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Dissertation Abstracts, Human Sexuality Studies

Doctoral Dissertation Abstracts


Kevicha H. Echols
Power of the “p”: A Critical Disclosure Analysis of Sex- Worker Publications

This dissertation research can serve as a foundation for gaining insights about what matters to persons in the sex work community. Through a critical discourse analysis of sex-worker publications this research explored how cultural, social, and political factors influence sex workers' experiences. The goal of this research was to illuminate the voices of persons in the sex work community and interpret how they define themselves and their experiences within the alternative publications produced by and for the sex work community.

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Kristen Conklin Flank, PhD
An investigation into masturbation and conversations about masturbation in heterosexual married individuals

This research investigated married individuals' attitudes about experiences of masturbation and communication about it with their partner, as related to self-reported levels of sexual satisfaction, sexual desire, and their differentiation of self. Participants (N=1251) who were 21 or older, heterosexual, and legally married, took an online survey of 103 questions. Analyses found that significant differences existed between participants who had or had not talked with their partner about their own and their partner's masturbation. Those who had these conversations claimed significantly higher levels of sexual satisfaction and sexual desire. Degree of differentiation of self showed no such correlation.

The study also examined use of stimulus material during masturbation and found that none of the investigated types of stimulus were correlated with level of sexual satisfaction. However, use of Internet pornography as a stimulus correlated with higher levels of sexual desire for their partners. Individuals who believed that masturbation was unnecessary if one is satisfied by one's partner had significantly lower levels of differentiation of self than those who did not. Similarly, those who agreed that masturbation is a form of infidelity or that masturbation becomes unimportant once in a relationship had significantly lower differentiation of self scores than those who did not agree.

Disapproving or being unsure about approval of a partner's masturbation was correlated with lower levels of differentiation of self. Clinicians, when taking into account the context and backgrounds they already know about a couple, can be more confident it may not harm to suggest couples have a private conversation about their own and each others' masturbation.

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George Willard Turner, Jr., PhD
The social-sexual voice of adults with mild intellectual disabilities: A qualitative case study

The purpose of this qualitative case study was to explore how adults with mild intellectual disabilities live out their social-sexual lives. Adults with intellectual disabilities (ID) are often assumed to be asexual or incapable of having sexual lives, resulting in a paucity of research-based knowledge. Research and educational efforts with this population have focused largely on basic sexuality education and abuse prevention, defaulting to safety over the possibilities of human connectedness.

This case study, informed by heuristic inquiry and guided by an emancipatory research paradigm, was an investigation of self-reported views, values, and desires of five adults with mild intellectual disabilities regarding relationships, romance, and sexuality. Data sources included observations and a series of interviews, which gave participants the chance to give voice to their social-sexual experiences. Data were analyzed utilizing both deductive and inductive coding along with narrative analysis. Results indicated that adults with ID value a life filled with relational passion and connectedness. They desire rich, pleasure-driven social-sexual experiences beyond the typical abuse prevention focus of disability services.

Case studies of the five participants are based on their individual perceptions and experiences. Cross-case findings are presented in these eleven areas: 1. Sexual Attitude, 2. Sexual Self-advocacy, 3. Sexual Self-identity, 4. Sexual Experience, 5. Sex Education, 6. Sexual Script, 7. Sexual Vocabulary, 8. Sexual/Relationship Support, 9. Sensuality, 10. Intimacy, and 11. Reproduction. This study offers a more psychologically and socially-aware perspective in an effort to dispel mainstream society's stereotypical portrayal of disability and sexuality.

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Natasha Watson, PhD
Perspectives of African-American Men in a Fatherhood Program Regarding the Joys and Struggles of their Intimate Relationships with African-American Women

The purpose of this qualitative research was to explore and understand more about the perspectives of Black men in a fatherhood program regarding the joys and struggles of their intimate relationships with Black women. As a phenomenological study, the focus was on the participant's lived experiences from their subjective, first person point of view. The selection of men participating in a fatherhood program provided a sample of low income men who were able to reflect on the influence of fatherhood on their relationships quite readily. Two research questions guided the study: What are the perspectives of Black men in a fatherhood program about the joys and struggles of their intimate relationships with Black women? How does fatherhood impact these joys and struggles? Data were collected during four focus groups conducted by either a male or female facilitator. Using purposeful sampling, participants selected were fathers who were currently in or had been in relationships with a Black woman, identified as Black themselves, and were members of an urban fatherhood program. Credibility was strengthened through peer debriefing and member checks.

This study produced findings that include both composite stories and a typology that compares dimensions along a continuum of negative to positive attitudes about and behavior toward Black women. All 48 focus group participants fit into at least one behavioral type. The behavioral types included dominating, rejecting, trying (but defeated), and committing. Inductive analysis of the data resulted in four major themes: ambivalence, issues of control, negative media messages, and pride in fatherhood. Study participants exhibited positivity and a desire to develop and maintain healthy relationships with Black women. Participants also displayed pride and optimism regarding fatherhood. Based on the findings in this study recommendations for practice are offered, as are recommendations for further research.

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Courtney Elizabeth Weaver, PhD
A study of power motivation as a correlate to unprotected receptive intercourse in men and women who have sex with men

Sexual behaviors have long been a topic of interest to researchers, as it is important to focus on studying such behavior in an attempt to understand patterns and identify interventions that can be introduced to alter more risky behaviors.

This study examined implicit power motivation [(n) power], activity inhibition (AI), and unprotected receptive intercourse (URI), with the goal being to understand why people engage in the behaviors they do. By identifying a risky sexual behavior that satisfies the power motive and understanding the reasons energizing the behavior, educators, clinicians, and researchers can find alternative behaviors that still provide the same level of meaning and fulfillment, but are less harmful to the individual engaging in them. While the results of this study found no statistically significant relationship between (n) power, activity inhibition, and URI, human behavior is vast, and more than one motivational force is at work.

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Kelly J. Wise, PhD
Gender differences in the parent/child relationship

The parent/child relationship has a major affect on a person's life. The gender of the parent affects the way the parent relates to their son(s) and daughter(s), thus there are gender differences in the parent/child relationship. This is especially true for high-risk families with child abuse or neglect issues, where many families consist of single mothers raising children on their own (Gardner, Trentacosta, Dishion, Connell, Shaw & Wilson, 2009; Gutterman & Lee, 2005; Lee, Perron, Taylor, & Gutterman, 2010).

Archival data was used in this research with families utilizing Preventive Services using the Parenting Relationship Questionnaire (PRQ). The Parenting Relationship Questionnaire (PRQ) is an assessment tool created by Kamphaus and Reynolds (2006) to use in clinical, educational, and therapeutic settings. The PRQ assesses the relationship between caregiver and children ages 2-18.

Archival data was gathered at intake and at the end of treatment to assess the Evidence Based Treatment effectiveness of a child welfare Prevention Program. Results were analyzed and fathers showed statistically significant difference in Communication, Parenting Confidence, Satisfaction with School, and Relational Frustration. Mothers showed improvement in Attachment and Discipline Practices, however, not at a statistically significant level. Recommendations for policy change, program development, and practice have been offered. Limitations of the study are discussed, as well as recommendations for future research.

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Thomas N. Wood, PhD
The relationship between extrinsic/intrinsic goal-orientation and the experience of mal sexual dysfunction

Erectile difficulties are common in men. However, there is no empirical explanation as to why some men are distressed by this phenomenon and some are not. To date, research literature has neglected the role goal-orientations or motivations play in sexual dysfunction. This exploratory study examined the relationship between goal-orientations and erectile dysfunction in men.

The sample included 27 men with erectile dysfunction as assessed by the Index of erectile Function (IIEF-5) who were then dichotomized into two groups, psychogenic and non-psychogenic, using the Performance Anxiety Sexual Scale (PASS). Motivational intent for sexual activity was then assessed for these two groups using the Situational Motivation Scale (SIMS), which measured levels of intrinsic and extrinsic goal-orientation. Inferential analysis indicated that psychogenic and non-psychogenic status showed a negative relationship with intrinsic motivation (t(26)=-2.19, p<.05). Additionally, regression analysis indicated that study participants who reported being married were significantly less likely to be categorized with psychogenic status (B=-3.15, SE=1.37, OR=.04, 95% CI=.00-.62, p<.05).

This study revealed that performance anxiety regarding erectile difficulty has a negative relationship to intrinsic motivation, indicating that men with intrinsic motivation for sexual interactions are less likely to be distressed by unreliable erections. These preliminary findings add needed information to the limited body of literature on the role of goals in sexual function and dysfunction. However, further research is recommended to examine the complexities of human motivation for sexual behavior.

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Nagma Virk, PhD
Sexual Intelligence: Development and Validation of a Construct

This study began the process of developing the construct of sexual intelligence and establishing it as another form of intelligence in addition to the already existing domains--cognitive, social, and emotional intelligence--along with the determination of its components. A definition of the construct along with a draft of the measure of sexual intelligence called the Virk Sexual Intelligence Test (VSIT) was presented to a panel of experts for their feedback. Revisions were made to the definition, based on the recommendations of the panel.

In the second phase of the study, a survey questionnaire was distributed to a sample of 50 participants, who were sexuality professionals, in order to receive feedback about the composition of the subscales of sexual intelligence.

The questionnaire was designed to elicit content-specific responses from the participants, which helped determine the components of the construct of sexual intelligence, broadly divided into sexual perception, sexual knowledge, and sexual management. The results of this research helped me to offer recommendations for future research on sexual intelligence and its measurement, which could establish it as a mental ability and a predictor of human sexual behavior.

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Debra E. Bazarsky, PhD
The love that dares speak its name: Identity and behavior of women and gender diverse people who are sexually intimate with women

The purpose of the dissertation was to better understand the sexuality of women who are sexually intimate with women (e.g., women who identify with no label or identify as same gender loving, lesbian, bisexual, queer, questioning, heteroflexible, etc.), and gender diverse people (i.e., those who are female-bodied, assigned female at birth, and/or woman-identified) who are sexually intimate with women. There has been minimal research about lesbian sexuality and even less that is inclusive of bisexual women and gender diverse people who partner with women. With the intention of building upon current literature in the context of 21st century queer identities, this dissertation distinctively assessed both participants' identity and behavior, whereas most previous studies focused on one or the other. This dissertation also sought to "expand the net" to capture the experiences of many who have been excluded in previous research due to limiting identity categories.

A mixed-method design with 1,031 study participants was used to assess sexual behavior and identity of women and gender diverse people who partner with women. A survey consisting of 117 questions was administered online and advertised widely over lesbian, gay, bisexual, transgender (LGBT) lists and through LGBT and women's organizations. Particular outreach was made to subpopulations including those who are 60 years of age and older, people of color, gender diverse and transgender people, and women who fit within the population being addressed by the study, but identify in a different way other than lesbian or bisexual. Findings were based on (1) demographic and descriptive data about how participants identify, (2) descriptive data about participant sexual behavior, and (3) open-ended survey responses.

Findings related to identity revealed that women and gender diverse people who partner with women have multiple ways of identifying their sexual orientation, gender identity, and sex, which are enhanced by other identities, such as race and ethnicity, class, age, spirituality, and family life. In terms of behavior, the most commonly reported sexual activities in order of frequency were (1) study participant rubs up against partner to stimulate clitoris, (2) orgasm with masturbation, (3) sensual touch, (4) orgasm with partner, (5) partner touches study participant's breast/chest, and (5) study participant rubs up against partner to stimulate clitoris. All of these except orgasm with masturbation were statistically significant factors for sexual satisfaction; orgasm with partner and sensual touch were the two largest predictors for sexual satisfaction. In addition, the remainder of behaviors that were statistically significant for participants who were completely satisfied sexually were giving and receiving oral sex, giving and receiving gender play, and bondage and discipline and sadism and masochism (BDSM) and kink play by the partner with the study participant.

One of the most surprising findings of the entire study with the highest mean score for sexual behavior, which was 4.96 out of 5.0, was one's partner rubbing up against the study participant for clitoral stimulation. The converse, the study participant rubbing up again one's partner for clitoral stimulation, had the third highest mean score. Therefore, engaging in tribade for clitoral stimulation was the most frequent activity. What was also interesting about this finding was the highest mean score and predictor for sexual satisfaction was focused on the partner's behavior rather than that of the study participant. In addition, despite the perception within the lesbian and queer community that sex toys are commonly used during sex, the mean score for sex toy use was very low, and findings showed sex toy use had little impact on study participant's sexual satisfaction.

In terms of sexual satisfaction, 85.3% of the study participants were either somewhat or completely satisfied with their sex life. More than two thirds (71.8%) of the participants reported having sex at least once per month, and about one third of the study participants reported having sex six or more times a month. Although not all of the participants were lesbian identified, most fell within the larger lesbian/queer women's community. These data challenge the commonly held perception of "lesbian bed death" that also appears in some of the literature.

This research reveals a complex narrative about how women and gender diverse people who are sexually intimate with women identify, to whom they partner, and what their sexual behavior is with their sexual partner(s) and themselves. In addition to opportunities for future research, this study offers practical applications for those who provide services to this population, including mental health professionals, medical practitioners, and educators. Lastly, and most importantly, this research gives voice to women and gender diverse people's lived experiences and provides data to those within the community to better understand their own sexuality, identities, and behaviors.

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Damon M. Constantinides, PhD
Intersections of gender and intimacy in the lives of transgender people with non-binary gender identities

Gender identity in the United States is often understood as a binary model with two choices, man or woman. For people who identify as transgender, this model does not always fit. Some transgender people have gender identities that are outside of the binary gender system. Current available research regarding intimacy and sexual intimacy focuses on the experience of heterosexual and binary gendered people.

This research does not include the experience of transgender with non-binary gender identities (NBGIs). Research about transgender experiences focuses on the sexual behavior or sexual orientation of transgender people who have binary gender identities such as transgender man or transgender woman. This study begins to fill the gap in research that explores the experience of intimacy and sexual intimacy through the use of in-depth interviews with 16 transgender people with NBGIs. My conceptual model was based on my experience as a non-binary transgender identified therapist.

I used both phenomenological and heuristic inquiry approaches and drew from feminist research tradition, strength-based social work, and participatory action research as a basis for my use of self in this qualitative study. Utilizing the themes found by exploring with study participants how they make meaning of the connections between their gender identity and intimate friendships and gender identity and sexually intimate relationships I developed a NBGI Sexual Intimacy Model. This model could be used by researchers, clinicians, educators, and transgender people and begins to fill the gap in intimacy and gender studies research.

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Travis Sky Ingersoll, PhD
Examining the relationship between fear of intimacy and sexual anxiety among Chinese college students

Although China can boast being one of the first civilizations to document its sexual history, modem-day Chinese people are lacking in sexual knowledge, as well as the necessary social resources needed to address the sexual education and counseling needs of its citizens. The current study aims to contribute to the study of contemporary Chinese sexuality by exploring the relationships between the Fear of Intimacy and Sexual Anxiety with a Chinese sample population.

Study participants included students attending a medium-sized university in Chongqing, China (N = 300). Results indicated positive correlations between scores on the Fear of Intimacy Scale and the Sexual Anxiety Inventory. Variances in scores dependent upon demographic information, such as one's stated gender, are discussed as well as the potential implication the present study may have on the future of Chinese sexuality education, counseling and research.

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Meredith L. Kramer-Leach, PhD
Sexuality education in a public school: Examining how the curriculum compares to students' self-expressed information needs

School-based sexuality education represents a formalized attempt to provide information and cultivate sexual knowledge and values. Based on the literature related to comprehensive sexuality education, this qualitative study explored aspects of an existing sexual health curriculum including delivery of content, its developmental appropriateness, and current content. Collected data, including anonymous responses and focus group transcriptions, assert that this curriculum is not meeting students' needs due to the lack of a realistic portrayal of student experiences, lack of teacher training, and a lack of developmentally, socially, and educationally appropriate content.

The work concludes with a discussion that includes recommendations for teacher training, curriculum development, group implementation, classroom adjustments, and future research that will enable student voices to be heard and student needs to be met.

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Lindsey R. Krenzel, PhD
What do sexuality counselors do? A content analysis of job descriptions to determine the roles, responsibilities and qualifications of sexuality counselors

This dissertation examined the required roles, responsibilities and qualifications of sexuality counselors. The research was a content analysis of sexuality counselors' job descriptions. The research questions asked about the overlap among sexuality counselors, educators, and therapists and also about the alignment of the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) requirements for sexuality counselor certification with the job descriptions.

The findings suggest that the role of the sexuality counselor is one of great variance. Sexuality counselors often have several other responsibilities in addition to providing counseling for clients surrounding issues such as sexual violence, reproductive health, and HIV/AIDS. These responsibilities include sexuality education, administrative duties, and referrals. Of the roles held by sexuality counselors, the three primary roles that emerge were found to be counseling, education, and referral. Additionally, sexuality counselors may work in a variety of settings including hospitals, health clinics, schools, or community centers. While every job description analyzed included sexuality counseling roles, none of them was titled "sexuality counselor." Additionally, the requirements for sexuality counselor certification, as defined by AASECT, did not closely match employers' expectations.

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Dianna Palimere, PhD
Psychosexual group therapy for adult female survivors of sexual abuse: A case study

Recent trends towards researching the effects of sexual abuse highlight the need for more studies to explore treatment interventions, such as psychosexual therapy for survivors of sexual abuse. A psychosexual group therapy intervention is proposed and the usefulness of the intervention was explored. The purpose of the psychosexual group therapy intervention is to aid survivors in healing some of the damage done to their sexuality, which was a result of sexual abuse.

The purpose of this study was to explore the perceptions of adult, female survivors of sexual abuse with regard to their sexuality and the helpfulness of participating in a psychosexual group therapy intervention. The participants chosen for this study were a clinical sample of women already involved in individual psychotherapy to treat issues related to their history of sexual abuse or assault, who volunteered to be part of a psychosexual group therapy intervention.

The findings of the study suggest that this type of group was beneficial to the participants. The participants reported an increase in their knowledge about sex, sexuality, and the impact that their abuse history had on their current sexual functioning. They also reported a better understanding of Posttraumatic Stress Disorder (PTSD), and the sexual sequelae caused by PTSD. Participants reported an increase in sexual desire and satisfaction, as well as, feeling like they were better able to manage triggers, flashbacks, and/or intrusive memories, which had previously been a hindrance to their ability to enjoy sexual activity, both alone or with a partner. Implications and suggestions for further research are discussed in the final Chapter.

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Timaree Leigh Schmit, PhD
How body morphology changes affect preference for attractiveness and thinness in a partner among women attracted to women

This dissertation examines whether there is a difference in preference for thinness and physical attractiveness between women who have maintained relatively stable body morphology and those who have changed body morphology among the population of women who are attracted to women. The first section is a brief overview of the conceptual background and methodology of the study. The second serves as an in-depth exploration of the literature that has informed the current perspective and helped in the formation of the research question. The third section specifically describes the methodology used in this study. The fourth details the findings and the fifth and final section revisits the major themes of the previous four.

Within the study of physical attraction, there have been many methods by which researchers have quantified beauty. The greatest predictor of overall attractiveness is body morphology: including height, weight, proportions, and distribution of fat. Individuals tend to seek partners of similar backgrounds and whose value is comparable in terms of appearance, intelligence, social status, and other facets of desirability. This strategy of mate selection increases the likelihood both partners will be mutually satisfied and the couple will remain intact. Accurately assessing one's own desirability as a mate in comparison to others and vying for mates of value that are similar are key components to this strategy's success. This involves intrasexual competition with others of the same sex who are perceived as potential rivals as well as intra-couple competition by continually re-evaluating one's value in comparison to one's mate to ensure equilibrium.

For women attracted to women, the targets of intra-sexual competition and intra-couple competition may be the same individuals. Lesbians have developed a unique set of beauty standards that may differ from the stringent expectations of thinness in mainstream culture, including a greater acceptance of a variety of body morphologies. There are, however, differences within the population of women who are attracted to women in terms of preference for thinness and physical attractiveness in partners. While body dissatisfaction and internalization of thinness expectations have not been shown to correlate with having high preference for thinness and attractiveness in lesbians, this study seeks to examine another variable as possible explanation: changes in body morphology.

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Constance M. Bowes, PhD
Integrating sexuality and spirituality: A case study of Shalom mountain retreat and study center leadership

Best practices among leaders of a contemporary retreat center in its attempt to integrate sexuality and spirituality are investigated. The Shalom Retreat process was developed within the milieu of The Human Potential Movement and the sexual revolution of the 1960s, and represents a response to changes in sexual attitudes during the second half of the twentieth century. Results indicate that new perspectives about sexuality and the body, the integration of the transpersonal, and the building of intentional community are all instrumental in addressing the body-spirit split. Core practices of the leaders interviewed include a whole-person ethos, a belief in the unity of body and spirit, and the belief that authentic and vulnerable leadership is critical to guiding others.

The findings are congruent with theories of humanistic psychology, transpersonal psychology, and group process that empower people from a holistic perspective and a growth-oriented approach to individuation. Findings support the position that the integration of sexuality and spirituality is central to healthy sexuality, personal transformation, and can be a tool for experiences of transcendence. A model for practitioners, The Four Essentials of Integration, is proposed.

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Latoya Brooks, PhD
Men with sexual compulsivity: Relationship between adult romantic attachment styles and sexual behavior types

This study explored the relationship between adult romantic attachment styles and sexual behavior types in men with compulsive sexual behaviors. Compulsive sexual behavior is a concern not only because of the effects on self and others; it also has the potential to reduce a person's ability to form and maintain intimate romantic relationships (Carnes, 1991; Cassidy, 2001; Katehakis, 2009; Leedes, 1999; Popovic, 2005; Zapf 2007). Although Leedes (1999) and Zapf (2007) made connections between attachment styles and men with compulsive sexual behaviors in their research, there is limited literature exploring the relationship between attachment styles and compulsive sexual behavior typologies.

Compulsive sexual behavior has harmful consequences for the individual and his or her family that may include social, emotional, physical, legal, and financial losses (Carnes, 1991). This research explored two questions: In what ways is there a relationship between adult romantic attachment styles and sexual behavior types in men with compulsive sexual behaviors? Do demographic factors differentiate the relationship between adult romantic attachment styles and sexual behavior types in men with compulsive sexual behaviors?

The Experiences in Close Relationships-Revised (ECR-R) and the Sexual Dependency Inventory-Revised were used to examine the relationship between adult romantic attachment styles and sexual behavior types. The data came from preexisting data collected by a sexual addiction and trauma facility in southeastern Pennsylvania. The sample consisted of 100 male clients over the age of 18 who were treated for compulsive sexual behaviors at the residential treatment facility.

The study found a significant, positive relationship between attachment styles and sexual behavior types, r = +.296, N = 100, p = .003, two-tails. Seventy percent of the males ( N = 70) with sexual compulsivity had insecure attachments. This study also found that demographic factors were not significant explanatory variables for sexual behaviors types. Attachment styles were significant explanatory variables for sexual behavior types among males in treatment for sexual addiction, accounting for 8.7% to 18% of the variance in sexual behavior.

Through understanding this relationship clinicians can develop therapeutic interventions to help the client examine how family history, culture, and past events influenced and maintained the compulsive behavior. Clinicians can also work with the individual to improve connections with others, build healthy sexual awareness, and establish intimacy in adult romantic attachments (Carnes, 2001).

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Dianne R. Browne, PhD
Unmarried Black fathers: Sexual attitudes and beliefs influencing decisions not to marry

Sex is a significant element in relationships between Black men and Black women (Billingsly, 1992; Harding & Jencks, Harrison, 1997; 2003; Ku, Sonenstein, Lindberg, Bradner, Boggess, & Pleck, 1998). Studies about adolescent Black males highlight sexual attitudes and beliefs that affect a young man's relationships with women (Gilmore, DeLamater & Wagstaff, 1996; Gohel, Diamond & Chambers, 1997; Marsiglio, Hutchinson & Cohan, 2001). However, very few studies examined the sexual attitudes and beliefs of men related to marriage.

Current trends in society suggested that unmarried fathers were an accepted phenomenon (Gibson-Davis, Edin & McLanahan, 2005). Common sexual scripts gave men permission not to marry based on community norms and expectations (Staples, 2006). Women's responses identified infidelity and lack of trust (Edin, England, & Linnenberg, 2003) as reasons for Black fathers not marrying. This qualitative study explored men's responses about the role their sexual attitudes and beliefs played in their decisions not to marry.

Focus groups were convened with 36 unmarried Black fathers, between the ages of 18-30. Men discussed their sexual attitudes and beliefs influencing their decisions not to marry as they related to women, unintended pregnancy, marriage, and being cool. Participant responses in this stratified cluster convenience sample revealed sexual attitudes and beliefs about women, men's initial attraction to women, and images of the participants fathers played a role in men's decisions not to many.

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Melanie Davis, PhD
Sexuality education as perceived by physicians and therapists: An assessment of attitudes about and interest in referring patients to sexuality educators

The complex nature of sexuality may benefit from an integrative approach to sexual healthcare that is based on professional relationships among physicians, psychotherapists, and sexuality educators. Based on the literature related to medical discourse about sexuality as well as the training and practices of physicians, therapists, and sexuality educators, this quantitative study assessed whether a relationship exists between physician and marriage and family therapist attitudes and behaviors regarding patient sexuality education, as well as their willingness to refer patients to sexuality educators.

Findings indicate that when they perceive a practice or patient benefit to doing so, 96.2% of physicians and 77.4% of therapists participating in this study would be willing to refer patients to sexuality educators for consultation. Responses from 52 physicians and 97 therapists are presented in the context of their applicability to the practice of referral marketing, wherein professionals build relationships and refer patients to each other. The work concludes with a discussion of possible next steps for the field of sexuality education and for independent sexuality educators seeking to participate in the provision of sexual healthcare. This exploratory study identified some of the challenges sexuality educators face when entering the healthcare environment and may help better position educators to build the profession of independent, individualized sexuality education in the healthcare setting.

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Jennifer L. Foust, PhD
Vulvar Vestibulitis Syndrome (VVS): The challenges of connecting to positive sexual health

The purpose of this study is to explore how women who have seen diagnosed with and suffer from Vulvar Vestibulitis Syndrome (VVS) attempt to achieve positive sexual health after full or partial relief of physical symptoms. A qualitative research design was used. Four women were individually interviewed for one hour about their experience of having VVS and how they have coped with it. Two of the women's partners were also interviewed. The data was coded using thematic analysis with the assistance of N Vivo software. The data was initially grouped into general categories and then refined into more specific categories. The specific categories were used to identify the major themes.

Four major themes were found in the data including: negative emotions and behaviors, negative effects, helpful strategies, and needs and wants. The results indicated that negative emotions and negative effects continue to exist after some of the physical symptoms have been reduced by medical treatment. Recommendations include: continued research in effective medical treatment for VVS, education for physicians about VVS, helping women adjustment their expectations for pain and sex due to having VVS, and providing support from others to women with VVS.

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Doreen Hardy, PhD
When we dare not speak its name: Anal taboo, anal health, and affect theory

Medical and sexological studies related to anal sexuality (AS) and anal health (AH) have been hampered by the anal taboo (AT) for centuries. Understanding the AT may lead to better health care delivery and more effective sexually transmitted infection (STI) prevention messages. This qualitative study explores the complex interrelationships of the AT, AS, and AH.

Several medical facts make this research problem worthy of attention. All STIs are highly transmissible anally, and anal cancer rates have risen over the last decade. Even though new cases of anal cancer are increasing faster in men, there are still more new cases of anal cancer among women, and nearly twice as many women are dying from the disease. Whether this is due to anatomical differences, more reticence to discuss anal symptoms with their medical practitioners, or lack of awareness of female anal cancer risk has never been investigated.

This study explores the AT in clinical settings when AH is at stake. It is based upon the following research questions: "To what extent or in what way(s) does dialogue about AS occur and not occur between health care providers and patients?"; "How do clinicians and patients move toward and away from relevant information related to AH?"; "To what extent are clinicians and patients aware of the AT?"; and "Are there differential effects related to gender in the way the AT operates?"

Comparative analysis of 27 interviews with a variety of stakeholders in AH issues along with continued literature review led to the concept that the AT could be construed as an affect storm, a dynamic combination of multiple fundamental affects--for example, the interaction of shame, fear, anguish and disgust. This grounded theory may prove useful to medical practitioners, patients, and sexuality educators who are motivated to overcome the influence of the AT.

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Tameca Harris-Jackson, PhD
Keeping the faith: Exploring the relationship between religiosity, sexual self-efficacy, and high risk sexual behaviors among Black American women

This study sought to explore the relationship between religiosity, high risk sexual behavior, and sexual self-efficacy in Black American woman. As a growing health concern and one of the leading causes of death for African American women in the U.S., a goal of this study was to examine which factor, if any, had the greatest influence on minimizing HIV/AIDS related sexual risk behavior (i.e., frequency of condom use and number of male sexual partners) in Black American women. Using a revised version of Allport and Ross' Religious Orientation Scale (1967) - the Intrinsic/Extrinsic Religious Orientation Scale-Revised (I/E-R), Rosenthal et al.'s (1991) Sexual Self-Efficacy Scale (SSE), and the Demographic and HIV/AIDS Risk Assessment Questionnaire (DHRA-Q) that was developed for this study, an online survey was developed and data were collected from 102 Black American women between the ages of 20 and 49 in Baltimore, Maryland.

Findings from this study revealed sexual self-efficacy, more than religiosity, to have an influence on women's risky sexual behavior (i.e., number of sexual partners and frequency of condom use). This study also revealed noteworthy findings relating to the application of the measures used. Specifically, a factor analysis of the I/E-R revealed the measure to be reliable for use with this population with minimal modifications. This study also revealed the SSE to show strong reliability for a new subscale - SSE Prevention.

Findings also support implications for continued prevention efforts in the Black faith community, to include incorporating standardized, culturally focused, sexuality education training to clergy. While the ability to generalize findings from this study, given the sample, are limited to Black American women who may identify as middle class and live in urban, southeastern U.S., overall, findings provide an interesting first look into the religiosity-sexual self-efficacy-sexual risk behavior relationship among Black American women and provides a promising foundation for implications for future research and practice.

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Gretchen Anderton, PhD
Excitement, adventure, indifference: Romance readers' perceptions of how romance reading impacts their sex lives

This mixed-methods study examined romance readers' perceptions of how reading romance novels has impacted their sex lives, feelings about their sex partners, knowledge of sexuality and their sexual behavior. Fifty-three women romance readers over the age of 18 completed an online survey composed of multiple choice and open-ended essay questions.

The literature on romance novels and romance readers suggests that romance readers may use romance novels as sexually explicit material to produce sexual arousal. In this study, it was found that participants use romance novels primarily to relax and escape the pressures of everyday life and only secondarily to produce sexual arousal.

Most of the study participants (75.5%) reported that reading romance novels has had an impact on their sex lives. This occurred in several ways, including making participants more likely to engage in sexual activity and by making them more likely to try new sexual activities.

Most participants (85%) reported that reading romance novels has not had an impact on their feelings about their sex partners or has had a positive impact on their feelings about their sex partners. With regard to safer sex practices, participants said that romance novels present incorrect or misleading information about safer sex and that they regard them as unreliable in this area.

A smaller number of participants (24.5%) stated that reading romance novels has not had any impact on their sex lives, sexual behavior or knowledge about sexuality. These participants emphasized the fictional nature of romance novels and stated that they read strictly for pleasure and do not learn anything or make any behavioral changes based on what they read.

The results of this study suggest that some women who read romance novels feel that reading romance novels is strictly a recreational activity, which has or should have no bearing on other aspects of their lives, and that other romance readers are open to potential positive effects that romance reading may have on their sex lives. This finding suggests that it might be useful in further research to focus on this second group of women. Another major finding of this study was that women who read romance novels and who are satisfied with their sexual relationships feel that there is no basis for comparison between their sex partners and the male protagonist or hero in a romance novel, or that their sex partners compare favorably to the male protagonists or heroes in romance novels. In contrast, women who read romance novels and who are not satisfied with their sexual relationships feel that their sex partners compare unfavorably to the male protagonists or heroes in romance novels.

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Tiffanie Davis-Henry, PhD
Perceptions of sexual desire in postpartum women: A comparative study among stay-at-home and working mothers

The topic of postpartum sexuality has been well researched. While much of the literature focuses on the hormonal, psychological and social impacts of female sexuality in the postpartum period, few studies explore the impact of employment on a woman's perception of her sexual desire. This study was designed to determine if there was a difference in the perception of sexual desire among postpartum women who identify as stay-at-home mothers when compared to working mothers. Additionally, this study examined what co-occurring factors may also contribute to these differences.

A quantitative, cross-sectional design was employed to assess the effect of employment status on sexual desire in postpartum women. A non-random sampling strategy was used to recruit adult women who were within their first year postpartum. Participants (N=217) self-selected for the study and completed an online survey developed by the researcher.

A Mixed Design Analysis of Variance (ANOVA) was used to identify differences in participants' perception of sexual desire, and examine the impact of biopsychosocial factors on sexual desire among postpartum mothers of varying employment statuses. A One-Way ANOVA was used to explore the relationship between sexual desire and the resumption of sexual activity after childbirth.

The results revealed a significant difference in participant's perception of their sexual desire but this difference was not related to employment status. There was also a significant difference between biological, psychological and relationship/social factors impacting sexual desire. These differences were independent of employment status as well.

A significant difference was found in psychological factors between employment statuses. Additionally, the interaction between relationship/social factors and employment status was also statistically significant. Through additional analysis, it was found that there was a significant difference in sexual desire relative to timeframe for resuming sexual activity after childbirth.

This study provides treatment professionals with information that can be used to educate new moms about potential explanations for changes in their sexual desire following childbirth. By knowing the possible impact specific biopsychosocial factors can have on their sexual desire, it is hopeful that new mothers will feel more empowered to communicate sexual concerns to their treatment providers.

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Kimberly Chestnut Dunlap, PhD
Correlates of wellness and sexual health

Wellness and sexual health are complex constructs. Each construct is composed of numerous concepts. Wellness is a lifestyle approach that addresses aspects of life such as nutrition, work satisfaction, spirituality, physical fitness, and relationships, to name a few. Sexual health includes the concepts of accurate information related to human reproduction, disease prevention, sexual pleasure, relationship, and many others. Although many of the components between the two constructs overlap in regards to an individual's well-being, sexuality is not included as a component of wellness in the vast majority of wellness models.

Research that addresses the important aspects of how sexuality influences well-being will be reviewed later to explain this connection. With issues such as childhood obesity, work stress, high cholesterol, and inactivity receiving increased attention in the U.S. culture, there is significant focus on lifestyle and how people are caring for themselves and their family. In supporting the cultural shift to increased awareness regarding lifestyle and life satisfaction, it is imperative that sexual health and wellness be included as aspects of a healthy lifestyle. Over the years studies have been done to assess the key aspects of the constructs of wellness and sexual health. Such studies have helped the constructs to evolve into the complex and comprehensive concepts they are today. Various measurement tools have been created to measure these constructs, and the results show that many aspects within each construct play an important role in determining how individuals assess their wellness and sexual health. The author posits that to obtain a genuine measure of overall wellness, sexual health must be included as a component, which acknowledges the importance of reproductive health, sexual esteem, sexual satisfaction, and disease prevention.

This study used the Wellness Index and The Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) as the measurement tools to collect data from a sample of undergraduate college students. Then, based on literature about the impact sexual health has on well-being, the author sought to find whether there were correlations between the overall measures and subscales of the measures. Data from 152 undergraduate college students were analyzed, and it was determined that statistically significant relationships were present between the subscales of the two instruments. The work concludes with a discussion of the practical implications of acknowledging sexual health as an imperative concept of wellness and the promotion of wellness and sexual health education within various personal and professional settings.

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Linda Hawkins, PhD
Gender identity development among transgender youth: A qualitative analysis of contributing factors

Adolescence is a time when fitting in and being unique are at dynamic odds with each other. One might desire to be 'different,' but not too different or different in such a way that puts one into an unwanted group. The real challenge comes when a youth's identity is one that is targeted for harassment, hate, discrimination, and/or violence (Burgess, 1999; Grossman, 1997; Grossman & D'Augelli, 2006; and Grossman & Starks, 2006). Gender identity and its development, in our current society, are focused on the binary system of male and female. Transgender and gender-variant youth are excessively targeted for discrimination and harassment by family members (Knafo, Iervolino & Plomin, 2005; Miller, 1996; Zucker & Bradley, 1995), by peers (Lev, 2004; Wyss, 2004) and by society at large (Lombardi, 2001; May, 2002; Roen, 2001).

Historically, the research and therapeutic guidance for supporting healthy identity development and working with transgender and gender variant individuals in the mental health setting were focused on white, middle to upper-class, biological males who were seeking support as they transitioned to a full presentation as socially accepted females, most through expensive surgical means (Bohjalian, 2001; Boylan, 2003; Diamond, 2004; Money, 1985; Morris, 1974). While providing valuable cornerstones to the study of supporting transgender individuals, past research and the ensuing guidelines rarely fill the needs of the youth.

To fill this gap, 28 gender variant and/or transgender youth between the ages of 18 and 26 participated in a Phenomenological Interview process to offer insight into the factors that influence their gender identity development. Interviews were transcribed and analyzed utilizing NVivo software. Results clearly indicate that the youth interviewed describe their gender identity development as multifactorially influenced. Twenty-eight overarching factors were synthesized from the responses. Participants also identified factors that were perceived to be helpful and not helpful. A Biopsychosocial framework was utilized to gain a conceptual appreciation for the multifactorial influences. Through these life narratives, recommendations for medical, mental health and educational professionals are offered by the youth and this researcher.

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Debra Sutton, PhD
Exploring the phenomenon of the sexual-spiritual split as mediated through experiences of women reared in Christian faith traditions: A qualitative study

This feminist, hermeneutical, phenomenological study examined how eleven women (ages 33-55), reared in Christian faith traditions, were influenced by dualistic thought, or the sexual-spiritual split. Five were active in a mainline religious tradition; six participated in spiritual practices but no longer consider themselves Christian. Methodologies (e.g., journaling, large group discussion and walking a labyrinth) were employed during a one-day group interview. The data was coded using NVivo software and analyzed.

This study affirms that the sexual identity of some women, reared in Christian traditions, can be shaped by religious traditions that divorce sexuality (body) from spirituality (spirit). This is a result of traditional religious teachings that demean and devalue women and promote the existence of woman as secondary to man. It is further exacerbated by families, without role models for change themselves, that perpetuate the learnings and experiences that fashion women to be invisible and admonish them into submission and silence. External authorities, such as family and church, teach girls value-laden messages, such as 'sexuality is a sin,' 'women are sexual beings not human beings,' and 'others are more important than one's self,' during their formative years. These messages perpetuate dualist thought. The internalization of these messages disempowers some girls and women.

In later years, some women question the messages that they learned from external authorities and progress towards empowering one's self. This study found that women are neither completely empowered nor disempowered, but are mutually empowered and disempowered in areas of sexuality and spirituality, in varying measures. It was found that the more participants connected to an internal authority the more they resisted aspects of traditional religion, rejected teachings that countered their experiences and beliefs, and disconnected from religious institutions that limited or devalued women.

The implication of this research suggests that women, willing to share their experiences regarding how dualistic thought has influenced them, benefit from hearing one another's stories. It further implies that religious organizations must reassess outdated messages that are disparaging to girls and women and reconnect sexuality and spirituality in their teachings.

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Yolanda Turner, PhD
An exploratory study of individuals involved in computer-mediated intimate relationships

This study investigated what characteristics might pertain to individuals who would engage in computer mediated intimate relationships (CMIR), and whether the perception of loneliness or lack of perceived off-line alternatives might contribute to an individual's participation in CMIR.

The sample population included only individuals who are presently involved in CMIR, or who have had CMIR in the past, never having met the relationship partner face-to-face off-line. After completing the study with an n of 317 respondents, analyzed data resulted in significant differences in the experience of loneliness and the perception of offline alternatives between participants whose CMIR is extra-dyadic and those whose CMIR is their primary relationship. Results showed that respondents whose CMIR were extra-dyadic were significantly less lonely than respondents whose CMIR was their primary relationships. Respondents' perceptions of offline alternatives were significantly higher when their CMIR was extra-dyadic than when their CMIR was their primary relationship. In addition, most individuals involved in CMIR did not go online intentionally looking for an intimate partner. Thus, loneliness is not necessarily the motivating factor in pursuing a CMIR. The implications are that an individuals' motivation for pursuing online intimate relationships may differ depending on the type of offline relationships in which they are involved. The study also found that individuals involved in intimate online relationships are typically honest with their online partners about their gender, appearance, and sexual orientation.

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Beverly Frantz, PhD
Sexual attitudes of staff working with sex offenders and non-sex offenders with intellectual disabilities in residential programs

The purpose of this study was to assess the relationship between the sexual attitudes of staff supporting adults with intellectual disabilities in traditional residential settings and specialized sex offenders residential programs.

Adults with Intellectual Disabilities (ID) tend to live in small community settings with limited social contact. For individuals with ID and sexually offending behaviors, their living situations and social contacts tend to be extremely regulated and restricted.

This research investigated the sexual attitudes of 95 staff members who supported people with ID in traditional residential setting and specialized sex offender residential programs. Study participants indicated their responses to 35 sexual attitude statements on a five-point Likert scale and eight sociodemographic variables. Results of this research suggest residential staff supporting people with ID in specialized residential sex offenders' programs have a more conservative view of sexuality and accept commonly held sexual misconceptions that staff who work in traditional residential settings.

Education aimed at increasing sex knowledge has two benefits. First, if may increase the residential staff's attitudes toward health sexuality and increase their ability to function more effectively. Second, understanding sexual attitude by sociodemographic variables provides program administrators with information to develop an enhanced method for pairing residential staff with other residential staff and with clients.

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Nick Myers, PhD
Black college students attitudes towards romance and mate selection

The purpose of this study was to take Larson's theory of Constraining Beliefs and measure its presence in a sample of Black college students. This investigation used the Attitudes About Romance and Mate Selection Scale (AARMS) developed by Nathan Cobb, Jeffry H. Larson, and Wendy L. Watson (2003).

The AARMS is a 32-item scale that measures Constraining Beliefs on seven subscales. The survey uses a Likert scale to measure the presence of the Constraining Beliefs in the students. This research had a sample 327 Black college student (127 males, 200 females), with the majority taken from a historical Black college located in Virginia.

The results showed two major points. Across the survey items, the data analysis revealed a significant difference between the scores of the males and females. Secondly, looking at the seven beliefs (factors), the data analysis showed a significant difference between the scores of the males and females on every factor.

The females in the sample showed slightly more agreement with the Constraining Belief than the males. Finally, an observation noted the high number of scores that were close to the Likert neutral score. The data analysis showed limited presence of Constraining Beliefs, which did rise to a statistically significant level.

Given the high number of neutral responses and neutral responses across the mean scores of the seven subscales, the presence of Constraining Beliefs was limited in this sample of African-American students. In regards to mate selection, it calls into question the possible presence of other variables, which are not measured by the AAMRS scale.

Recommendations are made for new measurement tools to be created to measure the concerns and issues that affect dating and mate selection in the African-American community. These new tools should be socially and culturally sensitive to their history.

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Elizabeth Schroeder, EdD
Addressing sexual orientation in New Jersey schools: An exploratory study

This study was designed to explore how high school teachers in the state of New Jersey teach about sexual orientation as part of their sexuality education classes. New Jersey's Core Curriculum Content Standards (CCCS) mandate addressing sexual orientation by the end of the eighth grade and continuing through 12th grade. Fourteen teachers from Northern and Central New Jersey were observed and/or interviewed about teaching a class specifically on sexual orientation. Findings from this study suggest that, although the state CCCS mandate teaching about sexual orientation, the wording is far too vague to offer any guidance to teachers on how best to do so. Data gathered revealed a wide range of knowledge, comfort levels, school- and community-based support, and teaching methodologies, with a heavy focus on values clarification activities. Teachers revealed that they are largely left to themselves to determine what and how to teach about sexual orientation, as well as the types of professional development programs they think would best support their efforts to do so. Although the school and community support was mixed, it was clear from the teachers that homophobia still pervades many classrooms and school environments. Overall, the study results suggest that the preservice teacher training programs and postgraduate professional development opportunities the teachers in this population received were insufficient in enabling them to address this sensitive topic effectively with young people.

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Justin Sitron, PhD
Sexological worldview in sexologists: Validation of a construct and a model to explain its development

Sexology is the scientific study of sex and sexuality. Throughout its beginnings, it has been comprised of scholars from many scientific disciplines. In recent years, leading scholars in the field of sexology have been calling for more students of sexology. Until now, sexological study has predominantly consisted of professionals in other human services fields that choose to specialize in sexology. With this suggested change and a culture that prefers evidence-based training practices, a need is established for specialized training programs that are specifically designed to meet the needs of scholars of sexologists and that are demonstrated to be effective.

Over the years, several studies have been conducted to evaluate the effectiveness the SAR (Sexuality Attitude Reassessment/Restructuring) – an affective training intervention for sexologists. This training program aims to help its students to develop more humanistic and pluralistic approaches to their work – a perspective where the professional is able to see their clients’ unique life experience – rather than a more traditional one in which professionals diagnose, judge and act on bias and impose their own perspective on the client, student, or research participant. Attempts have been made to measure the SAR’s effectiveness using several different measures and the research has yielded inconsistent and contradictory results.

The author posits that a new construct must be developed to measure the success of affective training for sexologists. The new construct, sexological worldview, is demonstrated to be a more accurate construct than attitude change. This study utilized an expert panel of 16 sexologists to review the definition of sexological worldview and establish its validity. Then, based on literature about affective training programs in multiculturalism and diversity that has taken place in fields of social work, education, medicine, and psychology, the author sought to find whether the established Developmental Model of Intercultural Sensitivity (DMIS) adequately defined the stages of sexological worldview development. Through interviews with a sample of 30 sexologists, the author established validity for the new construct and presents and adapted model that explains sexological worldview development, the Developmental Model of Intercultural Sensitivity – Sexological Use (DMIS-S). The work concludes with a discussion of the theoretical and practical implications of the new construct and the DMIS-S and presents models to explain the forces that motivate sexological worldview development and the stages of the DMIS-S with specific sexological applications.

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Mary Ann Sewell, PhD
Ameliorating fat stigma: Resilience as a correlate to self-esteem, body image, and sexual quality of life for internet-savvy Big Beautiful Women

Fat stigma is one of the last recognized acceptable forms of discrimination in this nation where 66% of the population is overweight or obese. Fat people are stereotyped as lazy, gluttonous and responsible for their condition which has been medicalized by the term 'obesity'. Fat women more than fat men are negatively judged in our thin-obsessed society. Women are unfairly discriminated against by parents, peers, educators, employers and health providers. Dating opportunities through traditional means can be limited by culturally-skewed notions of female attractiveness.

The internet however, has evolved as one method to circumvent conventional restrictions for marginalized fat women. On websites designed specifically to bring together fat women and the men who find their body type erotic, women call themselves Big Beautiful Women—BBW's.

This cross sectional, descriptive study focused on fat women who have learned to navigate the internet successfully to find offline sexual partners. The purpose of this investigation was to determine if resilience could be correlated with body image, self-esteem and quality of life, for these internet-savvy fat women.

Resilience was significantly correlated with body image, self-esteem and sexual quality of life for 149 survey respondents. Study results suggested the participants not only projected the image of big beautiful women but internalized this descriptor. These results are counter-intuitive, since fat stigma for women has been associated with poor body image, low self-esteem and a less than positive sexual quality of life in prior research literature. This study contributes to a more balanced perspective of the psychosocial profile of sexually active fat women.

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Raven James, PhD
Sexual self-esteem and women in substance abuse treatment

This study was designed to determine if the Sexual Self-Esteem Inventory for Women (SSEI) (Zeanah & Schwartz, 1996) was reliable for women in alcohol and other drug (AOD) treatment, and to explore the construct of sexual self-esteem of women in AOD treatment. The study examined the relationships between demographic, addiction, abuse, and treatment variables and sexual self-esteem in this population. Previous research that has been conducted on the sexuality needs and issues of women in treatment centers primarily on sexual and physical abuse, but relatively little research has been done that has been directed toward women’s subjective perceptions of sexuality in relation to the recovery process.

Demographical and abuse data was collected from 90 women and AOD treatment centers in New York State and the Sexual Self-Esteem Inventory for Women was administered. Correlation of scores from the SSEI-W and its subscales and the following abuse variables were conducted to test hypotheses related to abuse variables. Preliminary data analysis of the entire sample included validation of the SSEI-W through citation of previous factor analysis studies. Previous psychometric properties of the SSEI-W were presented, along construct validity procedures and subscale correlations. Cronbach’s alpha was calculated for the current study (.77 to .87 for subscales and .96 for the entire sample) and a correlation matrix produced moderate to high correlations for the sample.

Hypotheses testing utilizing non-parametric tests, showed significant differences between the mean scores of the physical abuse and physical/sexual abuse groups on the SSEI-W, Skill/Experience and Moral Judgement Subscales. Significant differences in mean scores between relationship variables were found on SSEI-W, Control, Moral Judgement and Adaptiveness scores. Significant differences were also found between bisexual and heterosexual women and the Moral Judgement Subscale.

This study provided strong evidence of the reliability of this measure in a female substance-abusing population and answered the proposed research questions and hypotheses. The study contributed to the knowledge of sexual self-esteem as it relates to an adult female population of women in AOD treatment. Methodological strengths and limitations of the study, educational and clinical implications and future directions of the research are discussed.

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Karen Scott, PhD
Identifying stressors and coping patterns during the donor insemination process with lesbian couples: Implications for health care providers

This dissertation used qualitative methods to explore the experience of lesbian couples during the donor insemination (DI) process, given three questions: a) What are the possible sources of stress impacting lesbian couples during the DI process; b) What types of coping patterns are being deployed that appear to assist lesbian couples in addressing and managing any stress during the DI process?; and, c)What are the possible implications for medical professionals who treat lesbian couples during the DI process? An interview guide was used with eight lesbian couples interviewed in their homes. Two couples were in a Research/Planning DI phase (I), one couple was in the Attempting Conception via DI Phase (II), two couples were in a Pregnant from DI phase (III), and three couples were in a Birth(s) from DI Phase (IV).

Results showed that most couples preferred an anonymous donor, enjoyed services offered by cryobanks, experienced the excitement of planning a pregnancy, and persevered again and again through the highly stressful two-week wait period to see results of attempted insemination. All couples reported some form of stress during the DI process. Somewhat surprising was how most couples reported a positive experience with the doctor(s)/medical staff, even as some encountered heterosexism/homophobia. Medication use was associated with side-effects (e.g. physical, mood swings, etc…) and financial strain. Women reported worries about health and the emotional roller coaster with mixed emotions, as well as coping strategies (e.g. relaxing, spiritual faith/prayer, journaling, humor, exercise, etc…) – suggesting what is common to lesbians and heterosexuals. Distinct lesbian stress also emerged (e.g. encountering heterosexism/homophobia, actual or anticipated heterosexism/homophobia, and insufficient social support because of selective sharing with the non-homophobic). Distinctly lesbian coping patterns involved coping well with heterosexism/homophobia (e.g. using laughter, taking social action for social change), avoiding homophobia (e.g. attending a clinic recommended to couple as lesbians), and a cautious coping pattern with selective sharing (i.e. with the non-homophobic).

Recommendations to lesbians pursuing DI included: communicating with lesbians who have already been through the process, attending a clinic recommended to a couple as lesbians, learning coping skills/techniques by networking with other lesbian couples; and passing on what you have learned to other couples. Recommendations to medical professionals included: creating appropriate medical intake forms to account for patient diversity; gaining knowledge about lesbian culture, couples, and families; acquiring culturally appropriate attitudes about lesbian couples; and, learning culturally appropriate behavior for delivering treatment services to lesbian couples.

Study limitations and recommendations for future research were discussed. The study offers insights into how medical professionals can improve service delivery, and how lesbian couples can empower themselves.

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Keith Cetera, PhD
Heterosexual male and female attitudes towards their partner's masturbatory behavior and its relationship to sexual satisfaction

Whether performed alone or with a partner, masturbation is a form of sexual behavior that enables individuals to learn about themselves on their own or with their partner, and thereby can provide a positive, healthy, sexual experience. Since masturbation may be seen by some couples as a solitary activity that might threaten their sexual relationship, others may see masturbation as an enhancement to their sexual relationship. In an effort to better understand how the attitudes toward a partner’s masturbatory behavior correlate to sexual satisfaction, this exploratory study reported on 26 heterosexual couples who completed an Attitudes Toward Your Current Partner’s Masturbatory Behavior Survey and a Sexual Satisfaction Scale to determine any relationship. Data was analyzed using Pearson’s correlation to show any relationship between attitudes toward a partner’s masturbatory behavior and the level of sexual satisfaction. However, additional significant findings reported that further investigation into this area of human sexuality is needed in order to better understand how therapists may want to discuss masturbation with their clients and assess a client’s attitude toward their partner’s masturbatory behavior.

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Andrea Taylor Frostino, PhD
Guilt and jealousy associated with sexual fantasies among heterosexual married individuals

Sexual fantasies are private thoughts that are unrestricted by social constraints; therefore, an individual’s true desires, regardless of whether they are embarrassing, illegal, unrealistic, or considered unethical by others, are played out in one’s mind. Sexual fantasies are likely to be the most common form of sexual expression in existence. Considering these unique dynamics, research on sexual fantasies may be more indicative of human sexuality than the study of individuals’ actual sexual behaviors.

This research study assessed the degree of guilt and jealousy associated with sexual fantasies among heterosexual married individuals. In addition to guilt and jealousy, the following factors were included in the study: age, gender, length of relationship, length of marriage, religious affiliation, political affiliation, education attainment, and spouse’s level of education attainment.

A thorough review of literature on guilt and jealousy associated with sexual fantasies failed to produce a survey instrument appropriate for this particular study; therefore, the researcher developed a survey instrument specific to this research topic. The survey tool consisted of 126 anonymous questions designed to assess individual’s guilt and jealousy associated with sexual fantasies.

The target population for this study included all adult males and females who were involved in a legally recognized heterosexual marriage at the time of survey data collection. Participants were recruited through a variety of resources including networking through friends, acquaintances, business associates, social groups, religious organizations, and a medical healthcare facility. A total of 323 participants were included in the final data set.

The degree of guilt and jealousy associated with sexual fantasies among heterosexual married individuals was impacted by several variables that were examined in this study. An individual’s age, gender, length of relationship, length of marriage, political affiliation, and religious affiliation impacted participant’s degree of guilt and jealousy. Participant’s education attainment and their spouse’s education attainment were the only variables that did not significantly influence their levels of guilt and jealousy.

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David M. Hall, PhD
The politics of same-sex marriage in the 2004 presidential election

George W. Bush and the Republican Party emphasized their opposition to save-sex marriage during the 2004 election, but they have since demonstrated that their legislative priorities are fiscal issues rather than the socially conservative priorities expressed on the campaign trail. This historical dissertation will analyze marriage equality, political rhetoric surrounding marriage equality, polling data from the 2004 campaign, voter mobilization efforts, and the legislative priorities of George W. Bush and the Republican Party. These sources will examine if the Republican Party used rhetoric around social issues to mobilize socially conservative working class voters with the intent of delivering legislative priorities favored by the corporate Republican constituency.

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Susan Milstein, PhD
The effects of a human sexuality course on students' confidence to engage in healthy sexual practices

This study examined the effects of a human sexuality course on students’ reported confidence to engage in healthy sexual behaviors, as measured by the Sexual Health Practices Survey. The study consisted of an educational intervention group and a comparison group. The intervention group received a sexuality curricula based on the Heath Belief Model’s components of a perceived threat, outcome expectancies, and self-efficacy. The comparison group received sexuality information that was designed only to increase one’s knowledge level.

At the time of the posttest, students in the intervention group reported statistically significant higher levels of confidence to engage in only two behaviors when compared to the intervention group. These results should be viewed with caution as the small population may have affected the survey’s ability to detect changes.

For many of the questions from the section of the survey which explored students’ confidence in specific sexual health practices, the means for the students in the human sexuality course fluctuated among the three administrations of the survey. This may be indicative of the effect that the course had on addressing students’ misinformation of perception of their abilities.

The results indicated that students in the human sexuality course were more likely to engage in healthy sexual behaviors, by having sex with fewer partners, or choosing to remain abstinent. Students’ papers indicated that the course did have an effect on their sexuality related behaviors, their behavioral intent, and a change in their beliefs and attitudes towards gays and lesbians.

The results also indicate a correlation between using a condom and the confidence to engage in many other sexual health practices. This may be an indicator that it is possible to effect confidence levels towards behaviors without having activities designed to specifically address them.

This study demonstrates that sexuality education, whether it is information only or information in addition to activities addressing self-efficacy and outcomes expectations, can help to improve students’ confidence to engage in specific behaviors.

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Joseph Nines, PhD
Sexuality attitudes and the priesthood

The recent discovery of widespread sexual misconduct by priests in the Roman Catholic Church in America has not only changed how the Church is responding to priestly sexual abuse, but has also resulted in an increased interest into the cause of such unacceptable behaviors and has brought the topic of priestly sexuality and sexual development to the fore. As a result there has been much written within the last few years dealing with questions about the formation of and support structures for active Roman Catholic priests and seminarians. However, these articles, studies and commentaries have focused primarily on the acts of abuse and the psychological and legal ramifications for the perpetrators and the victims. Some have suggested that celibacy and the priestly life provide sexually under-developed men with a place of refuge from their sexuality. Even worst, some have proposed that the priesthood is a breeding ground for sexual repression and that this is to blame for the acts of abuse of minors. One area that has yet to be investigated is the attitudes of Roman Catholic priests towards sexuality itself. This study assesses the attitudes towards sexuality of a sample of active and resigned Roman Catholic priests in the United States as regards contraception, abortion, homosexuality, masturbation and sex outside of marriage. The differences and similarities among these attitudes are compared and discussed. The attitudes that one has towards sexuality shape the belief system and behaviors of the individual. Assessing these attitudes and comparing them among priests both active and resigned is one way of understanding how the Church can respond to accusations that the priesthood provides an unhealthy atmosphere for sexually repressed men. It can also serve as an impetus for a more proactive role in recognizing potential sexual problems in the priesthood and assist in planning and implementing curricula for the formation of seminarians.

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Mary Rita Smith, PhD
Providing relationship building blocks for adults with intellectual disability

Adults with intellectual disability (ID) have often been ignored when it comes to addressing their needs for relationships overall. Many including parents, siblings, teachers, counselors, caregivers, and medical professionals challenge the idea of individuals with ID wanting to have intimate sexual relationships. This exploratory study addresses the needs for individuals to be given tools in order to have a better understanding about relationships overall, including those that may lead to intimate sexual encounters.

This project examines how eighteen adults with an intellectual disability can increase their knowledge about relationships by utilizing an assessment tool and having some of the individuals attend a human sexuality course. The course consisted of a ten-week training program that taught different components of human sexuality. There were ten participants who attended the classes. The other eight individuals agreed to be in the study and some requested inclusion into another class at a later date.

Prior to the commencement of the classes, all eighteen individuals were assessed using the Socio-Sexual Knowledge and Attitudes Assessment Tool – Revised (SSKAAT-R) developed by Griffiths & Lunsky (2003). Upon class completion, all eighteen original individuals were again assessed using the SSKAAT-R. The overall goal of the study is to determine if individuals who participate in a ten-week sexuality education class enhance their knowledge about human sexuality.

An interesting finding was that both of the groups, those that attended the classes and those that did not, increased their overall posttest scores on the SSKAAT-R. Another surprising result was that females from both groups had significant statistically increases in the post assessment scores. In addition to looking at how class attendance may influence individuals’ ability to acquire knowledge about issues related to sexuality, the study further explores how males and females may differ in their ability to learn materials related to human sexuality overall.

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Carey L. Bayer, EdD
Nurses' perceptions regarding addressing sexuality with patients in a pediatric intensive care unit

Sexuality, an integral part of every human being’s identity, including children, is infrequently addressed in the pediatric critical care setting. Literature on the topic of nurses’ perceptions of the sexuality of children is scant. Furthermore, literature on addressing the sexuality of patients in a pediatric intensive care unit (PICU) is nonexistent. Patients in a PICU are at different stages of sexual development during their hospital stay. They are at risk for sexual development regression and altered body image due to the nature of the invasive lifesaving devices placed in an on their bodies in the PICU. It is imperative to explore the nurses’ perceptions of talking about sexuality with their patients in order to understand why sexuality is infrequently addressed and how to help nurses learn to address sexuality with their critical patients.

This study explored the following: (1) Nurses’ perceptions of the sexuality of patients in the PICU; (2) Why sexuality is addressed infrequently in a PICU setting; and (3) Nurses’ perceptions of sexual identity development throughout the lifespan.

Interviews occurred with 21 pediatric critical care nurses who practice in a large, urban PICU in Philadelphia. Rich text gleaned from the interviews revealed 22 concepts from which three models were built: the Limited Model, Broad Model, and Overlapping Model. In one sentence, Nurse B expressed the essence of most of the interviews, “I think it’s [sexuality] a silent topic.” This sexual silence was reflected in 38% of nurses fitting in the Limited Model and 43% in the Overlapping Model. Only 19% of the nurses interviewed fit in the Broad Model.

The emerging theory is: Experiences in sexuality education, both formal and informal, combined with self-comfort, empathy, and use of broad sexuality definitions positively influences nursing practice for addressing sexuality in the PICU setting. The combination of these areas ensures that sexual issues are no longer silenced for patients. This theory arose from open, axial, and selective coding; body language observations; memoing; diagramming; and model building. Any nurse can recite a definition, but the nurse who puts the definition to use truly bridges the gap between cognition and practice.

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Consuelo Bonillas, PhD
Reproductive tract infection (RIT) maternal diagnosis

It has been well documented that intrauterine and perinatally transmitted reproductive tract infections (RTIs) can have severely debilitating and even fatal effects on a fetus or newborn (Cates, 2004; CDC, 2002b; Goldenberg, Andrews, Yuan, & Mackay, 1997; Watts & Brunhara, 1999). The purpose of this exploratory study was to investigate pregnant women’s perception of risk and the meanings they attach to their experiences in being diagnosed with an RTI during pregnancy. This study was conducted in order to identify and understand the influences and processes through which these women became pregnant and were infected with an RTI.

Six women diagnosed with an RTI during their pregnancy were interviewed using a semistructured format. Six guiding research questions helped structure the inquiry. The women were recruited from two urban prenatal clinics in Northern New Jersey. QSR NUD*IST 4 was utilized for this investigation in finding five critical themes that emerged from the data. These themes were (1) low perception of pregnancy risk; (2) low perception of RTI risk; (3) lack of RTI/sexuality education; (4) difficulties in partnered relationships; and (5) inadequate support systems. A core theme throughout the data was normative hardships. This core variable seemed to overshadow the women’s thought process in decision-making regarding protective behavior to reduce the chances of becoming infected with an RTI and in preventing and unplanned pregnancy. Triangulation was used by having four readers analyze the data, by conducting follow-up interviews to obtain confirmation of the emergent themes after six women were initially interviewed, and by collecting the data over time.

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Sandra Greenberg, PhD
Low sexual desire in heterosexual committed couples: An education intervention

Clinicians who treat problems of low sexual desire in heterosexual committed couples continue to find this problem both complex and difficult to resolve. Cultural pressures, a ubiquitous media, and medical models of diagnosis and treatment often reinforce notions of sexual pleasure and sexual desire that are inadequate and misinformed. This study is a preliminary investigation that explores the viability of an education intervention aimed at helping couples learn how to improve sexual communication and nurture sexual desire rather than overcoming pathology.

Designed as a one-day workshop, this intervention was developed using social learning, behavior, and adult learning theories. An integrated model of erotic functioning based on the theoretical frameworks of Stayton’s Model of Pan-Erotic Stimulus Pathway (ESP) served as a centerpiece of the learning. In addition, effective communication skills were practiced.

A quantitative-qualitative design was employed to assess the effect of the model on sexual communication and low sexual desire. Due to the small sample size, no statistically significant relationship was found between increased desire and improved communication for the participants as a result of the workshop as reported on Hurlbert’s Index of Sexual Desire and the Dyadic Sexual Communication Scale. However, through qualitative data provided by the participants as well as the researcher’s role as observer, differences were found in sexual communication and sexual desire as a result of the workshop. The understanding and skills developed through learning about Pan-Erotic Potential, the Erotic Stimulus Pathway, and sexual communication resulted in participants reporting increased awareness and sensitivity to these issues with their partners. Follow-up assessment revealed most participants having made some changes in their lives, including making more time to be with their partners, experimenting with specific phases of the ESP, and slowing things down.

Thus, this exploratory study indicates that sexuality education has the potential to play a significant role in helping couples invigorate their sexual relationship and increase pleasure to affect future desire. As a non-medical intervention, an education approach can provide couples with an alternative or adjunct to augment psychotherapy for problems of low sexual desire.

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Marcia A. Matthews, PhD
Lesbians who engage in public bondage, discipline, dominance, submission and sadomasochism (BDSM)

This phenomenological study looked at the previous research and therapy on bondage, discipline, dominance, submission, and sadomasochism (BDSM) sex play from psychodynamic, behavioral, and sociological perspectives. This collective body of research generally focused on gay and straight men and lacked an investigation of BDSM from the individuals’ subjective experiences. More specifically, research was lacking on lesbians who engage in public BDSM sex play. Thus, the purpose of this study was to examine the subjective experiences of lesbians who engage in public BDSM in order to advance current knowledge of the lesbian BDSM scene. Using a phenomenological approach, sex face-to-face in-depth interviews were conducted. In these interviews, the participants were asked to describe: how they had gotten into public BDSM sex play, what the experience was like for them, and what effects participating in the scene had on their lives. The data were analyzed using the process recommended by Moustakas (1994).

All of the women expressed having some interest in exploring BDSM, some since childhood or for many years before actually getting involved in the scene. Some of them had initial misgivings about their interest in BDSM, but when the opportunity presented itself, they took it. As “newbies”, the women were socialized into the scene. All of the women experienced feelings of nervousness or anticipation prior to scene play and most of the women engaged in negotiation. During scene play, tops reported being hyperaware of everything going on, getting into performing and being exhibitionists. Bottoms reported feeling “in the zone” in which they were allowed to selfishly concentrate on the sensations of their bodies while being “safe” and cared for. Both tops and bottoms experienced and exchange of energy/power. After scene play and during aftercare, participants reported catharsis and healing, feeling cherished, protected and sexually satisfied. The major theme that pervaded throughout the stages of scene play was one of connection with one’s partner and the overall community. A sense of fun and sexual satisfaction was also pervasive.

Three major themes emerged from the effects that BDSM sex play has on the women’s overall lives. The women gained a sense of empowerment and skills that improved their overall relationships. While these themes were overwhelmingly positive, a minor concern about others’ misunderstanding of BDSM also emerged.

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