological (5) and Psychosocial (3) Categories

Chromosomal 3
Hormonal (Prenatal) x3 (Carry-over) 243
9 Gender Identity x3
Hormonal (Pubescent) x3 729
27 Sex Assigned at Birth x2
Anatomical (Internal) x3 1,458
81 Sex Raised As x3
Anatomical (External) x3
243 Estimated Permutations 4,374
 Should we re-run the numbers?
Estimated Number of Typical and
Variant Sexual Development Paths
Biological Psychosocial

Chromosomal = 10 Gender Identity = 3

(male, female, variant)

Hormonal (x2) = 6 Sex Assigned at Birth = 2

(masculine, feminine, or variant (male or female - variant infants
development at prenatal and pubescent) are often reassigned)

Anatomical (x2) = 6 Sex Raised As = 3

(masculinized, feminized, or variant (male or female, or variant
development of internal or external organs) combined development)
 Sex Orientation
Chromosomal & Hormonal Variations
Estimated prevalence of 10 most frequent sexual development variations
(Estimated frequencies per every 100 live births)

XO (Turner Syndrome) 0.03690

XXY (Klinefelter Syndrome) 0.09220
XY (Androgen Insensitivity Syndrome -AIS Full) 0.00760
XY (Androgen Insensitivity Syndrome -AIS Partial) 0.00076
XX (Congenital Adrenal Hyperplasia - Classic CAH) 0.00779
XX (Congenital Adrenal Hyperplasia - Late Onset CAH) 1.50000
XX Vaginal Agenesis (females born without a vagina) 0.01690
True Hermaphroditism (both ovaries & testicles) 0.00120
Idiopathic Hermaphroditism 0.00090
Non-XX or non-XY (except for Turner & Klinefelter) 0.06390

Estimation of Frequency for All Causes 1.72815

(from Fausto-Sterling, 2000) - Not Included are other combinations

such as XYY (Jacobs 1:1500), Triple-X (XXX), Mosaic (XX/XXX or XY/XXY)
 Sex Orientation (male/female continuum)
How is a persons sex status designated?

Estimated Permutations of Typical and Variant Sexual Development

Separated into Biological (5) and Psychosocial (3) Categories

Chromosomal 10
Hormonal (Prenatal) x3 (Carry-over) 810
30 Gender Identity x3
Hormonal (Pubescent) x3 2,430
90 Sex Assigned at Birth x2
Anatomical (Internal) x3 4,860
270 Sex Raised As x3
Anatomical (External) x3
810 Estimated Permutations 14,580
Estimated Permutations across the eight dimensions
of sex orientation (male-female designation) could be
a few hundred or several thousand (4,374 to 14,580).

The Point:
We do not know
However, evidence strongly suggests sex orientation
(male/female designation) naturally occurs across a
continuum so it is more accurately represented as a
gender mosaic, certainly not by a binary dichotomy.
Introduction to Sexual Identity
 Positive Sexuality

Sexual Orientation (sexual attraction

pattern) This is a personal quality which
determines to whom ones sexual,
affectionate, and/or love interests are
directed.

Sexual orientation is the most familiar of

the three components of sexual identity
yet is still commonly misunderstood.
 Sexual Orientation
How does one determine and/or
measure sexual orientation?

It is more complicated than

with whom one chooses to sleep.
1. Behavioral (choice of sexual partner)
2. Fantasy (uncensored private attraction)
3. Physiologically (the ummm factor)
4. Emotional (being in-love factor)
 Sexual Orientation
The Kinsey Scale of Heterosexuality-Homosexuality
 A More Inclusive View Sexual Orientation
Two by Two Matrix of Sexual Attraction
High Attraction to Males Low Attraction to Males

High Attraction bisexual attraction You could be straight if a man

to Females You could be lesbian if a woman

Low Attraction You could be gay if a man asexuality

to Females You could be straight if a woman (Low attraction to either)
 This is NOT your grandfathers VA!
We Serve ALL Veterans That Have Served Our Country
 Positive Sexuality

Sex Role Orientation (gender role). This

refers to personal qualities and responses
to the role expectations that society
associates with a persons sex designation,
and is manifest in a persons gender-role
attitude and gender-role behavior.
Sex Role Orientation (gender role)

Two x Two Matrix of Sex Role Orientation

(based on the work of Dr. Sandra Ruth Lipsitz Bem)
Sex Role Orientation (gender role)
Is self-identifying as Gender Queer a sex
orientation or something different?
 Positive Sexuality
as Part of Personal Growth & Overall Health

A Sexual Health Program

For Women

Hypoactive sexual desire disorder (HSDD)

Arousal Disorders
Orgasmic Disorders
Dyspareunia
 Positive Sexuality
as Part of Personal Growth & Overall Health

A Sexual Health Program

For Men
Hypoactive sexual desire disorder (HSDD)
Rapid Ejaculation
Erectile Dysfunction
Delayed or Inhibited Orgasm Disorder
Sexual Compulsivity
 Positive Sexuality
as Part of Personal Growth & Overall Health

A Seven-Step Sexual Health Program

for Expanding Ones

Positive Sexual Self-Esteem

Increased Self-Acceptance

Enhanced Personal Satisfaction

 Positive Sexuality
as Part of Personal Growth & Overall Health

Always Remember Rule # 1

 Positive Sexuality
as Part of Personal Growth & Overall Health

Always Remember Rule # 1

Never hurt the Doctor!
 Positive Sexuality
as Part of Personal Growth & Overall Health

Step # 1
Learn key tenets of Sexual Health
It is important to understand the cultural &
historical influences on your sexual identity as
well as current sexual science
 Positive Sexuality
as Part of Personal Growth & Overall Health

Step # 2
Take a Baseline Measure
of your satisfaction for your personal
sexual health
(see list of available measures)
 Positive Sexuality
as Part of Personal Growth & Overall Health

Step #3
Sexual Self-Image Exercise
This is an experiential self-assessment of how well one can
appreciate and celebrate the positivity of the physical body.

Get NAKED in front of a mirror and look at (and feel) all parts of the
body from the tip of your head to the tip of your toes noting
ONLY POSITIVE ATTRIBUTES
Record a list of positive attributes in order to measure ones growth
of positive self-image and acceptance.
 Positive Sexuality
Sexual Health & Sexual Identity as Part of Personal Growth

Step #4
Sensual Exploration Exercise
This is also an experiential exercise but instead of how well one can
accept and appreciate the physical body it is about how well one can
explore the sensual capacities of the body.

There is no goal or expectation of experiencing orgasm in this exercise.

Get NAKED in a warm bath or warm bed, touching the skin from the tip
of the head to the tip of the toes noting
ONLY POSITIVE feelings and thoughts that are generated.
Record the list of positive attributes to measure ones growth
of positive self-image and acceptance.
 Positive Sexuality
as Part of Personal Growth and Overall Health

Step #5
Sensual Fantasy Exploration Exercise
This is also an experiential exercise but it is mostly inside the mind.

There is no goal or expectation of experiencing orgasm in this exercise.

When and wherever one has privacy, intentionally generate fantasy

stories that bring pleasure.
Record list of positive sensual fantasies to measure ones
growth and capacity for personal satisfaction.
 Positive Sexuality
Sexual Health & Sexual Identity as Part of Personal Growth

Step #6
Personal Pleasuring Exercise
This is another experiential exercise - not about appreciating ones
physicality but rather enjoying feelings of sensual & sexual pleasure.

While there is no requirement of experiencing orgasm in this

exercise, there is permission to feel sexual to ones fullest capacity
enjoying any part of the body in which these feeling are created.

Get NAKED in a warm bath or warm bed, touching ones skin in

places previously noted that feel the most sensuous and sexual.
Afterwards, record ones growth of positive sensual celebration.
 Positive Sexuality
Sexual Health & Sexual Identity as Part of Personal Growth

Step #7
Sharing Your Sensual Self
This is the real-deal in terms of experiential sharing if
and only if one choses to do so.
All interpersonal interactions must follow the guidelines of
consensual touch and the Relationship Bill of Rights as a guide in
terms of negotiating the touching with a partner.
Again - there is no requirement of experiencing orgasm in this
encounter but one can feel sexual to ones fullest capacity
enjoying any part of the body in which these feeling are created.
Afterwards, record ones growth of positive sensual celebration.
 Positive Sexuality
as Part of Personal Growth & Overall Health

Screening Tools for Measuring Sexual Health

Am I Normal? Ten-item Screening Tool

International Index of Erectile Function (IIEF)

Female Sexual Function Index (FSFI)

 Positive Sexuality
as Part of Personal Growth & Overall Health
Am I Normal? Screening Tool
Have you ever felt guilty regarding any of your own sexual behavior?

How satisfied are you with your level of accurate knowledge about human sexuality?

How satisfied are you with your own physical appearance (attractiveness of your body)?

Did you ever have questions about your own sexual orientation?

Have you questioned whether you were masculine or feminine enough?

Have you ever questioned yourself about being "good enough" as a lover?

Were you ever physically abused as a child or assaulted as an adult?

Were you ever sexually abused as a child or sexually assault as an adult?

How satisfied are you with regards to your ability to prevent yourself from engaging in
sexually compulsive behaviors (sometimes referred to as sex addiction behaviors)?
 Positive Sexuality
as Part of Personal Growth & Overall Health

Assessment Instruments for Measuring Sexual Health

Family Support for Healthy Sexual Development

Sexual Health and Wellness Satisfaction Scale (SHAWS)

Problematic Sexual Behavior Inventory

 Positive Sexuality
as Part of Personal Growth & Overall Health

Sexual Health and Wellness Satisfaction Scale

(25 item self-assessment or structured interview)

Measures personal satisfaction

across four major domains of sexual health:
Self-Satisfaction
Relational Satisfaction
Medical Satisfaction
Sexual Identity
Introduction to Sexual Identity
Introduction to Sexual Expression
Introduction to Sexual Hypercube
 Key Focus of Positive Sexuality
Improved Intrapersonal Satisfaction

Resolution of sexual dysfunction and effects of sexual trauma.

More personal satisfaction and greater sense of health.
Greater self-acceptance through less internal conflict &
negative self-image.

Improved Interpersonal Relations

Greater sexual satisfaction with ones partner.

Promote greater understanding and acceptance of others.
Less fear, prejudice, and violence toward those we perceive
as different from us.
 Personal Stories
of Sexual Empowerment
are featured and solicited for forthcoming

The Gender Revolution

& the New Sexual Health:
The Sexual HyperCube,
Sexophrenia, and Beyond
 Positive Sexuality
Reference Notes
While specific references are provided to particular sources (listed on
References slide); this work is based upon the work of many different
sexologists as well as scholars who do not identify as sexologists:
* Alfred Kinsey * William Masters & Virginia Johnson * John Money

* Harry Benjamin * Carl Jung * John Bancroft * Eli Coleman

* Sandra Lipsitz Bem * Daryl Bem * Beverly Whipple * Lisa Diamond

* Judy Seifer * Gerald Weeks * Cindy Meston * Greg Herdt

* Gene Able * Barry McCarthy * Brian Sykes * Lawrence Kurdek

These individuals influenced the creation of the sexual identity cube, sexual
expression cube and the sexual hypercube model
 Sexual Identity, Expression, & Hypercubes
Dr. Fred Peterson
References
Brown, G.R (1988). Transsexuals in the military: Flight into hypermasculinity. Archives of Sexual Behavior 17(6):527-537.
Coleman, E. (2004). Promoting sexual health: A presentation to the World Health Organization, Geneva, Switzerland.
Coleman, E. (2009). International Journal of Transgenderism (Volume 11, Number 1)
Edwards, W. & Coleman, E. (2004). Defining sexual health: A descriptive overview. Archives of Sexual Behavior 33(3):189-195.
Evans, N. J., Forney, D. S., Guido, F. M., Patton, L. D., & Renn, K. A. (2010). Student development in college: Theory,
research, and practice (2nd ed.). San Francisco, CA: John Wiley & Sons, Inc.
Fausto-Sterling, Anne (2000). Sexing the body: Gender Politics and the construction of sexuality. New York: Basic Books.
Haffey, B., Peterson, F., Bley, J., & Glaus, K. (2007). Addressing the sexual health concerns of sexual minority clients. Found
in L. Vandercreek, F. Peterson & J. Bley (Eds.), Innovations in Clinical Practice: Focus on Sexual Health. Sarasota,
FL: Professional Resource Press.
Peterson, F. (2007). The Complexity of Sexual Diversity: Sexual Identity Cube and Self-Awareness Exercise. Found in L.
Vandercreek, F. Peterson & J. Bley (Eds.), Innovations in Clinical Practice: Focus on Sexual Health. Sarasota,
FL: Professional Resource Press.
Peterson, F. & Carter, R. (2010). Re-conceptualizing and Redefining Sexual Identity in Light of Intersectionality and
Lifespan Transitions. Annual Convention of the Ohio Psychological Association, November, 2010..
McCammon, S., Knoz, D., & Schacht, C. (2004). Choices in Sexuality. Independence, KY: Atomic Dog Publishing.
World Health Organization. (2004). Progress in Reproductive Health Research A New Focus for WHO. Geneva.
Zucker, K. & Lawrence, A. (2009): Toward Version 7 of the World Professional Association for Transgender Healths Standards
of Care, International Journal of Transgenderism (Volume 11, Number 1)
 Positive Sexuality

Questions?
Answers?
Margaritas?

Contact:
937-479-0008
Docpete1000@aol.com
 Positive Sexuality
Two of the three primary components of the
sexual identity are:

25% A. Sex Orientation (male/female continuum) and sexual fantasty

B. Sex Orientation (male/female continuum) and sexual

25%
orientation

25% C. Sex role orientation and sexual behavior

25% D. Sex role orientation and sexual orientation

 Positive Sexuality
Two of the three primary components of sexual expression
are:

25% A. Sexual fantasy and sexual behavior

25% B. Sexual fantasy and sexual orientation
25% C. Sex role orientation and sexual behavior
25% D. Sex role orientation and sexual orientation