There is a sharp contrast between the assumed "universality" of male and female differences in sexual motivation reported by Buss, Symons, Baumeister and others utilizing self-report survey data, and the findings of traditional  cultural anthropologists  collecting data through classic methods of  ethnographic fieldwork . One major issue with the core claim of sexual economics theory is that it is philosophically and epistemically a western concept to its core, to the extent that most non-western societies have typically viewed male and female sexual drives as either the same [ 60 ]  or else characterized by higher female than male libido [ 61 ] [ 62 ] [ 63 ] [ 64 ]  Historical studies have outlined a specific time and philosophical background when the modern western conception of "horny" male and coy female became dominant, pointing out that prior to the 18th century these ideas were not even widely believed in the west. [ 65 ] [ 66 ] [ 67 ]  Since there were no  neuroscientific  breakthroughs which occurred between 1700 and 1800, the change in opinion (and the source of the modern western belief that men have a higher sex drive than women) was  ideological , not scientific in nature, related to the construction of a  bourgeois morality  which relegated women to a role as moral guardians who remained at home while men went out and "sowed their wild oats" (the so-called  cult of domesticity ). Today, westerners continue to follow this paradigm and assume its validity  a priori , despite lack of neuroscientific documentation indicating that men are biologically more hard-wired toward seeking sexual pleasure and a host of competing theories for this apparent "sex difference". [ 68 ] [ 69 ] [ 70 ]


The belief that men are more promiscuous on average than women is common in the general culture and has even been taken up by some  sociologists , despite the obvious mathematical problems: given a relatively similar number of males and females in a given human population, the amount of heterosexual sex promiscuity should average out to be more or less the same for both sexes. Self-report data typically finds that men report significantly larger numbers of lifetime sexual partners on average than women, which is a mathematical impossibility due to the near-equal distributions of the sexes in the population. Therefore, it is highly likely that biased and dishonest reporting is occurring, with more men inflating their number of sex partners and more women underreporting theirs. Studies using  bogus pipelines  in order to adjust for social desirability bias have found that women are just as likely as men to have sex with multiple partners and even to  masturbate . [ 71 ]  Even if one were to  steelman  the sexual economics theorists by pointing out that sexual behavior may not reflect men's inborn higher sexual motivation, one would still be forced to deal with cross-cultural evidence from non-patriarchal and non-restrictive societies like the  Mosuo  or the  Trobriand Islanders  whose "sexual economies" are fundamentally different from the model presupposed by this theory.


Sexual frustration  is a sense of dissatisfaction stemming from a discrepancy between a person's desired and achieved  sexual activity . It may result from  physical ,  mental ,  emotional ,  social , financial,  religious or spiritual  barriers. It can derive from displeasure during sex due to issues such as  anorgasmia ,  anaphrodisia ,  premature ejaculation ,  delayed ejaculation [ 1 ]   or  erectile dysfunction . [ 2 ] [ 3 ]  A sense of incompatibility or discrepancy in  libido  between partners may be involved. [ 4 ]  It may also relate to broader existential  frustration . [ 5 ]


Historical methods of dealing with sexual frustration have included  fasting  and the taking of libido suppressants such as  anaphrodisiacs  ( food supplements ) [ 6 ]  or  antaphrodisiacs  (medicinal supplements). [ 7 ]  It can also affect the sexually active, especially  hypersexual  people. [ 8 ]  It is a natural stage of the development throughout  youth , when going through  puberty  as a  teenager . [ 9 ]


Ways to cope with sexual frustration include engaging in solo sex,  meditating ,  exercising , exploring new techniques, discussing and being open with one's partner about sexual frustrations, or seeking professional assistance through a  sex therapist . [ 10 ]


Adolescents may experience sexual frustration due to a variety of factors, including societal expectations, hormonal changes, and the complexities of navigating relationships. For some adolescents,  sexting  serves as an outlet for sexual exploration within a virtual space, particularly for those not yet ready for physical sexual activity. [ 11 ]


During  menopause , individuals may experience reduced  sexual desire  and activity. However, engaging in sex remains important for many older people. Couples in their 50s or older expect ongoing sexual involvement, with an emphasis on traditional intercourse over other forms. Common  sexual dysfunctions , like ejaculatory issues in males and genital atrophy in females, pose challenges. Lack of awareness about these changes may hinder communication with partners, potentially leading to sexual frustration and  abstinence . [ 12 ]


People with  autism spectrum disorder  (ASD) may face sexual frustration far more than most other people due to challenges in social interaction, communication difficulties, and sensory sensitivities associated with ASD. These individuals often struggle to interpret  social cues  and establish meaningful relationships, leading to a sense of isolation. Sensory sensitivities can also contribute to discomfort in intimate situations. Additionally, the lack of tailored resources and support for  sexuality education  exacerbates their frustration. [ 13 ]


Sexual function  is how the body reacts in different stages of the  sexual response cycle . It is defined as the ability of an individual to react sexually or to experience  sexual pleasure . [ 1 ]


Relevant aspects of sexual function are described on the basis of a modified version of  Masters and Johnson 's work. [ 2 ]  The aspects of sexual function determined as being relevant to the assessment include;  sexual desire ,  erection ,  orgasm  and  ejaculation . Guidelines for assessing sexual function are suggested and divided into four stages:


Stage 1  deals with the documentation of the defined aspects of sexual function. The main questions are:


Stage 2  deals with the assessment of the frequency of different sexual activities, such as intercourse, within a given time frame. The possible explanations for an absence or a decreased frequency of sexual activities may include physiological,  psychological , social,  religious  and  ethical  reasons.


Stage 3  it is estimated if or to what extent waning sexual functions and/or activities cause distress.


Stage 4 , the association between the distress due to waning sexual function and  well-being  and  emotional isolation  is assessed.


These guidelines were constructed to assess male sexual function [ 3 ]  in relation with treatment for  prostate cancer . However, the concept has been modified and adapted for females. [ 4 ]


Sexual guilt  is a negative emotional response associated with the feeling of  anxiety ,  guilt , or  shame  in relation to sexual activity. Also known as  sexual shame , it is linked with the negative  social stigma  and cultural expectations that are held towards sex as well as the historical religious opposition of all "immoral" sexual acts.  It originates from the negative pressures exerted upon individuals during the course of their lives due to parental and religious teachings concerning sexual activity and expression. Participation in  sexual intercourse  does not need to occur in order for an individual to experience sexual guilt, however, as  self-pleasure  and the sexual activities of other people can also induce this feeling. Furthermore, a person who feels guilty or otherwise uncomfortable about sex might also experience sexual guilt. [ 1 ]


Sexual guilt can severely impact affected individuals and deteriorate the relationships of those close to them. It has been linked to cases of sexual dysfunction, clinical depression and other mental illnesses. [ 2 ]  Sexual guilt can also cause physical impacts and illnesses. If the individual feels shame or guilt towards sexual participation they may be less likely to seek protective and contraceptive measures or seek medical attention if they encounter symptoms from sexual intercourse.


Within the modern era of sexual expressiveness and instant sexual gratification, sexual education plays an important role in reducing the impacts and risk of sexual guilt as its incidence increases. Past historical research [ 3 ]  into the cause of sexual guilt has shown to require more study.


Participation in sexual activity or intercourse does not need to take place in order for someone to encounter sexual guilt. Sexual guilt can come from participating in sexual acts, thinking about participating in sexual acts or from critically judging sexual acts and attitudes of yourself or others. [ citation needed ]


Sexual guilt can originate from:


Studies have suggested that sexual guilt can be a predictor for individuals' past relationships, sexual attitudes and experiences [ 6 ]  such as


Sexual guilt can be caused by "messages about approved or disapproved attitudes toward sexual issues" [ 5 ]  that individuals face from external sources such as family, friends, and religious groups, cultural ‘norms’ or identifying as a non-binary sexual orientation.


There are two main  psychologically  recognised types of sexual guilt – “latent” guilt and “morning after” guilt. Each type of guilt can be found in different scenarios and can cause different effects upon the individual.


Latent guilt is an  intrinsic  feeling of shame or guilt that comes from the negative association of sexual activity or desire as a base or animal instinct. [ 2 ]  Individuals with latent guilt may believe that sexual activity shows a weakness that breaks down the individual's strength of character. People who encounter this form of sexual guilt do not have to physically participate in sexual activities to feel it. Individuals can feel shame towards their own inner desire, or they may possess a lowered  libido , and/or inability to climax which could impact their relationships. [ 13 ]


“Morning after guilt” is derived from the feeling of guilt, sin or shame felt by the individual after they have committed an act that is not in line with their own internal values or within the expectations of people in a relationship or within a certain group, nationality, culture or religion. [ 14 ]  This type of sexual guilt can most commonly be found within individuals who regret performing an act of sexual activity e.g. cheating within a relationship, partaking in premarital sex, or having sex with someone who the individual regrets performing the action with. As the colloquial name suggests, it is commonly experienced the “morning after”, or post-coitus. [ 15 ]


Ancient religions and cultures shape how society behaves today. The sexual attitudes of religions in the past can be seen as having an effect upon the sexual attitudes and pressures felt in the modern-day. Each religion looks at  sexual activity  independently and hold different rules and moral expectations while many have overlapping values and ideas about the role sex should play. [ citation needed ]


Religious beliefs and writings often set expectations upon people to behave and interact in a certain way. Marriage between a male and female is seen in multiple religions as the only type of relationship in which sexual activity should occur; this can place pressure upon people within non-heterosexual relationships.


The  Catholic Church  has a traditional view towards sexual activity, teaching followers that such activity should be done within the confines of marriage as a "noble and worthy" [ 16 ]  act between a man and a woman. The Church considers other sexual acts such as homosexuality and masturbation, as well as the use of contraceptives, to be sinful. [ 17 ]


Religions such as  Judaism  consider restraining from sex to be an immoral act, whereas  Islam  looks at sex as an act that should be responsibly acted upon through marriage. Sexual pleasure is emphasized within marriage when care and love is present. [ 18 ]  However, homosexuality is often strictly demonized within these religions, with some believing it should be punishable by death. [ 19 ]


Hinduism  is a religion that has a strong binding to sexual pleasure, or  kama ; however, this pleasure is thought to be a responsibility of marriage, and is to be avoided until the age of 25, in favor of virtuous living and intellectual, financial and spiritual development. The  Kama Sutra  is a text thought to be of sacred religious meaning in relation to sex, though it primarily aims to show the three pillars of Hinduism -  dharma ,  artha  and  kama . [ 20 ]   Vatsyayana's  text is supposed to signify the significance of sexual activity in relation to the priorities of virtuous living and financial gain,  Indra Sinha . [ 21 ] [ 22 ]


A research paper was done by Mark. P Gunderson and James Leslie McCary in which 373 college students completed a 173 item questionnaire to determine whether sexual guilt or religion was a better indicator of the individuals' "level of sex information obtained, sexual attitudes held and sexual behaviour expressed". They found that


"Sexual guilt is a far better and more powerful predictor of level of sex information obtained, sexual attitudes held, and sexual behaviour expressed than religion. The conclusion is that religion is an intervening variable with sexual guilt such that the more frequently students attend church, the more likely they are to have high sexual guilt which interferes with their sexuality." [ 23 ]


Social and cultural attitudes and expectations upon members of their community can be felt by the individual and cause sexual guilt, embarrassment, anxiety or even sexual  abstinence .  Some of these values and behaviours may have been derived from sexual myths and legends which have amalgamated into societal expectations and social stigmas towards acts and forms of sex.


Sexual orientation and identification is a major cause of sexual guilt, anxiety and feelings of non-inclusivity for people with a non- heterosexual  sexual orientation. Each country and territory has its own  LGBT  laws and rights [ 24 ]  which are based on the cultural values and beliefs of that region. In some cultures it is illegal to be in a same-sex relationship, which is punishable by imprisonment or death. [ 25 ]  Some of the laws and rights surrounding sex have been shaped by myths and legends which may support more traditional or spiritual forms of sex.  Some myths and art show evidence for the presence of  LGBT themes in mythology  and ancient cultures.


Research  into the effects of sexual myths upon the sexual guilt and levels of sexual activity of college men and women was undertaken by Donald L. Mosher upon 88 anonymous male and female students. It concluded that


"The level of sex experience was not correlated with belief in sex myths. Sex guilt was negatively correlated with level of sex experience and positively correlated with belief in sex myths. High‐sex‐guilt males endorsed myths portraying sex as dangerous, and high‐sex‐guilt females regarded virginity as important. It was concluded that structured sex education and values clarification are needed to complement and amend traditional socialization into hetero‐sexuality." [ 26 ]


Individuals who experience sexual guilt can experience a range of effects that can have a severe and highly detrimental influence upon their wellbeing, and the health and wellbeing of partners and close relationships. These can be seen as psychological or mentally impacting or have physical manifestations and effects.


Individuals who experience sexual guilt or who have experienced sexual guilt previously can be affected mentally by the challenges which this attitude can lead to. Possessing sexual guilt can lead individuals who are sexually active to be hyper aware or critical of their sexual performance which could lead to sexual dysfunction, [ 27 ]  depression, performance anxiety, and other illnesses. These mental effects can have compounding physical and behavioral impacts such as a fear of sex or loss of sexual desire in which the individual may  abstain  from sex completely. Individuals who feel a shame towards sexual acts can also be sexually inactive. Sexually inactive individuals can also feel a reluctance, disinterest or anxiety towards sexual acts due to the pressures from religion, media and people around them which can depict sex as a pursuit of the animalistic urges from the  id . "People can also feel sexual guilt about the nature of the erotic fantasies"/ sexual fantasies . [ 28 ]  Individuals who have symptoms may require professional psychological advice in order to work through the effects of sexual guilt.


Sexual guilt may leave the affected individual in a state of crippling anxiety in which they do not want to seek help or practice safe sexual practices.  Freud  linked the feeling of guilt, and its related emotion of anxiety. [ 27 ]  People who are less informed or practiced about safe sex practices are more likely to transfer sexually transmitted diseases or be involved in an unwanted pregnancy. Someone suffering from sexual guilt is less likely to seek medical assistance due to a feeling of shame or anxiety, this can then lead to more severe symptoms or infection.


Sexual meanings  are the meanings that are attributed, by a particular cultural-social-historical context, to  sexual acts  and broadly to all the aspects of the erotic dimension of squares  human sexual  experience. [ 1 ]  This also include the beliefs on what is considered sexual and what is not. Sexual meanings are  social and cultural constructs , and they are metabolized and subjectivized by the individual only after cultural and social mediation. [ 1 ]


In the first systematic study on this issue,  Michel Foucault , with his 1976  History of Sexuality , was the first to study this issue with a systematic  approach. He argued that the concept of what activities and sensations are "sexual" is historically determined, and it is therefore part of a changing "discourse". [ 2 ] [ 3 ] [ 4 ] [ 5 ]


Being the main force conditioning human relationship, sex is essentially  political . In any social context, the construction of a "sexual universe" is fundamentally linked to the structures of power. [ 1 ] [ 2 ] [ 6 ] [ 7 ]  The construction of sexual meanings, is an instrument by which social institutions (religion, marketing, the educational system, psychiatry, etc.) control and shape human relationships. [ 3 ] [ 4 ]


According to Foucault, sexuality began to be regarded as a concept part of human nature since the 19th century; so sexuality began to be used as a mean to define  normality  and its boundaries, and to conceive everything outside those boundaries in the realm of  psychopathology . In the 20th century, with the theories of Freud and of  sexology , the "not-normal" was seen more as a "discontent of civilization". [ 3 ] [ 8 ]


Sexual narcissism  has been described as an  egocentric  pattern of sexual behavior that involves an inflated sense of sexual ability and sexual entitlement.  In addition, sexual narcissism is the erotic preoccupation with oneself as a superb lover through a desire to merge sexually with a mirror image of oneself.  Sexual narcissism is an intimacy dysfunction in which sexual exploits are pursued, generally in the form of extramarital affairs [ citation needed ] , to overcompensate for low self-esteem and an inability to experience true intimacy. [ 1 ]  This behavioral pattern is believed to be more common in men than in women and has been tied to  domestic violence  in men and sexual coercion in couples. [ 2 ] [ 3 ]  Hurlbert argues that sex is a natural biological given and therefore cannot be deemed as an addiction.  He and his colleagues assert that any  sexual addiction  is nothing more than a misnomer for what is actually sexual narcissism or sexual compulsivity. [ 4 ]


Sexual repression  is a state in which a person is prevented from expressing their own  sexuality  or  sexual orientation . Sexual  repression  can be caused by an  emotional conflict , in which a person feels  guilt ,  shame , or distress regarding their natural  sexual impulses . These feelings of emotional distress can be exacerbated by outside factors, such as  family ,  religion , and  peer pressure . Sexual repression is often synonymous with  internalized homophobia , in which a  gay ,  lesbian , or  bisexual  person feels the need to suppress their own  homosexual  impulses and conform to  heterosexual  norms. Sexual repression can also be caused by external  oppression , in which the  laws  of a society prevent someone from expressing their sexuality freely.


Defining characteristics and practices associated with sexual repression vary between societies and different historical periods. The behaviours and attitudes constituting sexual repression differ across  cultures ,  religious communities  and  moral systems . Sexual repression can largely be categorised as physical, mental or an amalgam of both.


Sexual repression is enforced through  legislation  in certain countries, many of which are located in the  Middle East and North Africa region , and  South Asia . Common practices associated with the practice include  female genital mutilation . Individuals believed to have engaged in behaviours contradicting social, religious or cultural expectations of sexual repression, such as  same-sex sexual activity , may be punished through  honor killings ,  persecution  or the  death penalty .


Sigmund Freud  was the first to use the term 'sexual repression' widely, and argued that it was one of the roots of many problems in  Western society . [ 1 ]  Freud believed that people's naturally strong instincts toward sexuality were repressed by people in order to meet the constraints imposed on them by civilized life. Among many others, Freud believed renowned artist  Leonardo da Vinci  to have been a repressed homosexual, who he believed  "sublimated"  his sexual desires so as to achieve artistic brilliance. [ 2 ]  However, Freud's ideas about sexual repression have been subject to heavy criticism. According to sex therapist Bernard Apfelbaum, Freud did not base his belief in universal innate, natural sexuality on the strength of  sexual desire  he saw in people, but rather on its weakness. [ 3 ]


In some periods of Indian history,  anaphrodisiacs  were utilised in order to lower libido. [ 4 ]


In contemporary society, medication may be prescribed to registered sex offenders in order to lower the libido and ensure that further offences are less likely. [ 5 ]


Sexual repression is a recurring prohibition in many religious contexts. [ citation needed ]


Most forms of Christianity  discourage homosexual behavior . [ 6 ]


Many forms of  Islam  have strict sexual codes which include banning homosexuality, demanding virginity before marriage, accompanied by a ban on fornication, and can require modest dress-codes for men and women. [ 7 ]


Chemical castration  has also been practiced upon male choristers prior to puberty to ensure that their vocal range remained unchanged.


The practice of creating "Castrati" was common until the 18th century, and after a decline in popularity were only used in the Vatican up until the beginning of the twentieth century [ 8 ]  (new research suggests that the employment of castrati was tolerated by the Vatican as late as 1959 [ 9 ] ).


Marriage has historically been seen as means of controlling sexuality. [ 10 ]  Some forms of marriage, such as  child marriage , are often practiced as a means of regulating the sexuality of girls, by ensuring they do not have multiple partners, thus preserving their  virginity  for their future husbands. [ 11 ]  According to the  BBC World Service , "In some cases, parents willingly marry off their young girls in order to increase the family income or protect the girl from the risk of unwanted sexual advances or even  promiscuity ." [ 12 ]


Female genital mutilation (FGM), also known as female genital cutting or female circumcision, "comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons". [ 13 ]
The practice is concentrated in 27 countries in Africa as well as Iraqi Kurdistan, Yemen and Indonesia; and more than 125 million girls and women today are estimated to have been subjected to FGM. [ 13 ]


FGM does not have any health benefits, and has serious negative effects on health; including complications during  childbirth . [ 13 ]


FGM is used as a way of controlling  female sexuality ; the  World Health Organization  (WHO) states:


FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital  virginity  and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist "illicit" sexual acts. [ 13 ]


FGM is condemned by international human rights instruments. The  Istanbul Convention  prohibits FGM (Article 38). [ 14 ]  FGM is also considered a form a  violence against women  by the  Declaration on the Elimination of Violence Against Women  which was adopted by the  United Nations  in 1993; according to which:  Article Two: Violence against women shall be understood to encompass, but not be limited to, the following: (a) Physical, sexual and psychological violence occurring in the family, including [...]  female genital mutilation  [...] . [ 15 ]


An honor killing is the  homicide  of a member of a family or social group by other members, due to the perpetrators' belief that the victim has brought shame or dishonor upon the family or community, usually for reasons such as refusing to enter an  arranged marriage , being in a relationship that is disapproved by their relatives, having  sex outside marriage , becoming the victim of  rape , dressing in ways which are deemed inappropriate, or engaging in  homosexual  relations. [ 16 ] [ 17 ] [ 18 ] [ 19 ] [ 20 ]  With regards to honor killings of women, according to a UN Expert Group Meeting that addressed harmful practices against women:


They [honor killings] stem from the deeply-rooted social belief that male family members (in some cases, mothers and other women are involved in planning or carrying out honor crimes) should control the sexuality of or protect the reputation of women in the family, and that they may contain their movements or kill them for blemishing family honor, even when rumors or false gossip are the reason for public suspicion. [ 21 ]


Homosexual sexual expression is a sensitive topic in many societies. As of 2014, same-sex sexual acts are punishable by prison in 70 countries, and in five other countries and in parts of two others, homosexuality is punishable with the  death penalty . [ 22 ]  Apart from criminal prosecution, LGBT individuals may also face social stigmatization and  violence . [ citation needed ]


Researchers such as Peggy Reeves Sanday have proposed a relationship between sexual repression and  rape . [ 23 ]  Evidence has been found to contradict this hypothesis, with a study by Jaffee and Straus finding "no relationship between sexually liberal attitudes and rape." [ 24 ]


Sexual repression is a key talking point in  feminism , [ 25 ]  although  feminist views on sexuality  vary widely. [ citation needed ]


Michel Foucault , in his  History of Sexuality , refutes what he calls the "repressive hypothesis." [ further explanation needed ] [ citation needed ]


Although the typical expectation is that sexually repressed female individuals would experience less sexual arousal, one study regarding the effect of repression (among other variables) on sexual arousal concluded that repression-sensitization (R-S) and interactions with R-S did not have a significant effect on sexual arousal. These results were consistent with research performed in other studies regarding the same topic. Moreover, other research findings have demonstrated that repression may have differing effects between gender, namely, that "male repressors may inhibit sexual behavior, whereas female repressors do not." [ 26 ]


Reproduction-based sex was urged by  Mao Zedong , but later politicians instituted a  one-child policy . In a country where atheism is popular, the restriction cannot be ascribed to religion but to nationalist motives. [ 27 ]


Within the past few decades, China has undergone major changes (known as the sexual revolution) in society that have affected their outlook on sex. Li Yinhe, China's first female sexologist, observed that prior to the sexual revolution, very few couples would engage in premarital sex. These observations were accredited to the fact that, until 1997, premarital sex in China was considered illegal and offenders could be prosecuted. [ 28 ]


Furthermore, China's stance on sexuality before the sexual revolution was quite harsh in comparison to standards set by Western governments. China had previously banned the publication of pornography, organization of sex parties and prostitution, and even writing about sex. [ 28 ]  These regulations on sexuality before the revolution led to a legal precedent regarding the organization of prostitution in 1996 that had sentenced a bathhouse owner to death (though this is no longer punishable by death today). Today, the organization of sex parties is still illegal, although it is not strictly enforced anymore due to changes in Chinese attitudes which have led to fewer people reporting these sex parties. [ 28 ]


However, the Chinese sexual revolution still has a lot of progress to make regarding the repression of the LGBT community. Although China has made some progress in the way of LGBT rights (namely, removing homosexuality from the list of mental illnesses), LGBT rights are still limited by some standards. For instance, same-sex marriage still hasn't been recognized legally, although there is the existence of guardianship, a recent development that many people consider as the first step to the legal recognition of same-sex marriage. [ 29 ]  In addition, Chinese law does not legally protect the LGBT community from discrimination in the workplace. [ 28 ]


India  has developed its discourse on sexuality differently based on its distinct regions with their own unique cultures. According to R.P. Bhatia, a  New Delhi  psychoanalyst and psychotherapist, middle-class India's "very strong repressive attitude" has made it impossible for many married couples to function well sexually, or even to function at all. [ 30 ]


A Durex survey performed internationally resulted in Japan being the only country where more people have expressed discontent with their sex lives than those that have expressed fulfilling sex lives, an important major reason being that they are simply not having sex. [ 31 ]   Homebuilders in Japan have also observed that more than a third of homes built feature separated bedrooms for married couples, suggesting that even married couples are less inclined to have sex than married couples in other cultures. [ 31 ]


Japanese citizens' dissatisfaction with their sex lives can be partially attributed to their work culture, whose work hours can be considered lengthy in comparison to other work cultures. According to Michael Zielenziger, Japan's lengthy work hours has led couples to spend less time with each other, have reduced contact, and therefore have less sex. [ 31 ]  Japan's sexual repression can also be partially attributed to societal and business expectations, which generally expect that women should abstain from marriage, which is a major indicator of sex likelihood. [ 31 ]  Although Japan's work hours have even shrunk down to the United States' level of work hours per week, [ vague ]  large amounts of sexual dissatisfaction and repression are still observed. One reason for these observations is that Japan's economy has been stagnating and has contributed to more unemployment. These factors generate stress, which plays a significant role in forming an unpleasant sex life according to Durex. [ 31 ]


Russian history of sexual repression and LGBT rights includes an oscillation of attitudes, caused by both governmental interference and changing societal norms. [ citation needed ]


Soviet society in the past considered sex to be taboo and unacceptable to talk about. People sometimes expressed fear of losing their job and experienced shame from people they knew for simply using the word 'sex' openly due to the fact that discussion regarding the topic of sex in the Soviet Union was almost nonexistent. [ 32 ]  Near the end of the Soviet Union, however, the country would undergo major changes when it came to sex. Organizations and media such as  Tema  and  The Moscow Association of Lesbian Literature and Arts , which focused on sexual liberation, were created and promoted the discussion of sex in Russian society. [ 32 ]


The USSR's collapse also made way for LGBT rights to come to the forefront of societal issues. In 1993, Russia decriminalized homosexuality and set the precedent for future sociopolitical changes. New outlets of media - including pornography - regarding homosexuality were released within these years of social change. [ 32 ]  However, these changes would soon be quickly turned around when Vladimir Putin was elected in 2000. Despite previous failed attempts to revert the 1993 decriminalization of homosexuality, the Russian government created a turning point against LGBT rights in 2013 when Russia passed the  gay propaganda law , which signaled Russia's return to more conservative and traditional values. [ 32 ]  The sexual repression of homosexuals with the passing of this law was partly because Russia wanted to portray itself as different from Western countries and demonstrate strength through these differences. [ 32 ]


In the last few decades the United States has been removing much of the legislation tied to sexual repression of various groups. [ citation needed ]


The first half of the 1960s saw contraceptions such as the  birth control pill  and  Intrauterine Device  (IUD) become widely available, which contributed to sexual freedom for many people without having to rely on less reliable and uncomfortable physical contraceptives such as  condoms  or  diaphragms . [ 33 ] [ 34 ]  However, religious and conservative lobbying groups as well as the influence of  neo-eugenics  created push back on some other forms of birth control such as  emergency contraception  and  tubal ligation . Emergency contraception was being developed and produced by  Hoechst  under the name  RU-486 . Conservative lobbyist groups with ties to various religious powers such as the  Vatican , originally were promoting limiting healthcare coverage of items such as birth control, and once RU-486 was made public knowledge, these groups actively worked to threaten Hoechst by claiming they would cause the company financial hardship if they did not cease all activity pertaining to RU-486. [ 35 ]


In terms of more permanent forms of birth control such as tubal ligation and  hysterectomies , there has been a long history of  eugenicists  pushing for forced sterilization of non Anglo-Saxon or lower-class women. This stemmed from a belief that this would contribute to the betterment of American society.  However, neo-eugenics, which is the more modern iteration of the eugenics movement, additionally works to limit access of procedures of sterilization from those they deem “fit” to reproduce. The demographic targeted for this are mostly white middle-class women. [ 36 ]


During the late 1990s and the  Bush administration  (2000–2008)  abstinence-only sex education  groups were given considerable government funding to develop programming for schools. [ 37 ]  These groups were mostly represented by Christians who believed it to be their responsibility to address what they deemed as society's regressions towards a sex-based culture. Abstinence advocates generally focus on prohibiting sexual contact before heterosexual marriage. This has been linked to instigating a culture of sexual repressiveness affecting adolescent sexual behaviors, regardless of their sexuality. [ 38 ]  Research concerning the effectiveness of different forms of sex education for adolescents shows the highest success from comprehensive sex education. Characteristics of comprehensive sex education include informing students on the forms of birth control and how to use them, and sexual anatomy. [ 39 ]  The  Obama administration  (2008–2016) worked towards promotion of comprehensive sex education programming and pulled much of the government funding supporting abstinence-only program development. [ 39 ]


Sexual repression can be expressed but not limited to the following: [ medical citation needed ]


Sexual script theory  states that all social behavior, including sexual behavior, is socially scripted.  The theory was introduced by sociologists  John H. Gagnon  and  William Simon  in their 1973 book  Sexual Conduct . Its basic principle states that all social behavior, including sexual behavior, is socially scripted. [ 1 ]  Furthermore, it is the approved norms about   how individuals in a relationship may embrace one another, embody, and react to each other via the process of socialization.  [ 2 ]  The idea is that sexual scripts are guidelines for appropriate sexual behavior and sexual encounters. Sexual behavior and encounters become behavior that is learned as well as instinctive. [ 1 ]  Each partner in consensual encounters acts as if they are an actor in a play or film following a script, rather than acting on impulse alone. [ 2 ]  Therefore people in a relationship may draw upon this idea when thinking about their own sexual experiences or when participating in sexual acts themselves.  [ 2 ]


Research on sexual scripts and sexual script theory has concluded that sexual scripts are gendered. [ 3 ]
In most Western cultures, the way a society is set up and its rules help shape how people act. [ 3 ]  For example, marriage laws and vows, as well as laws against certain sexual behaviors or relationships, all play a part in guiding people's behavior. [ 3 ]  It's customary for the male to indicate, or at least present, a greater initial enthusiasm in sexual relations in a typical male-female romantic relationship. [ 3 ]  It may raise doubts about his masculinity, sexual prowess, and fertility if he doesn't show off a great deal of passion early in the relationship. [ 3 ]  On the other hand, the woman can start to question her own sexual appeal. [ 3 ]  This is due to the misconception that males are usually eager to get sexually excited, thus it could be detrimental to her self-esteem if he shows no sign of interest. [ 3 ]  She should be cautious not to come across as overly eager to engage in sexual activity, even if it is believed that she will be open to a sexual connection. [ 3 ]


Thus, sexual scripts have been described by researchers as a form of  social construction . [ 4 ]  Sexual Script Theory (SST) and its application in clinical practice are founded on the idea that the subjective understandings of each person about their sexuality (and called a sexual script) substantively determine that person's choice of sexual actions and the subsequent qualitative experience of those sexual acts. Scripts refer to social functions. [ 4 ]  They dictate what one should be doing at a particular time and in a particular place if one is to play the role characteristically associated with that script. [ 4 ]  There may be several people involved in the same situation, but they may differ in the roles that they have been given or have chosen to enact. It is a cognitive schema that instructs people how to understand and act in sexual situations. [ 4 ]


A key learning factor in understanding sexual script theory is social constructionism, which is, "the interpretation of reality, including human behavior, is derived from shared beliefs within a particular social group." [ 1 ]  Regarding sexual human behavior, the meanings attached to those behaviors, including what makes them “sexual” behaviors, derives from metaphorical scripts individuals have learned and incorporated as a function of their involvement in the social group. [ 1 ]  According to Gagnon and Simon, “Scripts are involved in learning the meaning of internal states, organizing the sequencing of specifically sexual acts, decoding novel situations, setting the limits on sexual responses and linking meanings from nonsexual aspects of life to specifically sexual experience.”  [ 1 ]  Gagnon and Simon layer sexual script theory in three levels, they state, "Scripts are a metaphor for conceptualizing behavior within social life. Most of social life most of the time must operate under the guidance of an operating syntax, much as language is a precondition for speech. For behavior to occur, something resembling scripting must occur on three distinct levels: cultural scenarios, interpersonal scripts, and intrapsychic scripts." [ 1 ]


Gagnon and Simon also note that the most prominent and affected have "age requirements" such as “You cannot engage in X until you are Y years of age,” or “By age Y you must have done X.” [ 1 ]  Gagnon and Simon further elaborate by stating,


"Common scripts themselves may have variants based on the relative ages of the actors, or at least the actors within a particular script are evaluated differently based on their respective ages. Adolescence and early adulthood are the most troubling stages for individuals and for the culture to which such individuals belong; it is during these stages that individuals develop and refine their interpersonal and intrapsychic sexual scripts. [ 1 ]  “The major cultural scenarios that shape the most common interpersonal scripts tend to be almost exclusively drawn from the requirements of adolescence and early adulthood. There are virtually none tied to the issues of subsequent segments of life.”  [ 1 ]


Simon and Gagnon also note the extreme ends of the lifecycle might be that of the presexual (childhood) and the postsexual (old age), at least in terms of predominant, shared scripts. [ 1 ]  They go on to explain, “Not that sexually significant events do not occur during these periods, but they are not or only rarely anticipated in prevailing cultural scenarios dealing with the very young and the very old." [ 1 ]


While Simon's and Gagnon's sexual script theory is novel and has been withstood since its release, they were not the first to suggest society influences human behavior and human sexual behavior. [ 1 ]  According to author Micheal Wiederman, "sexual script theory is a logical extension of symbolic interactionism, a term coined by sociologist Herbert Blumer in the 1930s based on the work of his mentor, sociologist George Herbert Mead who stated, “Symbolic interactionism focuses on how meaning is created, modified, and put into action by individuals in the process of social interaction." [ 1 ]  At the time of its creation Simon and Gagnon noted that, "their perspective was a reaction to the dominant theoretical views of human sexuality at the time: psychoanalytic and biological." [ 1 ]  In addition, Simon and Gagnon were not the first to employ the script metaphor to social interactions, sociologist Erving Goffman presented dramaturgy as a sociological perspective, likening human social interaction to the performance of assumed roles in a theatrical production. [ 1 ]


Before Simon and Gagon's theory, the dominant perspectives of sexual behavior had already been determined, by instincts or drives, inherently tied to human biology. [ 1 ]   Sigmund Freud  had established his psychoanalytic theory towards life and procreation called Libido, which may find natural and healthy expression or may be distorted into psychopathology. [ 1 ]  Freudian psychoanalytic perspectives on sexuality continued to hold sway even as biological perspectives rose to attention. [ 1 ]  Other prominent researchers such as  Alfred Kinsey , and  Willam Masters and Virginia Johnson , had published articles on human behavior and sexual behavior long before Simon and Gagnon. [ 1 ]  Alfred Kinsey cataloged the sexual behaviors of respondents and plotted them against such variables as age, sex, and social class. [ 1 ]  While Willam Masters and Virginia Johnson focused their research and therapy on bodily response to sexual stimuli; work is based on the assumption that there is universal, and therefore natural, sexual functioning. [ 1 ]  Simon and Gagnon's sexual script theory seemed to have come at a time when several researchers in the 1960s and 1970s were appealed by the social constructionism approach because many cultural events during that time, called into question essentialist perspectives that had been taken for granted previously. [ 1 ]  In addition, Simon and Gagnon considered sexual scripts as explicitly interwoven with gender scripts, and feminist movements at the time were calling into question assumptions about male and female, and the extent to which these assumptions were inevitable versus products of culture and socialization. [ 1 ]  Their theory came at a significant time in history with vast cultural changes in the United States. [ 1 ]


Paul Wright's 3AM theoretical framework is another method that has been used in research pertaining to sexual scripts and pornography. [ 5 ]


Wright has developed a "sexual script acquisition, activation, application model (3AM) of sexual socialization that explains how consumption of sexual media can impact attitudes and behaviors." [ 5 ]  Through the socially constructed scripts that guide what is behaviorally acceptable or unacceptable in human behavior, sexual media influence occurs through the provision of scripts. [ 5 ]  According to the 3AM, "sexual media can provide consumers with scripts they were unaware of (acquisition), prime scripts they were already aware of (activation) and encourage the utilization of scripts by portraying particular sexual behaviors or general patterns of sexual behavior as normative, appropriate, and rewarding (application)." [ 5 ]


Drawing upon  conversational analysis , sexual encounters are considered to be scripted if the parties involved use any of these five linguistic devices: [ 6 ]


Research on sexual scripts and sexual script theory has concluded that sexual scripts are organized through gender, class, ethnicity, and other social vectors. [ 6 ]


Sexual script theory and its application in clinical practice are founded on the undeniable reality that the subjective understandings of each person about his or her sexuality (and called a sexual script) substantively determine that person's choice of sexual actions and the subsequent qualitative experience of those sexual acts. [ 3 ]  Scripts refer to social functions. [ 3 ]  They dictate what one should be doing at a particular time and in a particular place if one is to play the role characteristically associated with that script. [ 3 ]  There may be several people involved in the same situation, but they may differ in the roles that they have been given or have chosen to enact. [ 3 ]  Script theory is a form of social scripting theory that has been defined clearly by Michael W. Wiederman: "Social scripting theory points to the fact that much of sexual behavior seems to follow a script. [ 3 ]  Similar to scripts that stage actors use to guide their behavior, social scripts instruct members of a society as to appropriate behavior and the meanings to attach to certain behaviors." [ 3 ]


Social scripting theory directly relates to sexual scripts, as it is just a specified example regarding sexual encounters and sexual behavior in a social context. [ 3 ]   Social theory  is also a useful resource in determining the construction of social scripts. [ 3 ]


The theory is linked to the wider development of  social constructionism  Social construction determines what acts are deemed appropriate. For example, sexual acts should happen in private. [ 7 ]  This is an important term for sexual scripts because these scripts can be exposed to children at a young age due to exposure to media and social norms. [ 7 ]  In other words, women are to be subjected to  male gaze  to be a part of the social construction system and maintain the social norms of a long-living society. [ 7 ]  This term not only determines how women view men, but also how they view themselves. When a man looks at a woman, the woman focuses on herself being looked at. [ 7 ]  She starts to view herself from another person's point of view and makes perspective her focal point whenever she sees herself in a mirror. [ 7 ]


The social construction of sexuality can be traced back to the medieval times through art. [ 7 ]  The presentation of the female body in art changes over time based on the time and the cultural changes. [ 7 ]  The opinion of society changes what the idea of women should look like. [ 7 ]  Currently, in society we see art and the media portray females as slim with exaggerated features. [ 7 ]  Women construct their physical features to attract to the male gaze. [ 7 ]  This has remained prevalent in our media throughout history. [ 7 ]


A  sexual norm  can be an individual or a social norm, which is a rule that is socially enforced. [ 8 ]  Sexual norm relationships are shaped by the traditional stereotypes surrounding sex and gender when it comes to males and masculinity and females and femininity. [ 8 ]   For example, many associate male social norms with assertiveness, aggressiveness, sexual adventurism, and emotional restraint. [ 8 ]  For females the social norms of femininity is delicate, passive, sexually modest, and emotionally sensitive. [ 8 ]  Sex and gender stereotypical norms can have negative impacts on a couples, sexual, emotional, psychological aspects of a relationship. [ 8 ]  Norms affect a wide variety of human behavior as Social norms regarding sexuality are present in most cultures. [ 8 ]  For example, the norm in most cultures consists of heterosexual acts between married individuals. Sexual norms are constantly changing and normal sexual behavior is a spectrum and cannot be rigidly defined. [ 8 ]


Deviance from normal sexual behavior is common and can be classified in several ways. If non-restrictive sexual norms are regarded positively they may be called "sexual freedom", "sexual liberation", or "free love". [ 9 ]  If regarded negatively they may be called "sexual license" or "licentiousness". Restrictive behavior when judged negatively is called "sexual oppression"; if judged positively they are called "chastity", "sexual restraint", or "sexual decency" is considered to be used for targeted sexuality.  [ 9 ]  In the west, sexual normality can be defined as any sexual practice which does not involve sexual perversions. [ 9 ]  There has been a liberalization in attitudes which has resulted in the legalization of homosexuality in many countries. [ 10 ]  There is a tendency in Western countries toward serial monogamy as a normal heterosexual lifestyle. [ 10 ]


Gender schema theory  also plays a part in the sexual script because studies show that males and females interact in different ways, even from a young age. [ 11 ]  In 1991, Martha Boston and Gary Levy found that through their research observations, children, primarily boys, were better with being able to sequence own-sex rather than other-sex scripts. [ 11 ]  "As well as acquiring knowledge about the sex-role stereotypes of their culture, young children also develop sex-typed attitudes, preferences, and behaviors that pervade many aspects of their lives." [ 12 ]


From an early age, men are often raised to embrace their sexuality, but women are usually brought up to suppress it. [ 13 ]  Anatomically, boys have the benefit (or curse) of genitals that are more easily viewed and handled by their owners. The young boy is taught to hold onto his penis to urinate and to handle it for purposes of washing. [ 3 ]  Conversely, the young girl is not taught to touch her clitoris. [ 3 ]  She is taught to wipe carefully after urination to avoid contracting an infection by transferring bacteria from her rectum to her vagina. The result is that boys and girls are given two subtly different sets of messages regarding their genitals. [ 3 ]  Boys readily discover that their genitals feel good when handled and are not necessarily any "dirtier" than other parts of their body that they can see. [ 3 ]  Girls readily learn that their genitals are difficult, if not impossible, for them to see and that there are "dirty" aspects, which require appropriate precautionary measures. [ 3 ]  Similarly, gender roles may encourage sexual exploration more for boys than for girls. [ 3 ]


A double standard exists in the traditional heterosexual sexual script. It endorses different sexual behavior for women and men in which women are expected to confine sexual behavior to the context of a committed relationship, and men are expected to engage in sexual behavior in all kinds of relationships. [ 3 ]  Young adult men who have not realized that their female peers hold a different set of sexual scripts are often perplexed. [ 3 ]  When young adults have finally gained a marked increase in privacy from family (such as going away to college or getting married), it often seems obvious to young men that sexual activity should "naturally" occur since a major barrier has been overcome. [ 3 ]  Females who take such a view run the risk of being labeled deviant. To be too sexually interested or aggressive, especially outside the context of an intimate relationship, implies masculinity, desperation, or some other flaw. [ 3 ]


Kennair et al. (2023) found no signs of a sexual double standard in short-term or long-term mating contexts, nor in choosing a friend, except that women's self-stimulation was more acceptable than men's. [ 14 ]


Ellen van Oost uses the concept of gender script "to illustrate the ways that the design of technological artifacts are affected by the gender assumptions held about their 'envisioned users'. [ 15 ]  " Drawing from Akrich's argument that "like a film script, technical objects define a framework of action together with the actors and the space in which they are supposed to act," van Oost extends the script approach to include the gender aspects of technological innovation. [ 15 ]  van Oost looks at the ways electric shavers are gendered for men and women starting in the late 1920s, including the "cigar" model for men and the "lipstick model for women." [ 16 ]  Van Oost also argues that the development of the electric razor systematically constructs a gender script of technological incompetence as feminine, and "inhibits the ability of women to see themselves as interested in technology and as technologically competent, whereas the gender script of [electric razors "for men"] invites men to see themselves that way. [ 16 ]  In other words: [electric razors] not only [produce] razors but also gender." [ 16 ]


Sexual scripts influence sexual health decisions for all sexually active people. [ 17 ]  As previously mentioned, sexual scripts are the socially constructed guidelines for human sexual behavior. According to psychology scholar Lindsey L. Ross-Bailey, "Women may abide by the sexual script that, “Women must maintain a feminine role by being submissive to male partners.” [ 17 ]  Women who endorse this sexual script may lack the assertiveness skills needed to initiate purchasing condoms, providing condoms, and enforcing condom use." [ 17 ]  The sexual script of "Men should be responsible for providing the condoms during sex", reigns prominent in heterosexual sexual encounters. [ 18 ]  Women who believe this sexual script are unlikely to carry condoms ever and, if sexually active, are at a greater risk of contracting STIs. [ 17 ]  Women who carry condoms carry the sexual script of being "promiscuous." [ 18 ] [ 17 ]


In the LGBTQIA community, the "bottom" and "top" terms are socially constructed sexual scripts. [ 19 ]  These terms indicate whether a person in a homosexual sexual encounter or relationship is the more "masculine" or "man" or the more "feminine" or "woman". [ 19 ]  Because of this distinction, the condom usage responsibility and all preconceived "male" sexual scripts are assumed under the "top" responsibilities. [ 19 ]


Sexual scripts in media have a great influence on young people and adolescents. [ 20 ]  According to researcher Rebecca Ortiz, "Greater exposure to sexual media content has been associated with stronger endorsement of recreational attitudes toward sex, increased intentions to have sex, earlier sexual initiation and even increased likelihood of adolescent pregnancy." [ 20 ]  Because a majority of young and adolescent people lack sexual experiences, they seek out media outlets to form their expectations and ideas about sexuality and sexual behavior. [ 20 ]


However, according to Ortiz, "less is known about how, why, and which sexual portrayals affect young viewers. [ 20 ]  The proliferation of stereotypically-gendered sexual messages in the media is of particular concern because constant exposure may lead to reinforcement of such stereotypes by viewers and could negatively affect their sexual well-being." [ 20 ]  These stereotypes typically aim to push further the narrative and traditional sexual scripts of "Women being submissive to men" and "men as dominating". [ 20 ]  According to Ortiz, this is called the Heterosexual Script, "The heterosexual script includes depictions of gender inequality between heterosexual partners, where male characters are often portrayed as sexual initiators and aggressors, while female characters are passive recipients and sexual gatekeepers who prefer love and affection over sex." [ 20 ]


Sexual scripts have distinct gender role differences and play a huge role in how people view and express themselves sexually. [ 20 ]  The female script looking typically for love and affection and waits for the man to make the first move. [ 20 ]  While the male script is looking for multiple sexual partners and praise for their sexual endeavors. According to Ortiz, this leads to the sexual double standard, "Such gender differences have been called the sexual double standard, such that men and women are subject to different “rules” of sexual behavior." [ 20 ]  Agreeing with this double standard can negatively impact both men and women. Women may learn to suppress their sexual desires and begin viewing themselves as sexual objects. [ 20 ]  Men who agree with this double standard are more likely to agree with rape myths and find them justifiable as well in the objectification of women. [ 20 ]  They are also more likely to believe in "token resistance", which states that women who say "no", really mean "yes". [ 20 ]


These gendered sexual scripts are exhibited heavily in mainstream media. [ 21 ]  There is a clear indication that people with excessive use of mainstream media who support these gendered sexual scripts are more linked to "greater psychological distress, diminished sexual agency, and more dysfunctional beliefs about relationships", this is especially true in young adults and adolescents, who have been linked to struggle individually and within their relationships. [ 21 ]


Rape script is also very prevalent in the media. [ 22 ]  It is defined as the stereotypes or false beliefs about rape, its victims, and rapists. [ 22 ]  These stereotypes are heavily influenced by religion, law, and the media. [ 22 ]  Rape scripts are the beliefs of the nature of rape, the roles of genders as well as domination and vulnerability are a large part of these beliefs. [ 22 ]  Many victims of rape look to the real rape script to determine whether they experienced rape. [ 22 ]  The real rape script describes the stereotypical story of the woman walking alone late at night when a man comes up behind her and proceeds to act violently and rape her. [ 22 ]  Many women do not believe they've been raped when comparing their experience to the real rape script due to the lack of violence as well as many other factors. [ 22 ]  The rape script is used in many ways, in movies, on the news, and on social media. [ 22 ]  Due to this, many victims end up getting blamed for their actions. [ 23 ]  As a result of victim blaming, many victims are afraid to come forward because they are afraid no one will believe them. [ 23 ]


Men's sexual scripts and pornography often correlate because they tend to legitimize gendered script stereotypes. [ 24 ]  Studies have found that pornography consumptions lead to a more sexual open-mindedness and non-judgmental outlook on sexual behavior, such as premarital sex, one-night stands, having multiple sex partners, and casual sex. [ 24 ]  This is especially true in male pornographic consumers, according to scholar Paul J. Wright. [ 24 ]


"...two recent national longitudinal studies of adults aged 45 years on average found that present pornography consumption predicted subsequent permissive sexual attitudes and casual sex behavior. [ 24 ]  Even more relevant is an experimental study that found that showing males pornography led to more support for “the view that parties should be free to form and discontinue intimate relationships without regulations by any government”. [ 24 ]  Second, there is evidence that pornography activates sexual scripts supportive of traditional masculinity. [ 24 ]  Interrogations of pornography carried out by humanistic scholars find that pornography portrays men as sexually powerful, controlling, aggressive, and dominant." [ 24 ]


The sexual scripts created and enforced in pornographic content create sexually expressive and open-minded views on sexual behavior, but they reinforce potentially harmful male sexual scripts. [ 25 ]  Research also suggests that sexual behavior found in pornographic content forms "how people are expected to perform and react when engaging in sex." [ 25 ]


According to scholar Farnosh Mazandarani, on-screen interactions in pornographic content are often studied and examined by scholars. Still, she argues that physical representations in pornographic content are vastly overlooked and a major factor in establishing sexual scripts. [ 25 ]  Mazandarani found that women in pornography are "four times more likely to be physically represented within a scene than men. [ 25 ]  When on-screen, male performers are more likely to have cameras actively move to cut them out of the shot (29% of the time) than females (4% of the time)." [ 25 ]  In fact, the framing of men's faces is sometimes entirely cut out of scenes or made silent. [ 25 ]


These differences in physical representations can majorly impact sexual scripts and sexual expectations. [ 25 ]  According to Mazandarani, "pornography is thought to provide a common script, or formula, for (1) what constitutes a sexual encounter, (2) what types of people should participate in a sexual encounter, (3) what events should or should not occur during a sexual encounter, (4) what verbal and nonverbal responses may be expected during an encounter, and (5) what possible consequences may occur when engaging in particular sexual scenarios." [ 25 ]  For many, pornography is viewed as a driving force to creating male and female sexual scripts. [ 25 ]


The theory has now been applied to a wide range of areas such as the following:


Writer Rictor Norton's critique of sexual scripts strongly suggests that Simon and Gagnon's sexual script theory is too restrictive. [ 32 ]  He states "that the theory of “sexual scripts” is an inadequate tool for understanding sexuality." [ 32 ]  Norton claims that society is not the driving the force in understanding sexuality, he claims that sexuality comes from the individuals own desires and morals. [ 32 ]  According to Norton, "it seems to me that this behaviourist model is even more determinist than the biological model, which suggests that erotic desire is a powerful motive force arising from within, which has the capacity of resisting the social forces that would attempt to restrain or redirect it." [ 32 ]


To add to this, researcher David Gurnham's critique of sexual scripts argues that the traditional sexual script between heterosexual men and women limits a woman's agency. [ 33 ]  He argues, "consent-giving according to the traditional script presupposes a more passive role for women, with the consequent implication that males may feel that their scripted role entitles them to use deceptive or coercive means [...] render consent invalid or at the very least severely compromised." [ 33 ]  Gurnham argues that this has the potential to lead to sexual acts made to "keep the peace" in potentially abusive relationships or dangerous situations. [ 33 ]  Gurnham further elaborates by stating this acceptance of traditional sexual scripts could lead to non-consensual sexual activity, "where a woman consents to sexual activity X (say, vaginal sex), which the male partner assumes to constitute tacit consent to sexual activity Y (say, anal sex), sexual attitudes research suggests that some people who affirm the traditional sexual script may not recognize any wrongdoing." [ 33 ]  He argues that traditional sexual scripts have the potential to do more harm, than good. [ 33 ]


Sexual stimulation  is anything that leads to  sexual arousal  or  orgasm . This thing can be physical or of other senses, and is known as a  stimulus .


Sexual stimulation is a broad term, usually understood to mean physical touching of the genitals or other body parts. The term can, however, include stimuli affecting the mind ( sexual fantasy ), [ 1 ]  or senses other than touch sight, smell, or hearing). Sufficient physical stimulation of the genitals usually results in an orgasm. [ 2 ] [ 3 ] [ 4 ] [ 5 ]  Stimulation can be  by oneself  ( masturbation  or  sexual fantasy ) or by a  sexual partner  ( sexual intercourse  or other  sexual activity ), by use of  objects or tools , or by some combination of these methods. [ 6 ]


Some people practice  orgasm control , whereby a person or their partner controls the level of stimulation to prolong the experience leading up to orgasm.


Physical sexual stimulation consists of touching the genitals or other  erogenous zones .


Masturbation ,  erotic massage , and  manual sex  are types of physical stimulation involving the genitals. This stimulation is usually from sensitive  touch receptors  in the skin or other erogenous zones, which detect when they're being touched.  Arousal  is triggered through these receptors in these body parts, [ 7 ]  which cause the release of pleasure-causing chemicals ( endorphins ) that act as mental rewards to pursue such stimulation. Someone may become aroused by simply touching another person, though the  bulbocavernosus reflex  only occurs when a sexual organ (penis or clitoris) is stimulated. [ 8 ]


One study found that women benefit more from pleasurable sex with a committed partner, while gender did not impact the relationship with masturbation. [ 9 ]


The purpose of  sex toys  is to provide pleasure and stimulation through an alternative route than just using people's bodies. They can be used by someone on their own, with partnered sex, or group sex. They can be exciting and provide new types of stimulation that the body cannot produce, such as vibrations.


Sex toys have been used as a source of sexual stimulation for thousands of years. There have been  dildos  found from the  Palaeolithic era , [ 10 ]  made of  siltstone  and polished to a high gloss. Dildos were also made of camel dung and coated with resin. [ 11 ]  Historians are uncertain whether these have been used for  religious rituals  or for personal pleasure. It is known that dildos were used for  fertility rituals , [ 12 ]  however. The  ancient Greeks  created their dildos from a carved penis covered in leather or animal intestines to create a more natural feel. [ 12 ]  The Romans created double-ended dildos for use with a partner. Ancient Chinese dildos were made of  bronze  or other metals and some were hollow allowing them to be filled with liquid to simulate an  ejaculation . [ 13 ]  These were used because wealthy Chinese men would often have too many wives to please. In Persia, it was thought that the blood of the  hymen  was  unclean , and should be avoided by husbands. On the night before a woman's wedding, a local holy man would come and break her hymen with a large stone dildo, a ritual also used to confirm the virginity of the bride. [ 14 ]


There are many areas through which a person can be sexually stimulated, other than the genitals. For example, the nipples, thighs, lips, and neck can all provide sexual stimulation when touched.


This table [ 21 ]  shows the sex differences in erogenous zones and includes the top ten most arousing areas for both sexes. Each body part was rated out of ten for how arousing it is when touched. Apart from body parts exclusive to one gender such as the penis or clitoris, many of the erogenous zones are similar and contain many nerve endings.


The  excitation-transfer theory  states that existing arousal in the body can be transformed into another type of arousal. For example, sometimes people can be sexually stimulated from residual arousal arising from something such as exercise, being transformed into another type of arousal such as sexual arousal. In one study [ 22 ]  participants performed some physical exercise and at different stages of recovery had to watch an erotic film and rate how aroused it made them feel. They found that participants who were still experiencing excitatory residues from the exercise rated the film as more arousing than those who had fully recovered from the exercise. This suggests that the remaining arousal from the exercise was being transformed into sexual arousal without any external stimulation.


The human sexual response is a dynamic combination of cognitive, emotional, and physiological processes. Whilst the most common forms of sexual stimulation discussed are  fantasy  or physical stimulation of the genitals and other erogenous areas, sexual arousal may also be mediated through alternative routes such as visual, olfactory and auditory means.


Perhaps the most researched non-tactile form of sexual stimulation is visual sexual stimulation. [ 23 ] [ 24 ] [ 25 ]  An apparent example is the act of  voyeurism  – a practice where an individual covertly watches another undress or engage in sexual behaviour. Although seen socio-historically as an unacceptable form of ' sexual deviation ', it highlights the human tendency to find sexual stimulation through purely visual routes. The multibillion-dollar  porn  industry is another example. A common presumption is that men respond more strongly to visual sexual stimuli than do women. This is perhaps best exemplified by the  Kinsey  hypothesis that men are more prone to sexual arousal from visual stimulation than are women. [ 26 ] [ 27 ]  Nonetheless, both sexes can be sexually aroused through visual stimulation. In one study, visual stimulation was tested by means of an erotic video. Although significantly higher in the male group, sexual arousal was the main emotional reaction reported by both sexes. Their physiological responses to the video also showed characteristics of sexual arousal, such as increased urinary excretions of  adrenaline . [ 28 ]  A subsequent study investigating male arousal showed that men were able to achieve rigid  erections  through visual stimulation of an erotic film alone. [ 29 ]


Studies that use visual stimulation as a means for sexual stimulation find that sexual arousal is predominantly correlated with an activation in  limbic  and  paralimbic cortex  and in  subcortical  structures, along with a deactivation in several parts of the  temporal cortex . These same areas are activated during physical sexual stimulation, highlighting how powerful visual stimulation can be as a means of  sexual arousal . [ 30 ]


Olfactory information is critical to human sexual behavior. One study investigating olfactory sexual stimulation found that heterosexual men experience sexual arousal in response to a female perfume. Individuals rated odourant stimulation and perceived sexual arousal. They also had  functional MRI  scans taken during the experiment. The results showed that olfactory stimulation with women's perfume produces activation of specific brain areas associated with sexual arousal in men. [ 31 ]  Another study found that homosexual men displayed similar  hypothalamic  activation to that of heterosexual women when smelling a testosterone derivate present in male sweat, suggesting that  sexual orientation  plays a role in how humans experience olfactory sexual stimulation. [ 32 ]


Evolutionary analysis of sex differences in reproductive strategies can help explain the importance of smell in sexual arousal due to its link to immunological profile and offspring viability. [ 33 ]  This is because olfactory cues may be able to trigger an  incest  avoidance mechanism by reflecting parts of an individual's genetic equipment. In one study, males rated visual and olfactory information as being equally important for selecting a lover, while females considered olfactory information to be the single most important variable in  mate choice . Additionally, when considering sexual activity, females singled out  body odour  from all other sensory experiences as most able to negatively affect desire. [ 34 ]


Auditory stimulants may also serve to intensify sexual arousal and the experience of pleasure. Making sounds during sexual arousal and sexual activity is widespread among primates and humans. These include sighs, moans, strong expirations and inspirations, increased breathing rate and occasionally, at orgasm, screams of ecstasy. Many of these sounds are highly exciting to people, and act as strong reinforcers of sexual arousal, creating a powerful positive feedback effect. [ 35 ]  Thus,  copulatory vocalisations  are likely to serve mutual sexual stimulation for mating partners. [ 36 ]


Even when not coupled with "touching", sounds can be highly sexually arousing. Commercial erotic material (mainly produced for the male market) uses such sounds extensively. As early as the 1920s and 30s, several genres of singers turned to "low moans" for erotic effect.  Vaudeville  Jazz singers often incorporated sex sounds into the narrative of the lyrics. Even contemporary music such as  Prince 's "Orgasm" or  Marvin Gaye 's " You Sure Love to Ball " includes sounds of the female orgasm. [ 37 ]  Research has shown music to be an auditory sexual stimulant. In one mood induction study, exposure to certain music resulted in significantly greater  penile tumescence  and subjective sexual arousal for men. [ 38 ]  In a similar experiment, women did not show significant physiological responses to certain types of music but did report higher levels of sexual arousal. [ 39 ]  Further studies have looked at the connection between auditory stimulation and the experience of sexual pleasure. Whilst the highest levels of physiological and subjective arousal were found for visual stimuli, spoken-text was found to elicit sexual arousal in men, implicating sounds as a means of sexual stimulation. [ 40 ]   Phone sex  is one type of arousal inducer that makes use of this effect.


Sexual arousal includes feelings, attractions and desires, as well as physiological changes. [ 41 ]  These can be elicited not only by physical but also mental stimulations, such as  fantasy , erotic literature, dreams, role-play, and imagination.


Sexual fantasy  is a form of mental sexual stimulation which many people engage in. [ 41 ]  It is where a person imagines a sexual experience while they are awake. Fantasy has less social or safety limits than in real life situations. It gives people more freedom to experiment or think of things they could not necessarily try in real life and can be anything from imagining your spouse naked, to imagining a sexual experience with a mythical creature. Common sexual fantasies include imagining activities with a loved partner, reliving past experiences and experiences with multiple partners of the opposite gender. [ 41 ]  It is also common to have fantasies about things you would not do in real life and about taboo or illegal activities, such as forcing another, or being forced by another to have sex, intercourse with a stranger and sex with a boy or girl or older partner. [ 41 ] [ 42 ]


It is useful for research because it makes differences between male and female heterosexual preferences clearer than studies of behaviour. Many sexual fantasies are shared between men and women, possibly because of cultural influence. [ 42 ]  However, there are still gender differences that have been found. Men are more likely than women to imagine being in a dominant or active role, whereas women are more likely to imagine themselves as passive participants. [ 42 ]  Women's fantasies have significantly more affection and commitment, [ 43 ]  whereas men are more likely to fantasise using visual imagery and explicit detail. [ 44 ] [ 45 ]  One explanation of this difference comes from the  evolutionary perspective . Women have a higher minimum parental investment than males (they have 9 months of gestation prior birth and are then the main care givers, whereas men only have to provide sperm to ensure their genes are passed on) and are therefore more likely to want commitment from their partner in order to gain resources to improve their offspring's chance of survival. [ 46 ]


Fantasies can have benefits, such as increasing arousal more than other forms of sexual stimuli (such as an  erotic story ) and increasing  sexual desire . [ 47 ] [ 48 ]  Individuals who disclose their sexual fantasies to their partners also have a higher sexual satisfaction. However, whether people are willing to open up to their partner generally depends on the content of such fantasies. [ 49 ]  A more negative effect of sexual fantasy is that it has been linked with  sexual crimes , and indeed sexual offenders often report that they have had fantasies related to their offense. [ 42 ]  However, such fantasies are also common among those who have not been involved in such criminal acts [ 42 ]  and non-offenders do not use their fantasies to guide their behaviour. [ 50 ]  Therefore, fantasy alone cannot be used as a sign that someone will become an offender. [ 42 ]


Nocturnal emission  orgasms or "wet dreams" or "erotic dreams" are when people ejaculate or orgasm during sleep. [ 51 ]  These occur during  REM (rapid eye movement)  phases of sleep, [ 41 ]  which is the main stage when humans dream. [ 52 ]  This implies that erotic dreams alone are enough to stimulate men, but erections accompany all REM phases. [ 41 ]  According to self-report data, as many as 22% of young women may also experience  orgasm  during sleep, with such dreams being more common in college students in higher school years than younger students. [ 53 ]  The orgasms experienced were positively correlated with high emotionality, including  sexual excitement , but also  anxiety . [ 53 ]


Sexual role-play  is when people act out characters or scenarios which may sexually stimulate each other. This can include  fantasies  (discussed above) and  fetishes , such as  BDSM  (bondage and discipline, dominance and submission, sadism and masochism) or  age-play . It has been described by some as an adult form of  L.A.R.P  (live action role-play). [ 54 ]  Role-play can also be carried out online, by typing stories to each other or pretending to be a character, and is therefore a form of mental stimulation you can engage in with another person without them being physically present. Many adolescents find online role-play pleasurable and arousing. [ 55 ]


Role-play can also include sexual  fan fiction , where characters from well-known stories, that were not sexually or romantically together in the original story, are written into sexual scenes.  Slash fiction  is a type of fan fiction where the characters of the same sex (originally male-male) engage in romantic or sexual activities. Slash fiction allows people the freedom to share stimulating things that can be counter-cultural. [ 56 ]


According to the National Library of Medicine, approximately 80% of middle aged women with heart failure have reported a decrease in vaginal lubrication, leading to challenges in successful intercourse. [ 57 ]  The reduction in lubrication affects the vaginal moisture during sexual activity. Women with  hypoactive sexual desire  (HSDD) may also experience a lack of interest in sexual stimuli, thus affecting their psychological responses to sexual cues. [ 57 ]   Within the study conducted by Sandra Garcia and her colleagues, suggested that trauma-related changes may impact genital tissues, affecting blood flow and response to sexual stimulation. [ 58 ]   As well as when psychologic distress is present it affects the ability to achieve  orgasm  despite adequate sexual stimulation. [ 59 ]  This is a result of relationship issues that affect sexual stimulation and sexual response, connecting back to orgasmic difficulties. [ 59 ]


The deficiency of estrogen leads to conditions like  dyspareunia , which is something important for maintaining adequate lubrication. [ 60 ]  Therefore there is hormonal treatment that is used which is the addition of in-taking estrogen supplements. [ 60 ]   But as well as the supplementation of  testosterone , which was shown as beneficial for enhancing desire, arousal, and sexual satisfaction. [ 60 ]   There could also be some hormonal changes when it comes to going through the phases of aging. A review in 'The Journal of Sexual Medicine', showed how pre-menopause women showed more sexual dissatisfaction. This was shown due to their hormonal imbalances. [ 61 ]


When sexual stimulation is perceived, there are systems in the brain that receive the stimuli and respond to it. During physiological sexual arousal, the  autonomic nervous system  responds to signals from central nervous system and prepares the body for sexual activity. [ 62 ]  The autonomic nervous system engages the parasympathetic and sympathetic systems, which are responsible for blood flow to genital and erectile tissues, and to muscles that participate in sexual responses. [ 62 ]  This results in responses like increased breathing rate, heart rate, and pupil dilation. The  limbic system  also plays a part in how sexual stimuli are received. [ 63 ]  A study done about pleasure and brain activity in men showed that electrical stimulation of the limbic system is highly pleasurable, and can sometimes generate orgasmic responses. [ 63 ]  During genital stimulation different areas of the brain are activated in men and women. For men, a study saw that genital stimulation caused part of the  cerebral cortex  and the insula, which is a part of the sympathetic and parasympathetic systems, to activate. [ 64 ]  For women, during clitoral stimulation parts of the secondary somatosensory cortex were activated. [ 64 ]  In both men and women the  amygdala  was deactivated. [ 64 ]


Some mammal species are  induced ovulators , requiring stimulation of the genitals during  copulation  in order to  ovulate . [ 65 ]


Sexuality and disability  is a topic regarding the sexual behavior and practices of people with  disabilities . Like the general population, these individuals exhibit a wide range of  sexual desires  and adopt diverse methods of expressing their  sexuality . It is a widespread concern, however, that many people with disabilities do not receive comprehensive  sex education , which could otherwise positively contribute to their sexual lives. This stems from the idea that people with disabilities are asexual in nature and are not sexually active. Although some people with disabilities identify as  asexual , generalizing this label to all such individuals is a misconception. Many people with disabilities lack rights and privileges that would enable them to have intimacy and relationships. [ 1 ] [ 2 ]   When it comes to sexuality and disability there is a sexual discourse that surrounds it. The intersection of sexuality and disability is often associated with victimization, abuse, and purity, although having a disability does not change someone's sexuality, nor does it change their desire to express it. [ 3 ] [ 4 ]


For physical disabilities that change a person's sexual functioning, such as  spinal cord injury , there are methods that assist where needed. An individual with disabilities may enjoy sex with the help of  sex toys  and physical aids (such as bed modifications), by finding suitable  sex positions , or through the services provided by a  sex worker . [ 2 ]


Much of the sexual biases in the United States are traced back to Puritan ethics. Issues on the acceptance of sexuality and disability root back to 2000 years. The review of history on sexuality in philosophy, religion, and science leads to the modern day views on sexuality and disability. Religious institutions were the first entities to combat sexuality. They believed that sex was a sin and should not be practiced unless it was done with intents of reproducing. Then doctors began developing medical views on sex. Sexual pleasure was deemed a sickness. The taboo around sexuality being a disease and sin restricted many people from expressing their sexuality, especially people with disabilities. [ 4 ]


After much groundbreaking research, it was not until the 20th century that sex and pleasure became normalized. With the normalization of sex, pleasure became the main focus. Healthy sex meant a good performance that led into an orgasm. If a person was not able to orgasm during sex they were seen as inadequate for  sexual intercourse . With this a sex therapist would help the individual explore oral sex, and clitoral orgasm. When a person with a disability is not able to achieve an orgasm it was not seen as problematic, because they did not have sexual desires. The neglect on the sexual lives of people with disabilities roots from the idea that they are child like and asexual. Because people with disabilities do not fall under the category of being sexual, there were no resources for them to seek  sexual assistance . [ 4 ]


Over the years sexually disenfranchised groups were working towards sexual acceptance for all people, including queer and disabled communities. The work of these groups began to open doors for people with disabilities to become more expressive of their sexuality. Even with these new found opportunities, sexual pleasure for people with disabilities remained unspoken of. [ 4 ]


Having a disability may sometimes create an emotional or psychological burden for the individual with disabilities. They may feel inhibition about pursuing relationships, fearing rejection on the basis that they have a disability.  Self-image  may suffer as a result of disfigurement, or lack of confidence. A New York disabled dating service manager explains, "Sexuality, travel, mobility, pain: Everything takes on a different dimension." [ 5 ]  In  The Ultimate Guide to Sex and Disability , Miriam Kaufman points out that attempting to hide a disability or minimize its existence is ultimately an added burden, encouraging readers to "come out" to themselves as having a disability, to accept their disability. [ 6 ]


There is often fear associated with the intersection of sexuality and disability. Many people with disabilities embody a fear of being rejected due to the way they look. This hypersensitivity causes the individual with disabilities to keep interactions platonic. Author of Sex and Disability Robert McRuer studied a man with disabilities. McRuer gave insight on the individuals sexual and non-sexual encounters. This man had a belief that crossing the line into sexual encounters meant it would cause severe bodily harm for him. During a sexual encounter, the man felt very uncomfortable and could not cross the sexual boundary. This was due to his fear of being judged. This is an issue common in some people with disabilities. The "evaluative gaze" coming from others causes people with disabilities to feel judged and uncomfortable in their own bodies. [ 7 ]


It is a common misconception that people with disabilities are insecure and have a negative self-image. A study was done on 7 adolescents with  cerebral palsy , to assess their self-image. Of the group there were 3 girls and 4 boys, ranging between 12 and 17 years old. A personality inventory was conducted and the results came out to be positive. The group of adolescents with disabilities viewed themselves very positively, rating their self-image higher than norm groups. After the inventory, the interviewer Lena Adamson wrote this conclusion in her "Brief report—Self-image, Adolescence and Disability", published in the  American Journal of Occupational Therapy : [ 8 ]


The following conclusions are made: Further studies on self-image and the psychosocial development of adolescents with disabilities should (a) focus on the social interaction outside their immediate families, and (b) continue to use and develop methods where these adolescents can give voice to their own experiences and opinions.


Individuals with disabilities are rarely regarded in society as sexy or believed to be sexually active. When sex and disability are linked, it is common for marginalization to occur. Many people shy away from the idea that individuals with disabilities can have sex. This is due to a lack of information on the subject. Popular scholarly texts on disability rarely discuss sex, conversely disability is rarely discussed in the field of sexuality studies. Disability studies is a new field, it is just recently beginning to have a voice in the scholarly communities. Cultural theory on HIV and AIDS is one area of study that has broadly considered disability and sex. Since the AIDS epidemic, the queer community have been including physically and intellectually disabled individuals in their activist interventions. Even with these efforts, the correlation between sexuality and disability are not discussed in disability studies. [ 7 ]


In society, it is widely believed that women with disabilities are asexual. One reason for this belief is that Individuals with disabilities are seen as  eternal children . Others see the intertwine of sex and disability as an acrobatic act. It is difficult for many people to imagine an individual with a disability having sex, because of the restricting impairments. [ 9 ]  Viewing women with disabilities as asexual has issues. In contemporary United States, women with disabilities are not viewed as physically attractive because society does not view them as sexually desirable. This results in women with disabilities to be limited and constrained in their capacity to love and be loved. [ 10 ]


In the United States, pleasure and sex have been largely ignored, especially when it comes to individuals with disabilities. Medical facilities, public schools, and religious groups have created a "don't ask don't tell" policy when it comes to sex education. The United States government has spent over 500 million dollars funding a program that restricts public schools from teaching sex in the classroom.


The idea that sex is meant for reproduction can be damaging to the sexual lives of individuals with disabilities. Because some disabilities restrict an individual from having children, the idea of this person having sex is eliminated. Additionally, the hereditary nature of certain disabilities may make caregivers of disabled adults uncomfortable allowing them to engage in sexual activity. There also exists a history of  forced sterilization  of disabled people, such as the  Buck v. Bell  case legalizing the practice in the US and the  Law for the Prevention of Hereditarily Diseased Offspring  mandating disabled people be sterilized in Nazi Germany.


The  mechanics of sex  may be daunting, and communication, experimentation, medication and manual devices have been cited as important factors for sexual activity where disability is involved. Additionally, recognition of the pleasure that is derived from sexual activity beyond penetration and intercourse is also highlighted. [ 11 ]  For example, changes may take place in a person's  sexuality after spinal cord injury ; sensitivity to touch can increase above the lesion location in someone with a spinal injury. [ 12 ]  From research undertaken by the  Christopher and Dana Reeve Foundation , orgasm was achievable for 79% of men with incomplete spinal cord injuries and 28% of men with complete injuries. [ 11 ]


Oral sex  and  manual sex  are other alternatives where penetration is not possible or not wanted, and wedge devices can be used to aid with positioning—wedges can be used as an aid in sex generally. Sex toys may be used as  assistive devices  as well; for example,  vibrators  can be used to provide extra stimulation and in circumstances where hand mobility is impaired. Other supportive devices include manual stimulation pumps, for erection promotion and maintenance, and "sex furniture", whereby rail or clamp enhancements, or specialised designs facilitate sexual activity. [ 11 ] [ 12 ] [ 13 ]


Writer Faiza Siddiqui sustained a serious brain injury that led to a decrease in her sexual drive and the loss of her ability to orgasm, with the latter most likely the result of damage to Siddiqui's hypothalamus. Siddiqui explained her learning process in relation to sexual activity following the accident in a 2013 article: [ 14 ]


I had to clear away all the thoughts I had about my imperfect body ... Since then, I've started to feel less shame about my unresponsive body ... My brain can't concentrate on as many things anymore, so I have to focus more on every little twinge and the lightest of touches. Surely that's going to mean better sex? I can't say that the sex is exactly better – I can't be on top anymore – but I'm learning that it doesn't really matter ... I had to grow up. Growing up is something that we're all having to do.


Some people with a spinal cord injury are able to "transfer their orgasm" using sexual energy to any part of the body that has sensation. For example, Rafe Biggs acquired a spinal cord injury in 2004. Through his work with a sexologist he discovered during a massage that when his thumb was being massaged; it felt very similar to his penis. [ 15 ]   It was through this experience that he learned that he could transfer his orgasm, using tantric energy, to his penis. Kenneth Ray Stubbs also has a spinal cord injury and is able to use tantric bodywork to obtain an "orgasmic feeling". [ 16 ]   If a person is able to use sexual energy correctly then they would be able to experience an orgasm in any part of the body that is capable of feeling sensation. [ 17 ]


Sexuality for people with disabilities is often linked to fetishes and "freakish excess". [ 7 ]


Apotemnophilia is when an individual amputates their own limb for sexual pleasure. A case research done in the Journal of Sex Research states "Apotemnophillia is related to erotization of the stump and to overachievement despite a handicap." Little is known about the relationship between sexual pleasure and amputated limbs. This is due to the fetish being fairly new. Apotemnophilia was first introduced to the public in the magazine  Penthouse  in late 1972. The fetish was brought up by a young man with a disability who practices this fetish. After reading his accounts some editors of the magazine related with this feelings and published his story. [ 20 ]


Some individuals who have this fetish, have made successful amputation attempts. For those who want to be amputated but do not have the means or strength to do so, are able to get professional assistance. [ 20 ]


Sex and disability does not only have an unattractive connotation. [ 21 ]   Sex and Disability writer Robert McRuer found that Devotism had renewed self-assurance in a group of women with disabilities. He writes "Women who had felt profound shame about their bodies reported significant gains in their self-confidence after discovering devotees." [ 7 ]  This empowerment has led to positive changes in the women's behavior. It has been reported by Robert McRuer that because of this some women with disabilities are more confident in their self-image and do not hide their disabilities as they previously have. [ 7 ]


People who have a devotism fetish are referred to as Devotees. Robert McRuer argues that devoteeism relies on disgust and desire. The description of the devotees' desire come from an ableist assumption that disabled bodies are disgusting. It is typical for a devotees to view themselves as the only people who are sexually attracted to amputees. This belief establishes a ground for Devotees exceptionalism. [ 7 ]


BDSM  is a topic in the sex and disability culture. It has been described as empowering for people with disabilities because of their acceptance of non-normative bodies. BDSM could be used as a way to control pain for people with chronic pain.   Bob Flanagan  used BDSM to help him cope with his Cystic Fibrosis. His ability to control his own pain excited him as he was known to push himself as far as he could. "I was making a mockery out of something serious that had happened to me," said Flanagan when making light of his pain related to Cystic Fibrosis. Flanagan was an artist. He was a writer, an actor, and also created a traveling museum exhibit called "Visiting Hours" that showed the intersectionality of Cystic Fibrosis and sadism and masochism. [ 22 ]  In the exhibit, "Visiting Hours", [ 23 ]  museumgoers would experience an environment that was a combination of a children's residential hospital and a BDSM torture chamber. The purpose of this exhibit was to portray Flanagan's pain through a pleasurable lens showing that BDSM could offer some sexual healing. [ 24 ]


Women and girls with disabilities are a common focus in fetishism due to their immobility. This makes them especially vulnerable to sexual abuse. [ 25 ]


In February 2013, it was reported that citizens with disabilities in the Netherlands were eligible for a government-funded scheme that provided funds to cover up to 12 occasions of sexual service per year. [ 26 ]  During the same period, Chris Fulton, a campaigner in the UK with cerebral palsy and muscular dystrophy, called upon the UK government to also provide financial support for sexual services for people with disabilities. Fulton explained: [ 27 ]