An Indirect Measure of Implicit Sexual Assertiveness: Reliability and Validity of the Sexual Assertiveness IAT in Young Adults in The Netherlands

In the present study we investigated the reliability and validity of an Implicit Association Test of sexual assertiveness (the SA-IAT) in a sample of young adults (n = 159). The D600 algorithm was used to calculate implicit sexual assertiveness scores. Explicit sexual assertiveness was measured using a selection of items from the Hurlbert Index of Sexual Assertiveness. Personality traits were assessed using the revised, short version of the Eysenck Personality Questionnaire. The internal consistency of the SA-IAT was evaluated based on split-half reliability, and found acceptable with α = 0.61 for the practice trials, and α = 0.70 for the test trials, after correction for attenuation. Convergent and divergent validity were evaluated using correlation analysis. Correlation with explicit sexual assertiveness was found to be low, as expected. Divergent validity of the SA-IAT was evaluated against the personality traits of extraversion, neuroticism, and social desirability. Except for a significant correlation of implicit sexual assertiveness with extraversion in the full sample and the female subsample, implicit sexual assertiveness and personality traits were not found to share variance, as expected.

Horse owners' attitudes towards and motivators for using complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) is becoming increasingly popular in horses.

METHODS

Online, cross-sectional survey in 1532 horse owners. Attitude towards CAVM, subjective norms, perceived behavioural control and intention for future CAVM use were measured based on the theory of planned behaviour. Structural equation modelling was performed to characterize factors influencing intention to use CAVM.

RESULTS

Past use of CAVM, predominantly manual therapies and herbal supplements, was reported by 72.5% of all participants. Frequently reported indications were improving horse's well-being, illness which did not resolve after conventional treatment and chronic illness. The attitude towards CAVM was positive with a median (interquartile range) score of 6 of 7 (4.75-7.00). Predictors for past CAVM use were higher owner age, alternative medicine self-use and higher education (non-university). The strongest predictor of future CAVM usage was perceived behavioural control and perceived CAVM efficacy, as well as positive attitude towards and perceived knowledge about CAVM. The veterinarian was reported as a source of information about CAVM by 86.4% of all participants.

CONCLUSIONS

Horse owners showed a high intention to use CAVM with the owners' perceived behavioural control and perceived CAVM efficacy as the strongest predictor. Veterinarian-client communication is important to inform horse owners correctly.

Dutch Adolescents' Motives, Perceptions, and Reflections Toward Sex-Related Internet Use: Results of a Web-Based Focus-Group Study

The Internet offers adolescents unique opportunities to actively shape their own sexual media environment. The aim of this study was to gain in-depth insight into Dutch adolescents' motives, perceptions, and reflections toward Internet use for (a) finding information or advice related to romance and sexuality; (b) searching for and viewing pornographic or erotic material; and (c) romantic and sexual communication (i.e., cybersex/sexting). Data were collected through 12 Web-based focus groups (36 adolescents aged 16 to 19 years, 72.2% girls) and analyzed through three stages of open, axial, and selective coding. The themes that emerged from the focus-group discussions suggest that sex-related Internet use is a complex and ambivalent experience for adolescents. Sex-related Internet use seems an increasingly normalized and common phenomenon. Participants perceived the Internet as a useful source of sexual information, stimulation, inspiration, and communication. Yet they discussed a range of negative consequences and risks related to sex-related online behaviors, particularly concerning pornography's potential to create unrealistic expectations about sex and sexual attractiveness. Participants generally believed they had the necessary skills to navigate through the online sexual landscape in a responsible way, although they believed other young people could be influenced inadvertently and adversely by sex-related online content.

Sex Work Criminalization Is Barking Up the Wrong Tree

There is a notable shift toward more repression and criminalization in sex work policies, in Europe and elsewhere. So-called neo-abolitionism reduces sex work to trafficking, with increased policing and persecution as a result. Punitive "demand reduction" strategies are progressively more popular. These developments call for a review of what we know about the effects of punishing and repressive regimes vis-à-vis sex work. From the evidence presented, sex work repression and criminalization are branded as "waterbed politics" that push and shove sex workers around with an overload of controls and regulations that in the end only make things worse. It is illustrated how criminalization and repression make it less likely that commercial sex is worker-controlled, non-abusive, and non-exploitative. Criminalization is seriously at odds with human rights and public health principles. It is concluded that sex work criminalization is barking up the wrong tree because it is fighting sex instead of crime and it is not offering any solution for the structural conditions that sex work (its ugly sides included) is rooted in. Sex work repression travels a dead-end street and holds no promises whatsoever for a better future. To fight poverty and gendered inequalities, the criminal justice system simply is not the right instrument. The reasons for the persistent stigma on sex work as well as for its present revival are considered.

Sex Work Criminalization Is Barking Up the Wrong Tree

There is a notable shift toward more repression and criminalization in sex work policies, in Europe and elsewhere. So-called neo-abolitionism reduces sex work to trafficking, with increased policing and persecution as a result. Punitive "demand reduction" strategies are progressively more popular. These developments call for a review of what we know about the effects of punishing and repressive regimes vis-à-vis sex work. From the evidence presented, sex work repression and criminalization are branded as "waterbed politics" that push and shove sex workers around with an overload of controls and regulations that in the end only make things worse. It is illustrated how criminalization and repression make it less likely that commercial sex is worker-controlled, non-abusive, and non-exploitative. Criminalization is seriously at odds with human rights and public health principles. It is concluded that sex work criminalization is barking up the wrong tree because it is fighting sex instead of crime and it is not offering any solution for the structural conditions that sex work (its ugly sides included) is rooted in. Sex work repression travels a dead-end street and holds no promises whatsoever for a better future. To fight poverty and gendered inequalities, the criminal justice system simply is not the right instrument. The reasons for the persistent stigma on sex work as well as for its present revival are considered.

A Scale for the Assessment of Sexual Standards Among Youth: Psychometric Properties

The (hetero)sexual double standard (SDS), prescribing sexual modesty for girls and sexual prowess for boys, negatively affects sexual and mental health. Nevertheless, endorsement and enactment of the SDS is still common. In this study, we respond to recent calls for modernization in the field of sexual double standard research. We describe the development of the "Scale for the Assessment of Sexual Standards among Youth" (SASSY), as well as its psychometric properties. This instrument was designed to measure contemporary sexual double standard endorsement, defined as "the degree to which an individual's attitude reflects a divergent set of expectations for boys and girls, in that boys are expected to be relatively more sexually active, assertive, and knowledgeable and girls are expected to be relatively more sexually reserved, passive, and inexperienced" among adolescents and emerging adults. In Study 1, a pool of 35 items was administered in a Dutch sample (N = 465, 54.8% female, age 16-20). A 20-item set formed a one-dimensional and internally consistent scale and was subsequently administered in a second Dutch sample. Study 2 (N = 818, 58.4% female, age 16-25) again assessed the 20-item set. After dropping one item, the 19-item SASSY proved to be one-dimensional and internally consistent, exhibiting good test-retest reliability, construct validity, and convergent validity. Finally, the instrument showed configural and metric measurement invariance across gender, age, education level, and sexual experience level, and configural, metric, and scalar measurement invariance across time. These studies confirmed the 19-item SASSY to be a reliable and valid new tool for the assessment of contemporary sexual double standard endorsement among adolescents and emerging adults.

The Impact of Personal Gender-Typicality and Partner Gender-Traditionality on Taking Sexual Initiative: Investigating a Social Tuning Hypothesis

Sexual assertiveness is an issue of interest in the context of gender equality and sexual health. This study investigated the social tuning hypothesis that encountering a gender-traditional partner would lead to stronger gender-typical behavior, i.e., respectively, higher and lower levels of taking sexual initiative among men and women. Participants (N = 271) read a vignette describing a romantic partner, who was either presented as gender-traditional or not, followed by a sexual scenario. Subsequently, participants were asked about their expectations toward their own sexual initiative taking. Results showed a significant 'target gender-traditionality × participant gender × participant gender-typicality (masculinity/femininity)' interaction meaning that less gender-typical men were more likely to initiate sexual contact in the experimental, compared to the control condition. Men low in masculine characteristics showed higher initiative taking in response to a gender-traditional target female. We conclude that less gender-typical men seem to employ more social tuning toward their sexual partner, whereas more gender-typical men seem to adhere to their gender-typical behavior regardless of perceived partner characteristics. These results were not seen among the women in the sample. These findings are a starting point for the further development of experimental investigations regarding the gendered nature of both sexual initiative taking and sexual assertiveness in general.

Patterns and Universals of Adult Romantic Attachment Across 62 Cultural Regions

As part of the International Sexuality Description Project, a total of 17,804 participants from 62 cultural regions completedthe RelationshipQuestionnaire(RQ), a self-reportmeasure of adult romanticattachment. Correlational analyses within each culture suggested that the Model of Self and the Model of Other scales of the RQ were psychometrically valid within most cultures. Contrary to expectations, the Model of Self and Model of Other dimensions of the RQ did not underlie the four-category model of attachment in the same way across all cultures. Analyses of specific attachment styles revealed that secure romantic attachment was normative in 79% of cultures and that preoccupied romantic attachment was particularly prevalent in East Asian cultures. Finally, the romantic attachment profiles of individual nations were correlated with sociocultural indicators in ways that supported evolutionary theories of romantic attachment and basic human mating strategies.

Reorienting adolescent sexual and reproductive health research: reflections from an international conference

On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference--(1) ASRH promotion is broadening on different levels and (2) this broadening has important implications for research and interventions--that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g., condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.

Psychosexual Correlates of Sexual Double Standard Endorsement in Adolescent Sexuality

Endorsement and enactment of the (hetero)sexual double standard (SDS), prescribing sexual modesty for girls and sexual prowess for boys, has been shown to be negatively related to sexual and mental health. To be able to challenge the SDS, more insight is needed into the conditions that shape gendered sexual attitudes. A survey was conducted among 465 heterosexual adolescents (aged 16-20 years), examining the relationship between a number of relevant demographic and psychosexual variables and SDS endorsement. SDS endorsement was assessed using a newly developed instrument, the Scale for the Assessment of Sexual Standards Among Youth (SASSY). Gender (being male) and religiousness were significantly associated with increased SDS endorsement. For both boys and girls, increased feelings of entitlement to self-induced sexual pleasure (e.g., masturbation) were significantly associated with reduced SDS endorsement, whereas higher gender investment was significantly associated with increased SDS endorsement. Furthermore, increased feelings of entitlement to partner-induced sexual pleasure and more frequent talking about sexuality with peers were associated with increased SDS endorsement among boys but not among girls. We conclude that future research should explore peer influence processes through peer communication about sex, gender investment, and feelings of entitlement to both self and partner-induced sexual pleasure.

Lower Psychological Well-Being and Excessive Sexual Interest Predict Symptoms of Compulsive Use of Sexually Explicit Internet Material Among Adolescent Boys

Although a growing body of literature addresses the effects of young people's use of sexually explicit Internet material, research on the compulsive use of this type of online content among adolescents and its associated factors is largely lacking. This study investigated whether factors from three distinct psychosocial domains (i.e., psychological well-being, sexual interests/behaviors, and impulsive-psychopathic personality) predicted symptoms of compulsive use of sexually explicit Internet material among adolescent boys. Links between psychosocial factors and boys' compulsive use symptoms were analyzed both cross-sectionally and longitudinally with compulsive use symptoms measured 6 months later (T2). Data were used from 331 Dutch boys (M age = 15.16 years, range 11-17) who indicated that they used sexually explicit Internet material. The results from negative binomial regression analyses indicated that lower levels of global self-esteem and higher levels of excessive sexual interest concurrently predicted boys' symptoms of compulsive use of sexually explicit Internet material. Longitudinally, higher levels of depressive feelings and, again, excessive sexual interest predicted relative increases in compulsive use symptoms 6 months later. Impulsive and psychopathic personality traits were not uniquely related to boys' symptoms of compulsive use of sexually explicit Internet material. Our findings, while preliminary, suggest that both psychological well-being factors and sexual interests/behaviors are involved in the development of compulsive use of sexually explicit Internet material among adolescent boys. Such knowledge is important for prevention and intervention efforts that target the needs of specific problematic users of sexually explicit Internet material.

Prevalence and correlates of young people's sexual aggression perpetration and victimisation in 10 European countries: a multi-level analysis

Data are presented on young people's sexual victimisation and perpetration from 10 European countries (Austria, Belgium, Cyprus, Greece, Lithuania, the Netherlands, Poland, Portugal, Slovakia and Spain) using a shared measurement tool (N = 3480 participants, aged between 18 and 27 years). Between 19.7 and 52.2% of female and between 10.1 and 55.8% of male respondents reported having experienced at least one incident of sexual victimisation since the age of consent. In two countries, victimisation rates were significantly higher for men than for women. Between 5.5 and 48.7% of male and 2.6 and 14.8% of female participants reported having engaged in a least one act of sexual aggression perpetration, with higher rates for men than for women in all countries. Victimisation rates correlated negatively with sexual assertiveness and positively with alcohol use in sexual encounters. Perpetration rates correlated positively with attitudes condoning physical dating violence and with alcohol use in men, and negatively with sexual assertiveness in women. At the country level, lower gender equality in economic power and in the work domain was related to higher male perpetration rates. Lower gender equality in political power and higher sexual assertiveness in women relative to men were linked to higher male victimisation rates.

Prevalence and correlates of young people's sexual aggression perpetration and victimisation in 10 European countries: a multi-level analysis

Data are presented on young people's sexual victimisation and perpetration from 10 European countries (Austria, Belgium, Cyprus, Greece, Lithuania, the Netherlands, Poland, Portugal, Slovakia and Spain) using a shared measurement tool (N = 3480 participants, aged between 18 and 27 years). Between 19.7 and 52.2% of female and between 10.1 and 55.8% of male respondents reported having experienced at least one incident of sexual victimisation since the age of consent. In two countries, victimisation rates were significantly higher for men than for women. Between 5.5 and 48.7% of male and 2.6 and 14.8% of female participants reported having engaged in a least one act of sexual aggression perpetration, with higher rates for men than for women in all countries. Victimisation rates correlated negatively with sexual assertiveness and positively with alcohol use in sexual encounters. Perpetration rates correlated positively with attitudes condoning physical dating violence and with alcohol use in men, and negatively with sexual assertiveness in women. At the country level, lower gender equality in economic power and in the work domain was related to higher male perpetration rates. Lower gender equality in political power and higher sexual assertiveness in women relative to men were linked to higher male victimisation rates.

Educational Differences in Adolescents' Sexual Health: A Pervasive Phenomenon in a National Dutch Sample

Educational level is strongly associated with age of first intercourse and risk of unintended pregnancies. This study examined these associations in a large representative sample of Dutch adolescents and also included associations of educational level with other sexual health aspects. Adolescents aged 12 to 25 (3,926 boys and 3,915 girls) completed an online questionnaire that included measures of romantic and sexual experience; the evaluation of their sexual debut; the risk of sexually transmitted infections (STIs) and pregnancy; and sexual attitudes, satisfaction, self-efficacy, knowledge, victimization, and functioning. The results showed that adolescents on a vocational track or who completed fewer years of education were more at risk of several adverse sexual health outcomes than adolescents on an academic track. They had their first sexual experiences at an earlier age; evaluated these experiences less favorably; had less sexual health knowledge and fewer refusal skills; and had a higher risk of unintended pregnancy, STIs, and victimization. Possible explanations for these consistent differences are discussed. Sex education and services should pay specific and targeted attention to less educated young people and tailor their efforts specifically to the needs, characteristics, and realities of this group.

Sex-related online behaviors and adolescents' body and sexual self-perceptions

BACKGROUND AND OBJECTIVE

This study investigated: (1) the prevalence and development of 2 receptive (sexually explicit Internet material [SEIM] use and sexual information seeking) and 2 interactive (cybersex and general social networking site [SNS] use) online behaviors in adolescence; (2) whether development of these behaviors predict adolescents' body and sexual self-perceptions; and (3) whether parental strategies regarding adolescents' Internet use reduce engagement in sex-related online behaviors.

METHODS

Four-wave longitudinal data among 1132 seventh- to 10th-grade Dutch adolescents (mean age at wave 1: 13.95 years; 52.7% boys) were collected. Developmental trajectories of sex-related online behaviors were estimated by using latent growth curve modeling. Self-perception outcomes at wave 4 and parental strategies predicting online behaviors were investigated by adding regression paths to growth models.

RESULTS

Boys occasionally and increasingly used SEIM. Patterns for girls' SEIM use and boys' and girls' sexual information seeking and cybersex were consistently low. SNS use, however, was a common, daily activity for both. Higher initial levels and/or faster increases in sex-related online behaviors generally predicted less physical self-esteem (girls' SNS use only), more body surveillance, and less satisfaction with sexual experience. Private Internet access and less parental rule setting regarding Internet use predicted greater engagement in sex-related online behaviors.

CONCLUSIONS

Although most sex-related online behaviors are not widespread among youth, adolescents who engage in such behaviors are at increased risk for developing negative body and sexual self-perceptions. Particular attention should be paid to adolescents' SNS use because this behavior is most popular and may, through its interactive characteristics, elicit more critical self-evaluations. Prevention efforts should focus on parents' role in reducing risky sex-related online behaviors.

Young adolescents' sexual and romantic reference displays on Facebook

PURPOSE

Social networking sites (SNSs) form increasingly popular venues for adolescents to express their developing identity, including their sexual self. This study investigated how and to what extent early and middle adolescents display sexuality and romance on SNSs and the demographic and psychosexual factors associated with their displays.

METHODS

Dutch adolescents aged 11-18 years were recruited and Facebook friended. Participants' Facebook profiles were evaluated for sexual and romantic references and Facebook engagement. Participants completed a digital questionnaire measuring constructs related to romantic and sexual development. Analyses included chi-square and Student's t-tests.

RESULTS

A total of 104 adolescents (M(age) = 15.01, 68.3% female) were Facebook friended. Of 104 profiles, 25 (24.0%) contained 67 sexual references, and 27 (26.0%) contained 204 romantic references. Sexual references were mostly posted by others and referring to others or to no one in particular, whereas romantic references were predominantly posted by and referring to the profile owner. Displayers of sexual and romantic references were, compared with nondisplayers, older, more engaged in Facebook, more sexually experienced, and perceived more of their peers as approving of sex and as sexually active. In addition, sexual displayers were more likely boys and more sexually interested. There were no differences with respect to sexual intention and sexual attitudes.

CONCLUSIONS

A minority of young adolescents display sexual and romantic references on SNSs. References may reflect adolescents' offline sexual and romantic experiences. Yet, they may be powerful in creating behavioral norms; therefore, guidance on interpreting and displaying such messages should be promoted.

Associations between common mental disorders and sexual dissatisfaction in the general population

BACKGROUND

Little is known about the associations between common mental disorders and sexual dissatisfaction in the general population.

AIMS

To assess the associations between the presence of 12-month and remitted (lifetime minus 12-month) mood, anxiety and substance use disorders and sexual dissatisfaction in the general population of The Netherlands.

METHOD

A total of 6646 participants, aged 18-64, took part in a face-to-face survey using the Composite International Diagnostic Interview 3.0. Childhood trauma, somatic disorders and sexual dissatisfaction were also assessed in an additional questionnaire. Associations were assessed with multivariate regression analyses.

RESULTS

In total, 29% reported some sexual dissatisfaction. Controlling for demography, somatic disorders and childhood trauma, significant associations with 12-month mood disorder (B = 0.31), substance use disorder (B = 0.23) and anxiety disorder (B = 0.16) were found. Specifically, relatively strong associations were found for alcohol dependence (B = 0.54), bipolar disorder (B = 0.45) and drug dependence (B = 0.44). The association between remitted disorders and sexual dissatisfaction showed significance for the category substance use disorder.

CONCLUSIONS

People with mood, anxiety and substance use disorders show elevated scores on sexual dissatisfaction, even when relevant confounders are controlled for. Sexual satisfaction appears to be reduced most by alcohol and drug dependence and bipolar disorder. Once remitted, substance use disorder shows a persisting association with present sexual dissatisfaction.

Autism and normative sexual development: a narrative review

AIMS AND OBJECTIVES

To explore the existing knowledge on sexuality and autism spectrum disorders. To this end, the concept of normative sexual development was used as an organising framework.

BACKGROUND

Sexual health can be seen as a developmental task for all children, adolescents and adults. Core autism features are related with skills central to sexual development and functioning. More insight in sexual development in people with autism is relevant for education, support and interventions by parents and professionals in somatic and mental health care.

METHODS

A comprehensive search of scientific online databases and reference lists was conducted. Publications based on qualitative and quantitative research, including case studies, were selected.

RESULTS

Fifty-five articles and reports were selected and discussed. Information was grouped according to three domains: sexual behaviour, sexual selfhood and sexual socialisation.

CONCLUSION

Sexual development is a part of life for people with autism of all developmental levels and is generally understudied in this population. Most information was available on behavioural aspects and experiences of socialising agents, such as parents and professionals. Developmental processes and the relation between sexual behaviour, selfhood and socialisation remained unclear.

RELEVANCE TO CLINICAL PRACTICE

Nurses working in schools, institutions and general health care support children, adolescents and adults with autism and advice their families, teachers, other educators and caregivers on sexuality issues. They can have an important role in daily assessment and support of this developmental domain by actively enquiring about the different aspects of sexual development and by offering information. Our findings offer an overview on the existing knowledge and support the idea that sexual development is normative for people with autism just as for anybody else.

Prostitution push and pull: male and female perspectives

Smith, Grov, Seal, and McCall's (2012) analysis, focusing on how young men become, and stay, involved in male escorting, is a welcome contribution to the still relatively thin male sex worker literature. For this study group, notably supportive working surroundings, effective coping strategies, and a growing sense of "self-efficacy" eventually turn sex work into an increasingly comfortable experience and viable moneymaking option. In this commentary, I add some reflections from a broader perspective to these insights. I also consider some evidence on the numbers of men and women in sex work and make some observations on male versus female positions related to push and pull factors, stigma, and the experience of sex work.

Sexual health problems and associated help-seeking behavior of people with physical disabilities and chronic diseases

The aim of this study was to investigate help-seeking behavior in relation to sexual problems among people with a disease or an impairment, as well as determining factors that promote people to seek professional sexological help. A total of 341 respondents (224 men, 117 women) participated. Approximately 50% wanted professional help with finding a sexual partner and sexual adjustment problems. Further, approximately 40% wanted professional help for problems in their sexual relationship, practical sexual problems, and the inability to enjoy their sexuality. In total, two third considered contacting a health care professional of which 35% had indeed had contact with a health care professional. Only a third of those evaluated these contacts as positive. To identify factors associated with the respondent's participation in psychosexual therapy, we performed a logistic regression analyses with a participation in a psychosexual intervention as the dependent variable. Sexual dissatisfaction was the strongest predictor of participation in psychosexual therapy. Furthermore, people who indicated that they wanted professional help for their sexual problems and people who had already discussed sexuality issues with a health care professional were more likely to participate. Disease and demographic characteristics did not influence one's decision to participate.

Prevalence and characteristics of sexual violence in the Netherlands, the risk of revictimization and pregnancy: results from a national population survey

Prevalence figures on sexual violence among a representative sample of both men and women were not yet available for the Netherlands. The aim of this study, therefore, was to investigate the prevalence of sexual violence in the Netherlands and to add these figures to the international body of knowledge. Experiences of sexual violence during lifetime, before the age of 16 and in the year before the start of the study were measured. In addition, types of sexual violence were examined, as were the characteristics of the perpetrators. Lastly, revictimization and pregnancy as a result of rape experiences among the victims were investigated. Data were generated from a population survey on sexual health. The sample consisted of more than 6,000 men and women between the age of 15 and 70 years old. Prevalence rates as high as 21% for men and 56% for women were found. Fifty percent of the female victims and 30% of the male victims of child sexual abuse had experienced adult victimization. Of the female rape victims, 7% became pregnant as a consequence of rape. In the Netherlands, as elsewhere, the prevention of sexual violence should be prioritized.

Examining sexual health differences between lesbian, gay, bisexual, and heterosexual adults: the role of sociodemographics, sexual behavior characteristics, and minority stress

Many studies focus on the differences in mental health between lesbian, gay, bisexual (LGB), and heterosexual individuals. Less attention has been paid to the differences in various aspects of sexual health and the potential explanations for these differences. Data from a Dutch population study on sexual health (aged 19-70 years; N = 4,333) were used to examine the potential differences in sexual satisfaction, sexual victimization, sexual dysfunction, and sexual health care need. At the same time, this study examined whether the differences could be attributed to differences in general factors influencing sexual health (sociodemographic variables and sexual behavior characteristics) or to LGB-specific factors (minority stress). The results showed that bisexual women and bi- and homosexual men had more often experienced sexual coercion and reported a higher need for sexual health care than their heterosexual counterparts. Both general determinants (e.g., a higher number of sexual partners or being single) and LGB-specific factors (e.g., internalized homonegativity or negative social reactions related to sexual orientation) were associated with different aspects of sexual health. Interventions aimed at improving the sexual health of LGB individuals should focus on general risk factors, as well as on LGB-specific stressors. Methodological limitations of the study and implications for further research are discussed.

Parenting and Adolescents’ Sexual Development in Western Societies

This review examines associations between parenting styles and the psychosexual development of adolescents. Methods and results of empirical studies of associations between parental support, control, and knowledge and the sexual behavior and sexual health of adolescents are described and evaluated. The results show that, in general, higher scores on support, control, and knowledge relate to a delay of first sexual intercourse, safer sexual practices, and higher sexual competence. Despite the vast amount of literature on this subject, the majority of these studies focus on single dimensions of parenting and unidirectional parenting influences. This review generates hypotheses regarding interactions of different parenting styles and reciprocal associations between parents and their children. There is a need for more dynamic, dialectical studies of parenting, and children’s sexual development.

Doing gender in sex and sex research

Gender is central to sexuality, and vice versa, but there are a number of difficulties with the treatment of gender in sex research. Apparently, it is hard to find a balance between two conflicting needs. First, obviously, it is necessary to make distinctions between women and men, for political as well as research-technical and theoretical reasons. A second requirement, at odds with the first one, is the necessity to understand gender and its relation to sexuality and the body as much more complex than simplistically referring to two sets of individuals. This is all the more necessary when one realizes the possible drawbacks of exaggerating the differences between the sexes (in particular when they are biologically explained), because of stereotyping, stigmatizing, and expectancy confirmatory processes. This essay identifies and discusses 10 difficulties in the treatment of gender in sex research, reflects on their origins, and reviews theory and evidence with the aim to (1) consider the relative strength of gender/sex as an explanatory variable compared to other factors and processes explaining differences between men and women on a number of sexual aspects, (2) inform an understanding of gender and its relation to sexuality as an ongoing, open-ended, multi-determined, situated, interactional process, with the body as a third player, and (3) argue in favor of a nuanced, well-balanced treatment of gender in sex research.

The risks and rights of sexualization: an appreciative commentary on Lerum and Dworkin's "bad girls rule"

This commentary wholeheartedly supports the critical observations by Kari Lerum and Shari L. Dworkin in this issue of the Journal of Sex Research with regard to the 2007 Report of the APA (American Psychological Association) Task Force on the Sexualization of Girls. The APA task force makes an overwhelmingly strong point for the dangers of the sexualization of women and girls and the self-objectification connected to it. However, their discussion of the evidence is noteworthy for being one-sided, generalizing, and negatively toned. Among the arguments presented in this commentary are notions about the rather diverse and often ambiguous nature of sexualized imagery and about the all too often ignored complexity of its presumed "effects." In addition, the issue of female sexual power and the case of sex workers are discussed. When sexualization is defined as only negative, both sex worker's rights and, more generally, women's rights to be sexual, get into a tight corner. The main contention is that sexualization is associated with risks, as well as with rights, and that any productive analysis will have to consider both.

Influencing risk behavior of sexually transmitted infection clinic visitors: efficacy of a new methodology of motivational preventive counseling

A quasi-experimental study was conducted at a Dutch sexually transmitted infection (STI) clinic to compare the effects of educational counseling and motivational interviewing (MI)-based HIV/STI counseling on determinants of condom use and partner notification at 6-month follow-up. It also examined the feasibility of MI-based counseling in a busy real-life clinic. The counseling approaches were historically compared: respondents in the control condition were recruited between April and July 2005, those in the experimental condition between September and December 2005. The study involved 428 participants. These were all high-risk clients of the STI clinic. Their mean age was 33.7 years, and 39.6% were female. The study showed that MI-based counseling had a more positive effect on self-efficacy, intentions to use condoms with casual partners, and long-term condom use with steady partners. It had no adversarial outcomes on other social cognitions or behaviors compared to educational counseling. Furthermore, MI-based counseling is experienced as a more respectful and structured way of counseling. MI-based counseling was relatively easily implemented into the current clinic procedures. In addition to the implementation of the training, neither specialized staff nor additional or longer client visits were needed. However, some nurses indicated that the new method required more personal investment and effort. Limitations of the current study are the low response rates, the high educational level of most participants, and the small sample size regarding partner notification. Nonetheless, we conclude that MI-based counseling was a more effective approach to preventive counseling compared to educational counseling and feasible in the busy real-life setting.

Sexual trajectories during adolescence: relation to demographic characteristics and sexual risk

The "sexual trajectory" is an age-graded set of various new sexual experiences, defined by three key dimensions: sequence, duration, and timing. A comprehensive description of sexual trajectories creates the possibility to investigate potential risks of certain trajectory types. The present study attempted to answer three questions: (1) Is it possible to identify a typology in (the early stages of) sexual trajectories? (2) Is sexual trajectory type related to demographic characteristics, such as sex, ethnic background, and educational level? (3) What are the associations between sexual trajectory type and recent sexual risk behavior? A representative Dutch sample of 1,263 males and 1,353 females (M = 20.46 years; range, 12-25) who had engaged in sexual intercourse completed a questionnaire about sexual (health) behavior. About three quarters of participants followed a progressive sexual trajectory from less intimate (e.g., kissing) to more intimate behavior (e.g., sexual intercourse). Immigrant groups and less educated youth were more likely to follow a nonlinear trajectory. A progressive trajectory was associated with a higher likelihood of consistent contraceptive use with the most recent partner and, for girls, with a lower likelihood of having unprotected anal intercourse with the last partner. It was hypothesized that the nonlinear trajectory could be ascribed to a lack of opportunities or skills to plan and steer early sexual experiences and that these limitations were fairly stable over time. Sexual education should aim at providing adolescents with sufficient (self) knowledge and skills to construct their sexual trajectories according to their own wishes or needs.

Coping styles as mediator of sexual orientation-related health differences

The higher prevalence of health problems in homosexual compared to heterosexual populations is usually understood as a consequence of minority stress. We hypothesized that differential rates of health problems also could result from sexual orientation-related differences in coping styles. We explored this using data collected in a general population-based study (N = 9684) via face-to-face interviews. A higher prevalence of both mental and physical health problems, as assessed with individual questions, the GHQ-12, and checklists, was observed in homosexual compared to heterosexual men and women. Coping style was related to sexual orientation in men, but not in women. Compared to heterosexual men, homosexual men more strongly applied emotion-oriented and avoidance coping strategies. Emotion-oriented coping mediated the differences in mental and physical health between heterosexual and homosexual men. Findings suggest the importance of further exploration of the development and use of emotion-oriented and avoidance coping by homosexual men.

Parental support and knowledge and adolescents' sexual health: testing two mediational models in a national Dutch sample

This study investigated age- and gender-specific associations between parental support and parental knowledge of the child's whereabouts, on the one hand, and sexual experience and sexual health (the ability to have safe and pleasurable sexual experiences) on the other hand. A representative Dutch sample of 1,263 males and 1,353 females (aged 12-25 years), who had previously engaged in sexual intercourse, completed a questionnaire that included measures of these constructs. Both parental support and knowledge were positively associated with contraceptive use, social skills in sexual interactions, sexual satisfaction, and delay of sexual debut. Findings also revealed that the majority of correlations between parental support and sexual experience and sexual health are attributable to the relationship between a supportive family environment and parental knowledge of the child's whereabouts. Parental knowledge thus appeared to be more important for healthy sexual development than parental support.

High levels of same-sex experiences in the Netherlands: prevalences of same-sex experiences in historical and international perspective

Some authors suggest that the public stance toward homosexuality can influence the prevalence of same-sex experiences (e.g., Butler, 2005). Since the Dutch stance toward homosexuality has become more positive during the last decades, it was hypothesized that the current Dutch prevalences of same-sex experiences are higher than in other times and countries. This hypothesis was investigated using the data of a recent Dutch population study, and comparing these results to those from previous and international studies. The current Dutch figures were indeed higher than recent figures from other countries. Among women, the recent figures were also higher than those found in previous Dutch studies. The prevalence of same-sex experiences among Dutch males stayed the same. These results and the methodological aspects of the study are discussed.

Adolescents' contact with sexuality in mainstream media: a selection-based perspective

Most work on adolescents' contact with sexuality in mainstream media has been framed in terms of media effects upon the sexual self-concepts, attitudes, and behaviors of youth, even when such causality cannot be inferred. Rarely examined are the sexual characteristics of adolescents that may predict contact with sexual media. Using Steele's (1999) Media Practice Model as a foundation, we reported on these associations for 2,184 Dutch adolescents. This study emphasized sex differences in the characteristics that predict such contact, and the role of youths' critical evaluations of information about sex in the media. Correlation and regression analyses revealed several sex differences in the characteristics related to sexual media contact, with individual characteristics accounting for more variance in females and critical evaluations accounting for more variance in males. This report underscores the need for more comprehensive, longitudinal studies of adolescents' media consumption and its connections to sexual development in youth.

Do homosexual persons use health care services more frequently than heterosexual persons: findings from a Dutch population survey

Use of health care services has been suggested to be lower among homo- or bisexual persons than among heterosexual persons, due to a lack of trust in the health care system. However, population-based studies on differences in health care utilization according to sexual orientation are scarce. The purpose of the current study was to explore differences in health care utilization and confidence in health care between heterosexual, bisexual and homosexual persons. A survey of a random sample of patients of Dutch general practices (n = 9684) gathered data on socio-demographic variables, sexual orientation, health status, confidence in health care and health care utilization. Differences in health care utilization between homo- or bisexual persons and heterosexual persons were analyzed with logistic regression analysis, in which we statistically adjusted for socio-demographics and health status. Reported health was lower among homosexual men and women as compared to heterosexual persons. There were no sexual orientation-related differences in confidence in health care. Controlling for health status, it appeared that gay men more frequently used mental and somatic health care than heterosexual men, and that lesbian or bisexual women more frequently used mental health care than heterosexual women. We found a higher rate of health care use among homosexual and bisexual persons as compared to heterosexual persons, that could only be partly explained by differences in health status. To gain a better understanding of our findings, data on the predisposition to use health services among homosexual and bisexual men and women is needed.

Sexual orientation and mental and physical health status: findings from a Dutch population survey

OBJECTIVES

We sought to determine whether sexual orientation is related to mental and physical health and health behaviors in the general population.

METHODS

Data was derived from a health interview survey that was part of the second Dutch National Survey of General Practice, carried out in 2001 among an all-age random sample of the population. Of the 19685 persons invited to participate, 65% took part in the survey. Sexual orientation was assessed in persons aged 18 years and older and reported by 98.2% of 9684 participants. The respondents' characteristics are comparable with those of the Dutch general population.

RESULTS

Gay/lesbian participants reported more acute mental health symptoms than heterosexual people and their general mental health also was poorer. Gay/lesbian people more frequently reported acute physical symptoms and chronic conditions than heterosexual people. Differences in smoking, alcohol use, and drug use were less prominent.

CONCLUSIONS

We found that sexual orientation was associated with mental as well as physical health. The causal processes responsible for these differences by sexual orientation need further exploration.

Burnout among female indoor sex workers

This study examined levels of "burnout" and associated factors among a sample of female indoor sex workers in the Netherlands (N=96). Levels of burnout on 3 dimensions (emotional exhaustion, depersonalization, and personal competence) were assessed. Only sex workers' mean score on depersonalization was significantly higher than that of a comparison group of female nurses and comparable to those of another comparison group of patients with work-related psychological problems. Evidence was provided for the importance of experiential and context-related factors in burnout among indoor sex workers. For instance, 42% of the variance in depersonalization was explained by not working by choice, negative social reactions, experiences of violence, and lack of control in interaction with clients. Depersonalization may be a strategy to cope with negative conditions and experiences in sex work, but was significantly related to indicators of stress and emotional exhaustion. More than half (53%) of the variance in emotional exhaustion was explained by lack of management support, negative social reactions, not working by choice, and negative working motivation. Personal competence was highest among sex workers with a professional attitude, who started sex work at a relatively older age, and who were well supported by colleagues and management. It is concluded that burnout is not as much associated with sex work per se, but with sex work under certain conditions, among which stigma (notably negative social reactions) and stigma-related experiences (such as role conflict, experiences with violence, and lack of a worker-supportive organizational context) are important.

Outcomes of a systematically designed strategy for the implementation of sex education in Dutch secondary schools

This study examines the effects of a systematically designed innovation strategy on teachers' implementation of a sex education curriculum and its related determinants. A quasi-experimental group design was used to assess the effectiveness of the innovation strategy. Teachers filled in questionnaires on the determinants of curriculum implementation and kept a record of their actual use of the curriculum. We measured several determinants, including teachers' curriculum-related beliefs, characteristics of the interactive context and characteristics of the innovation strategy. Participating teachers (n=109) carried out most of the activities they were supposed to (81%). Multiple linear regression indicated that their outcome beliefs and perceived instrumentality of the curriculum best predicted extent of use of the curriculum (R2=0.23). The innovation strategy had a positive impact not only on extent of use (18.4 activities versus 15.8 activities; t=2.3, P<0.05), but also on teachers' curriculum-related beliefs. It can be concluded that a systematically designed innovation strategy has the potential to produce significant changes in classroom-based sex-education practices. Not only did teachers exposed to the innovation strategy implement more of the curriculum than teachers in the control group, also teachers' beliefs and expectations about student learning constituting their classroom behavior changed accordingly.

Patterns and universals of mate poaching across 53 nations: the effects of sex, culture, and personality on romantically attracting another person's partner

As part of the International Sexuality Description Project, 16,954 participants from 53 nations were administered an anonymous survey about experiences with romantic attraction. Mate poaching--romantically attracting someone who is already in a relationship--was most common in Southern Europe, South America, Western Europe, and Eastern Europe and was relatively infrequent in Africa, South/Southeast Asia, and East Asia. Evolutionary and social-role hypotheses received empirical support. Men were more likely than women to report having made and succumbed to short-term poaching across all regions, but differences between men and women were often smaller in more gender-egalitarian regions. People who try to steal another's mate possess similar personality traits across all regions, as do those who frequently receive and succumb to the poaching attempts by others. The authors conclude that human mate-poaching experiences are universally linked to sex, culture, and the robust influence of personal dispositions.

Another decade of social scientific work on sex work: a review of research 1990-2000

The international, psychological and sociological research literature on prostitution from 1990 through 2000 is reviewed. The stage is set by scanning topics and perspectives in earlier writings. Then the research is discussed under the following headings: (a) HIV related research (HIV prevalence studies, factors in condom use, and prevention program evaluation); (b) workers' background and motivational issues (early victimization and connected factors, economic motives and connected factors); (c) work related issues (working routines, risks and stresses, and managing risk, work and identity); (d) research on clients, and (e) issues related to social and legal status. The literature is still much more about sex than it is about work. In addition, although an increasing number of authors have criticized the dominance of a deviance perspective over work perspectives on prostitution, the literature still reveals many features of stigmatization. For instance, the wrongs associated with sex work are all too often attributed to the nature of sex work itself instead of to the stigma attached to it or to specific negative circumstances. Likewise, the association between prostitution and negative features (in particular HIV and early victimization) is overwhelming, despite evidence that, for large groups of sex workers, these issues are of limited relevance. Generally, writers fail to adequately differentiate among types of sex workers. In particular, in relation to issues of health and well-being, differentiation among sex workers on the basis of specific features of their working situation (e.g., contexts, routines, relations, conditions) has hardly been studied and is recommended for the future.

Universal sex differences in the desire for sexual variety: tests from 52 nations, 6 continents, and 13 islands

Evolutionary psychologists have hypothesized that men and women possess both long-term and short-term mating strategies, with men's short-term strategy differentially rooted in the desire for sexual variety. In this article, findings from a cross-cultural survey of 16,288 people across 10 major world regions (including North America, South America, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, South/Southeast Asia, and East Asia) demonstrate that sex differences in the desire for sexual variety are culturally universal throughout these world regions. Sex differences were evident regardless of whether mean, median, distributional, or categorical indexes of sexual differentiation were evaluated. Sex differences were evident regardless of the measures used to evaluate them. Among contemporary theories of human mating, pluralistic approaches that hypothesize sex differences in the evolved design of short-term mating provide the most compelling account of these robust empirical findings.

Universal sex differences in the desire for sexual variety: tests from 52 nations, 6 continents, and 13 islands

Evolutionary psychologists have hypothesized that men and women possess both long-term and short-term mating strategies, with men's short-term strategy differentially rooted in the desire for sexual variety. In this article, findings from a cross-cultural survey of 16,288 people across 10 major world regions (including North America, South America, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, South/Southeast Asia, and East Asia) demonstrate that sex differences in the desire for sexual variety are culturally universal throughout these world regions. Sex differences were evident regardless of whether mean, median, distributional, or categorical indexes of sexual differentiation were evaluated. Sex differences were evident regardless of the measures used to evaluate them. Among contemporary theories of human mating, pluralistic approaches that hypothesize sex differences in the evolved design of short-term mating provide the most compelling account of these robust empirical findings.

'Menopausal symptoms': associations with menopausal status and psychosocial factors

This study investigated the relative importance of psychosocial factors as opposed to menopausal status in relation to so-called 'menopausal symptoms' among a large sample of premenopausal, perimenopausal and (naturally and surgically) postmenopausal women (n = 4308) in The Netherlands. The incidence of psychological, somatic, vasomotor and sexual symptoms was assessed and related to menopausal status and to measures relating to coping behaviors, (body- and self-) esteem and quality of life. Among the findings were that vasomotor symptoms in particular, and loss of interest in sex to a lesser extent, were relatively strongly associated with menopausal status. Psychological and somatic symptoms, however, were found to be more closely associated with psychosocial factors (although perimenopausal women as a group were found to suffer them most). Findings are discussed and interpreted as further evidence that only vasomotor symptoms may rightly be called 'menopausal'.

Condom use by Dutch men with commercial heterosexual contacts: determinants and considerations

We report responses from 559 clients of female prostitutes, with a view to determining to what extent previously identified factors play a part in condom use. To increase the response rate to advertisements in daily and weekly newspapers, interviews were held by phone. This procedure had the advantage of ensuring the anonymity many clients demanded. Of those clients having vaginal or anal contact (91%), 14% had not always used condoms in the previous year. Compared with consistent condom users, these men were less highly educated, had twice as many commercial contacts, and had more contacts with "steady" prostitutes. They were either more emotionally motivated to visit prostitutes than were consistent condom users or exhibited a stronger need for sexual variation. They showed a more compulsive attitude toward visiting prostitutes, had a more negative attitude toward prostitution in general, evaluated condoms more negatively, had a higher personal efficacy to achieve unsafe contacts, and had a higher general risk assessment, commensurate with their behavior. Men with only safe contacts had either an intrinsic or an extrinsic motivation for condom use. Among extrinsically motivated men, their behavior change was more recent and had not yet taken root: They still envisioned unsafe commercial sex to be possible in the future. Education aimed at the small group of men practicing unsafe contacts will not easily and directly lead to behavior change. But these educational activities may support prostitutes to persist in (consistent) condom use, regardless of clients' pressure to do otherwise.

Segmentation of heterosexual prostitution into various forms: a barrier to the potential transmission of HIV

The results of an earlier Dutch study on prostitutes' clients, interviewed face-to-face, were cross-validated by means of telephone interviews, which both guaranteed anonymity and produced a larger sample of respondents (n = 559). Depending on their preference and financial resources, they had visited different types of prostitution; but about half of them had restricted themselves to one type. Inconsistent use of condoms was reported by 14% of the clients who had had vaginal or anal intercourse. Condoms were most frequently used in clubs, brothels and window prostitution, and least often in street, home and escort prostitution; in the last two sorts especially not with regular prostitutes. Whether or not prostitutes came from non-Western countries had no influence on protective behaviour of these clients. The formation of networks between different sorts of prostitution, through unsafe sexual contacts in two or more sorts, involved only 3% of respondents. Thus, prostitution in The Netherlands should be seen as a number of sparsely-connected networks rather than as a single network. The formation of networks between prostitution and the population at large is made possible by the 10% of the respondents who had had unsafe contacts with both commercial and private partners.