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Changing trends in Sexuality

Changing trends in Sexuality. ADOLCON 2013 – 23 24 Nov Pune. Dr Swati Y Bhave Senior Consultant Advanced center of Pediatrics , Indraprastha Apollo Hospital, Delhi & Executive Director AACCI , Mumbai. Contents of this lecture. Changing trends in Young people – 10 -24 yrs

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Changing trends in Sexuality

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  1. Changing trends in Sexuality ADOLCON 2013– 23 24 Nov Pune Dr Swati Y Bhave Senior Consultant Advanced center of Pediatrics , Indraprastha Apollo Hospital, Delhi & Executive Director AACCI , Mumbai

  2. Contents of this lecture • Changing trends in Young people – 10 -24 yrs • Changing trends in parental attitude ( 25-35 yrs & >40 yrs age ) • Changing trends in societal attitude and norms • Implications for future

  3. Sexual Orientation Relationships Sexual Attraction Paradigm of Sexuality Biological Sex Sexual Behavior Gender Identity/ Expression

  4. Basic changes in Youth • Loss of childhood innocence. • Premature exposure to sex related issues and lack of emotional maturity to handle these issues. (UK study tablet use 2-5 Yrs age ) • Physically capable doing and enjoying sexual intimacy but …NOT YET CAPABLE of handling the emotional consequences or medical issues that result from it . • Extreme peer pressure to “fit in”, “be cool and hep”

  5. Media effectPremature wanting to grow up!!

  6. Basic changes for adults • Difficulty in trying to break away from rigid society norms and Indian traditions. • Having to learn more tolerance / permissiveness • Inability to deal with the recent changes and confusion. • Difficulty in acceptance of new terms • Change in past definitions • Immoral …… ….NOW personal choice or life style • Perversion……. NOW different orientation

  7. Basic issues for parents • How to balance between rigidity –strictness permissiveness or tolerance • How to handle issues of sexual precociousness. • How to protect and guide from peer pressure and high risk behaviour. • How to deal with unwanted teen pregnancy , sexually transmitted infections. • How do deal with shattered emotions of a dumped or rejected teen. • How to cope with addictions and“promiscuousness”

  8. Parental attitudes • There is limited communication on the subject of sex between parents and children • That is why a large section of teenagers lead double lives that would scandalize their parents, should they ever find out. • In the absence of social interaction and parental guidance on sex, children are likely to turn to the Internet. Parental supervision of Internet access now very difficult with smart phones • India today survey • 80% parents refuse to talk to their children about sex . • Only 25% parents agree that their children might be sexually active. • Among those who think that their children are sexually active, a majority will deliberately look the other way some will scold them. • Only a third tried to talk to their children and educate them about sex. • Most respondents are also shy of showing affection towards their spouse in front of their children. http://indiatoday.intoday.in/story/sexual-identity-sex-life-one-nightstand/1/161406.html 2011

  9. Acceptance of changing sexual behaviour where will this lead us ……… • Masturbation and oral sex was a sin in the past …..Today healthy expression and safe sex . • Old DSM classification Homosexuality was perversion …..Today it is acceptable as different sexual orientation. • Bonded Sex, SM –perversion. • Today Fifty shades of Grey …..trilogy best seller • People who practice pedophilia and incest are also claiming it to be a variation of sexuality • It is frightening ………..will this become acceptable as different sexual orientation.

  10. DSM-5 Typo: Pedophilia Described as 'Sexual Orientation' The phrase "sexual orientation" was used erroneously in the discussion section about pedophilia in the recently released fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In a press release, the American Psychiatric Association (APA) notes that the correct terminology is "sexual interest" and that it will correct the error in the manual's electronic version and in the next print edition. The APA adds pedophilic disorder is a "paraphilia" and not a sexual orientation. Other paraphilic disorders included in the manual include exhibitionistic disorder, sexual sadism disorder, and fetishistic disorder.

  11. APA press release • "APA stands firmly behind efforts to criminally prosecute those who sexually abuse and exploit children and adolescents. We also support continued efforts to develop treatments for those with pedophilic disorder with the goal of preventing future acts of abuse," the association adds. • "Although proposals were discussed throughout the DSM-5 development process, diagnostic criteria ultimately remained the same," they wrote at the time. "Only the disorder name will be changed from pedophilia to pedophilic disorder." • The APA notes in its latest release that the newly discovered "pedophilic disorder text error" will be corrected.

  12. Hymenoplasty • A large number of girls today indulge in premarital sex and justify this as a means of “enjoying life and have a satisfied sex life before marrying “ –of boys can do it why not we? • But they marry a boy chosen by their parents from a conservative mind set where a “woman’s virginity is sacrosanct” . Hence restoration of “virginity “ is important and necessary . • I have spoken to a number of gynecologists about this and the charge is anywhere between 1-2 lakhs • So it is not affordable to all

  13. Ethical debate -Hymenoplasty • Boys : this is gross cheating and betrayal and both the girls and doctors who do this should be punished. • Girls : men who give so much importance to virginity deserve to be cheated. • Boys : the girls should come clean and it is upto the boy whether to marry a non virgin or not. Girls can also exercise their right • Girls :Why is society so unfair to insist on a “womans virginity” only . Men have no “ test “ to prove or disprove their virginity • Doctors for : There is no moral issue involved . It is a simple surgical procedure • Doctors against : This is not this is not a procedure I will do . Many of them said they do not perform abortions also unless really medically indicated for saving womans life

  14. Chinese solution to “virginity” • Trust Chinese people to find a low cost device for any and everything • In a session in the IAAH conference at Turkey in the session on Adolescent sexuality they presented a “virginity kit” that is available “ • I had taken a photo but could not locate the slide • It consists of a membrane that can be “stuck on “ on the wedding night that requires force to “penetrate “ • Inside there is a small fragile pouch that ruptures and releases “blood”. • This is 100 % proof of the brides virginity !!!!!!!

  15. Different sexual orientation LGBT-1 • We have come far away from homosexuality being a criminal activity ( IPC and other country criminal codes ) and a perversion and mental illness ( old DSM) • Yet Lesbian, gay, and bisexual youth have to cope with the prejudice, discrimination, and violence in society and, in some cases, in their own families, schools, and communities. • High incidence of depression, suicide , drug abuse, STDs , anal and oral cancer etc Just the facts 2008 sexual orientation and youth American Psychological Association. Retrieved from www.apa.org/pi/lgbc/publications/justthefacts.html..

  16. Different sexual orientation LGBT-2 Can we choose our sexual orientation? • Despite myths and misconceptions there is no evidence that being gay is caused by early childhood experiences, parenting styles, or how someone is raised  • It is not something that we can choose  or choose to change • Not fully understood what determines a person's sexual orientation, but likely explained by variety of biologic and genetic factors •   It is like part of someone's nature, and not a disorder.

  17. Important aspects of LGBT • Sexual orientation conversion therapy -attempt to eliminate gay or bisexual desires .Tried in USA by religious groups. Proven to be ineffective/harmful • Both teens and parents need guidance and support • Parents may feel confused, unprepared, apprehension, guilt, queries or concerns, may feel protective, worried. • Some parents may already know or are reconciled. For most teens ' coming out' takes courage. It is an extra layer of stress. • Do they need to hide it? fear of not being accepted, harassment, not fitting in, being judged. • Need time to process how they feel, and accept this aspect of their own identity before they reveal it.

  18. Hindustan times survey 17 – 25 yrs Pre-martial sex 29 % (35% M 22% W) Live in relationships 20 % Homosexuality 20 % 23%-m 17 % w Mumbai 40 % Calcutta -30 % 2013 2009

  19. Hindustan times survey 2013 Feb 17 – 25 yrs

  20. Sex & the Indian YouthIndia Se undertakes the first ever survey of  overseas Indian youth to understand their attitude towards sex and the results are startling. http://www.indiaseonline.com/?p=744 Though no longer a taboo topic at the dining table, a majority of Indian parents still want to believe that ‘their children do not indulge in sex’. Sometimes, this rigid mindset of parents acts as a barrier to effective and open communication on this issue. Random survey of around 50 Indian youngsters between the ages 16 - 25 on sex & their communication(or lack thereof) with parents regarding sex and romance. 52% youngsters were non-resident Indians while the remaining were Singaporeans of Indian origin. 83 % open to pre-marital sex >50 % admitted that he/she had had sex at least once. 45 % youngsters said it was OK to have sex before the age of 18.

  21. Surveys in young adults – future teen age parent

  22. India today 2011 Respondents are above 25, married for over 20 years (mostly arranged marriages) and have children. In that sense, this survey throws light on sexual notions of the "settled" Indian, the regular family person. MEN PAID SEX ? 20.5 %-yes 25% single men 22% married men HOW MANY TIMES- 10% 1-2 times 5.6 % 3-5 times 3.6 % 5-10 times 1.2 % lost count DO WORKING WOMEN CONTRIBUTE TO INCREASING INFIDELITY.? Yes 55% -M and 43% W SEXUAL FANTASIES 65% different situations 27% watching other 13% orgies 8 % three somes DOES THE IDEA OF WIFE SWAPPING EXCITE YOU? 16 % men yes 18% women yes Bangalore 41% Kolkata 22% >1 SEXUAL PARTNER 37 % men 12% women ONE NIGHT STAND 28 % One night stands orgies and paid sex 13 % women 71 % women have had only one sexual partner,

  23. Paid sex becoming acceptable by society – legalizing brothels- Various experiences • Germany efforts to legalise prostitution • Sweden punishing pimps not prostitutes‘ • Mumbai banning dance bars • Delhi rescuing and putting girls in observation homes and Nari-niketans

  24. A MaRS-YUVA Youth 17-25 National Sex Survey - Dec 1, 2009 Pre-marital sex -29 % W - 22 B- 35 50 % wanted love marriage Homosexuality ok 20% W 17 % M 23 Mumbai 40% Calcutta 30% Outlook-Skore Sex Survey 2012 (ages 18-35).

  25. PORN & Sexting almost 65% respondents acknowledged having what is now referred to as ‘buddy sex’ before marriage. 30% of urban youth don’t think there’s anything wrong with homosexuality 29% of urban males admit to having had a homosexual experience at least once Societal accept of” incest” • Marrying first cousin • Mama’s or chacha’s Son /daughter • Marrying mama or chacha Outlook-Skore Sex Survey 2012 (ages 18-35).

  26. 70% w- will not marry non-virgin 64 %   males - virginity not imp 49 % UM males Stable relationship 82 % women 77% men . Are you in Live in Relationship-23% Are u in Premarital Sex - 25% BUDDY SEX Outlook-Skore Sex Survey 2012 (ages 18-35).

  27. BUDDY SEX Outlook-Skore Sex Survey 2012 (ages 18-35).

  28. Masturbation Sexual fantasy Outlook-Skore Sex Survey 2012 (ages 18-35).

  29. Media /TV effect on Sexuality • BODY image issues – weight, height , pimples, muscles • Eating disorders • Junk food and obesity and sexuality • Tobacco ,alcohol ,drugs and sexuality . • Body hair • Sexual behaviour /relationships in serials.

  30. All magazine surveys have titillating and Explicit pictures and sensational headlines For attracting sales This is one of the milder ones Media effect of hair in men

  31. Basic changes in society • Education: more financial independence to follow self gratification. • Urbanization and nuclear families gives more personal freedom and less need to confine to social norms of sexual behaviour. • No ostraziation by society specially if you are financially affluent. • Liberal attitudes, non-interference in other peoples life.

  32. Sexuality as depicted in Hindu epics • What may be considered immoral by middle class • In the past accepted -Marrying or procreating with other male members from family • Marrying elder brothers wife after his death • Sleeping with brother- in law or father in law for a heir if husband incapable • Ambika and Ambalika had to procreate with Vyas muni because husband Satyavrat ) had expired .Vyas was the brother of their husband- beta of Satyavati from Rishi Parashar • Premarital sex was taboo but practiced – birth of Karna • Kunti conceived children from devas- not her husband –Vayu- Bhim , Indra -Arjun. • Draupadi had 5 husbands

  33. Backlash from Indian society This has led to the emergence of two distinct societies. One India lustily embraces the opportunity, liberty and anonymity that urbanisation gives it. The older generation try to safeguard their old world values. This India grapples to understand its young. They fear their sexual anarchy and take every opportunity to censor them. In public spaces, you can see them harassing youngsters either in the form of uniformed policemen or as members of fundamentalist religious or linguistic groups. Khap panchayat and honour killings, Moral policing , Religious fatwas or diktats

  34. Debates about whether skin show by girls is contributing To the increasing incidences of sex crimes- molestation , assault and rapes But I also teach girls that skin show has the risk of attracting unwanted sexual harassment and they have to make a choice how they want to be looked at…………………WITH RESPECT ………ORAS A SEXUAL OBJECT In my teen workshops I emphasize to Boys that no man has a right to touch or Molest a girl because she is “provocatively dressed “. Nor this can or should be used as an Excuse to justify their sexual harassment actions

  35. What are the likely consequences of these accepted variations of sexual behaviour • Let us look at the western experience

  36. Increasing incidence of oral sex • CDC Teens are engaging in oral sex than vaginal intercourse- perceive oral sex to be safer with fewer health-related risks. • to maintain virginity • or avoid pregnancy • or risk for sexually transmitted infections (STIs). • rapidly have their first intercourse experience shortly thereafter • Increase in oral STD • oral (HPV). Thefirst nationwide estimate 2012 oral HPV 7 % American adults - about 16 million people, mostly men. • Oro-pharyngeal cancer rates among men. Oct 2012 US study :oral sex may account for an additional 10,000 cases of this cancer of the upper throat in men each year. Boys 15-19 years receiving oral sex (47% ) giving oral sex (35 %). For girls of this age group: 40 % .

  37. Changing trends in sexual behaviour Increase in anal cancer 1 epidemiologist Janet Daling, Ph.D., a member of Fred Hutchinson's Public Health Sciences Division 2 National Cancer Institute: records of 6,093 anal-cancer patients (2,888 men and 4,015 women) diagnosed between 1973 and 2000.

  38. Social networking dictates sexual behaviour

  39. Social networking sites • Sex sites • With the objective to titillate, sex is portrayed as a commodity on these sites. • With their emphasis on desire and fulfilment over intimacy-it is these sites where youngsters perhaps get their first notions of sex. • It's small wonder then that we read about increasing incidents of sexual abuse among young children. Pit falls • Addiction to Porn or deviant sexual practices • Distorted view of sexuality …. Problems in real life • Cyber sex and associated dangers • Exposure to pedophiliacs' • Cyber bullying • Paid sex • Sexual avtars And many more …….

  40. Efforts to rein in internet porn • A PIL has been filed in Delhi on 18th Nov 2013 asking Govt to ban access to child porn . Court has asked reply from GOI Dept of Telecommunications • Google has agreed to stop access if certain words are typed in which will lead search engines to porn sites . • Around 100,000 people will get blocked as per estimate

  41. Advantages - Social networking sites • Allows teens to find support online that they may lack in traditional relationships, especially for teens who are often marginalized, such as lesbian, gay, bi and transgendered (LGBT) teens, those who are living with an illness or disability, or those who may feel physically unattractive or socially reticent (McKenna & Bargh, 2000). • 17 % of teens who use the internet report they use it to gather information about health topics that are hard to discuss with others, such as drug use and sexual health (Lenhart, 2010). • Teens also use online searches to gain answers to many of their health concerns with 31% of online teens getting health, dieting, or physical fitness information from the internet.

  42. Literature review • What would be the best approach to deal with • Adolescent sexuality ? • How to reduce harm done by Early and risky sexual experimentation

  43. Comparision between Dutch and USA F -15-19 yrs/1000 HIV -15-19 yrs/1000 Contraceptive use USA DUTCH

  44. Dutch and US Adolescents’ Reflections on First Sexual Experiences “Wish I had waited longer to have sex” I went as far as I wanted to go It was fun I was ready M F US teens Dutch Teens Albert, 2004 Graff et al 2005

  45. SAHM • Why are there such large differences in sexual health outcomes between countries with so many similarities? • Can Cultural Approaches to Adolescent Sexuality Change? Not Under My Roof: Parents, Teens and the Culture of Sex (University of Chicago Press) http://works.bepress.com/amy_schalet

  46. US- Sex equated with risk and disease( same applies to India ) Sex as risk taking Fear based approaches to prevention by • policy makers • healthcare providers • parents • youth

  47. Sexuality development is a natural part of human developmentYet - adolescent sexuality is equated with risk Over past three decades, two approaches have predominated in sexual health policy and practice: • Abstinence-only • Sex as risk taking C- N- N A - B - C the 4th Edition of the SAHM - Adolescent reproductive and sexual health project ARSHEP curriculum

  48. UNITED STATES • RAGING HORMONES • Teens unable to control hormonal urges • Immature development of the cognitive and emotional capacity to handle them • PARENTS’ ROLE IS TO CONTAIN BATTLE OF THE SEXES • Males want sex, • females want love • Consequences fall on females PARENTS MUST ‘PROTECT’ FEMALES, “REIN IN” MALES FALLING IN LOVE IS RARE - Extraordinary • Parents: “Teens just ‘think they are in love’; it is not real • Teens: “I want to be in love but other teens just want to have sex” • SEXUAL ACTIVITY AND LOVE NOT EQATED SEX SHOULD BE A SECRET • Teens keep sex a secret • Some parents prefer ‘not to know’ • Secrecy weighs especially on girls • PARENTS AND TEENS CANNOT DISCUSS SEXUAL ISSUES

  49. Dutch Approach -A New ParadigmDiffers from risk and abstinence programs • Adolescent sexuality is a normal process of psychosocial and biological development • Sexuality is a continuum along which youth move as maturity and relationships permit • Adults play vital role in providing resources and supporting the development of skills

  50. Normalization:“Normal” Sexuality This is not the same as “permissive sexuality “ But it means “not secretive” • Sex should be normal, acceptable part of life • An open subject is rendered negotiable • Parents may not always be completely comfortable with teen sex, but they do not want it to lead to deception • Sex should lead to secrets but discussed openly between family members • Sex should not cause conflict and alienation between parents and teenagers

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