The psychology of sexuality is certainly one of the most interesting areas that very few experts deal with, so this inexhaustible topic of human functioning is extremely important for adequate psychological well-being.
What is psychosexology?
Psychosexology is an interdisciplinary field that combines psychology and sexology. Although sexuality plays a crucial role in human life, very few professionals specialize in this subject. Sexuality is more than a physical function – it is a reflection of our mental state and emotional development.
“Mature sexuality is a source of psychological well-being, while dysfunctional sexuality can be the cause of deep psychological problems.”
Where is psychosexology used?
- In clinical psychology – for the treatment of sexual dysfunctions
- In forensic psychology – assessment and treatment of sexual offenders
- In counseling victims of sexual violence
- In psychodiagnosis of traumatic sexual experience
- In resolving various (psyscho)sexual problems
Psychosexual problems
Psychosexual problems are often not isolated – they reflect broader emotional and cognitive conflicts:
• Difficulty achieving sexual satisfaction
• Avoidance of intimacy
• Dysfunctional partner relationships
• Unprocessed childhood trauma
The dark side of sexuality
Sexuality can be a driver of health and closeness, but also a source of pain:
• Destructive, when it takes the form of addiction, obsession, or control
• Neglected, in communities where sexual education does not exist
• Taboo, leading to suppression and the development of feelings of guilt
Sexual offenses, repressed traumas, and a lack of understanding of one’s own sexuality can lead to serious psychological consequences, both for the individual and for their relationships.
More in detail?
The psychology of sexuality is undoubtedly one of the most fascinating fields that very few professionals specialize in, making this inexhaustible topic of human functioning extremely important for adequate psychological well-being. Psychosexology is, therefore, a combination of two sciences: psychology and sexology (as a medical subdiscipline), placing it partly within the domain of clinical psychology.
One aspect where psychosexology and forensic psychopathology intersect is in the case of sexual offenses and their perpetrators (more commonly men, less commonly women), as well as the treatment and support of victims of such offenses — and even the treatment of the offenders themselves, as society must address these individuals in some way. However, the actual number of victims is always significantly higher than reported, as is the number of perpetrators, because victims are often reluctant to report sexual offenses due to weak legal protections.
Fortunately, psychosexology is not as dark as these cases of sexual crimes might suggest. If embraced, it is actually a very positive and joyful field. However, it can become destructive if sexuality is excessive, which may result in sexual dysfunctions — a subject of psychosexology closely linked to the psychopathology of everyday life.
Human sexuality is perhaps the most complex domain of human existence, and yet, it is a domain that involves nearly all members of the human species, either directly or indirectly. Sex marks the beginning of our lives, but a characteristic unique to human (not animal) sexuality is not just reproduction, but the capacity to experience pleasure from it. For some individuals or groups, this enjoyment may turn into debauchery, leading to sexual dysfunctions in their intimate lives.
True and mature sexuality typically emerges only after the age of twenty-five, although this is highly individual—some people may not reach mature sexuality even in their thirties or forties. Sexuality experiences its own ups and downs and is closely linked to one’s psychological life. When adults are sexually fulfilled, they tend to handle other life problems more easily. However, for some individuals, sexual issues are not their only problems; rather, sexual activity can serve as a coping mechanism for everyday stress. On the other hand, accumulated psychological problems usually worsen the sexual life between partners.
There are numerous sexual issues for which people may seek help from a psychologist. Among women, these are most commonly related to experiencing orgasm or vaginismus. The latter can also be a problem for their partners, while the former is very common in our conservative society, where girls typically do not engage in masturbation.
Very often, girls raised in traditional religious environments are advised not to masturbate. Regardless of religious affiliation, every girl reading this text who has never done it before, it should, just as every young man should — although boys usually do it instinctively, whereas for girls it is forbidden. This alone reflects the double standards in sexuality between women and men.
Men, on the other hand, often seek help due to issues related to confidence in bed, obsession with the size or shape of their genitals — which can also be present among women. Women, for instance, may occasionally feel aversion toward their own genitals, as they are often taught to associate them with being “shameful,” leading young girls to feel they “should be ashamed.” In some religions, women are considered “unclean” during menstruation, as if menstruation were not simply a natural, “God-given” (read: nature-given) function. On the other hand, there are men who enjoy having sex with a menstruating woman, though this can sometimes be a source of conflict within the relationship, especially if the woman does not share that same enjoyment.
In couples, sexual problems often arise due to a lack of knowledge or an inability — or lack of awareness — of how to communicate certain sexual preferences to one’s partner. The sexually receptive partner in a romantic or sexual relationship may think that sharing their preferences with the insertive partner will cause disgust, so they remain silent, while the partner may actually perceive those same preferences as desirable sexual behavior.
In psychosexological counseling, an individual’s sexuality is examined in great detail, and the assessment of sexuality is generally part of both clinical and forensic-clinical psychodiagnostic evaluation. Sexual history is analyzed from childhood to determine whether any sexual trauma occurred during that period, because — almost without exception — childhood sexual trauma that is not properly processed through therapy leads to a complete sexual breakdown in adulthood and can result in very self-destructive behavior.
The sexual trauma experienced in childhood is then relived in adulthood, causing sexuality to “regress” and leading to dysfunctional sexual behaviors. For example, in individuals with pedophilic disorders (hebephilia — sexual preference for early pubescents up to age 14, or ephebophilia — preference for older pubescents and early adolescents up to ages 17/18), it is very common to find childhood sexual abuse experiences that correspond to the same age group they later sexually prefer. Pedophiles are often aroused by children of specific age ranges, which may be related to the age at which they themselves were abused.
Many adolescents are not psychosexually “mature” or “grown-up” to the extent that their level of psychosexual maturity matches their cognitive maturity. Physical development may advance significantly — and thus also biological or sexual development — but that does not mean the young person is mentally or psychosexually mature enough to engage in sexual activities. A 15-year-old may appear to be 19 physically, but psychosexually, they might still be at the level of a 13-year-old, meaning their sexuality is still in a child-like phase.
The formation of a healthy psychosexual identity and healthy sexual interactions with others is the foundation of a healthy sexual — and therefore psychological — life. Sexuality also requires responsible behavior, because risky sexual behavior is associated with negative consequences for both physical and mental health. Sexuality develops from the beginning of our lives and brings different challenges in different life stages.
Issues related to the psychodiagnostic assessment of psychosexual problems, as well as psychosexual counseling, can be grouped into several general areas:
- Gender issues (development of gender identity, gender roles, formation of gender identity)
- Childhood sexuality
- Adolescent sexuality
- Sexual relations in adulthood
- Sexual expression / Expressing one’s own sexuality
- Variation in sexual expression
- Sexual orientation
- Pregnancy, contraception, abortion, and childbirth
- Challenges in sexual functioning
- Sexually transmitted diseases
- Sexual violence and exploitation
Prostitution and pornography consumption
Gender Issues
Gender issues have evolved over time and have become a very important topic today in the pursuit of gender equality — that is, equality between women and men in modern society. Women have long been marginalized and still often remain in a significantly more submissive position than men regarding human rights, leading to exploitation, abuse, and other forms of mistreatment of women, as evidenced by the numerous acts of violence and femicides committed in recent times.
On the other hand, various forms of abuse also exist in which men are psychologically abused by their female partners, to which they respond with physical violence — and thus, violence persists in the couple or family system as a modus vivendi.
People often seek help due to feelings of inequality in marriage, emotional romantic relationships, business partnerships, or within family environments. These experiences often stem from the very structure of relationships between two people, which are almost always built on a dynamic where one partner is dominant and the other submissive. Personality structures frequently do not match, leading to misunderstandings. However, establishing balance through understanding one’s own and the partner’s personality traits and vulnerabilities makes it easier to make decisions related to gender-related stress.
The concept of gender issues has significantly changed today, and we are increasingly adopting perspectives that are typical of Western culture. Historically, gender issues have been seriously neglected in Eastern cultures — and in many places, they still are.
In the anatomy of human sex organs, many genital structures are homologous, meaning they correspond to each other—they originate from the same embryonic tissue (e.g., the clitoris corresponds to the penis as an external organ, with the main difference being that female sex organs remain more “internal” while male organs are “external,” due to the nature of fertilization and the possibility of coitus and later reproduction).
The endocrine glands are responsible for secreting hormones into the bloodstream, which then transports them to target organs. In women, the ovaries produce estrogen and progesterone, while in men, the testes produce androgens—hormones related to male sexual development, including testosterone, a hormone widely known due to its frequent media coverage. However, testosterone is secreted not only in the testes but also in the ovaries in women.
Androgenic hormones are responsible for the development of male genitalia and secondary sex characteristics (e.g., beard growth, deep voice), while estrogenic hormones control the sexual development of women, including their genitalia, menstrual cycle, certain aspects of pregnancy, and secondary sex characteristics (e.g., breast development). Men also produce small amounts of estrogen in the testes, and women produce small amounts of testosterone in the ovaries. However, in some individuals, this balance is altered—men may produce higher levels of female hormones and women higher levels of male hormones—which can lead to gender dysphoria.
Gender dysphoria is not a disorder in itself, but it can be linked to various mental health concerns. The most important regulator of all these processes is a part of the brain called the hypothalamus.
Gender issues mostly refer to gender roles that society culturally assigns to women and men, which are reflected in people’s psychology through masculinity and femininity. These are personality traits that may relate to psychological, not only psychosexual functioning. Masculine and feminine traits in individuals develop in different ways and with different intensity. Sometimes we say that some women are “more feminine” than others, or that they display “masculine” behaviors that are “culturally typical” for the male gender, or that some men are “more feminine” compared to others who are “more masculine,” in terms of how they adapt to socially assigned gender roles.
Biologically, men are “taller, stronger, and more aggressive,” while women are neurologically more advanced, mature faster, and are biologically more resilient. In a psychological sense, gender differences are negligible and virtually non-existent, so within the culturally imposed gender distinctions in society, we often find the presence of prejudice and stereotypes.
Masculinity and femininity (or manliness and womanliness) are considered mutually exclusive traits in Western society, but the current scientific understanding is that they represent a single dimension of traits. On one end of this spectrum is masculinity, and on the other femininity, with individuals being more or less androgynous—that is, having low androgyny (when they are either more masculine or more feminine) or high androgyny (when they possess a high intensity of both masculinity and femininity).
It is a common belief that masculinity is reflected in traits such as strength, lack of emotionality, fearlessness, sexual experience, and financial independence, while feminine traits include beauty, gentleness, empathy, modesty, and emotionality. However, such views are the product of social stereotypes and do not represent a rule.
Society expects that biological sex (male or female) will align with gender identity and gender expression. When behaviors deviate from this alignment with the expected gender identity and roles, we encounter the phenomenon known as “transgender” or gender dysphoria.
There are individuals who do not identify with the “transgender” population either, but rather consider themselves “queer”—a term that lacks an adequate translation in other languages (the most common translation of this word is another languages is “weirdo,” which is in fact how many people perceive those who identify as queer, and this perception itself can cause certain psychological difficulties for them).
People who do not feel that they belong to the biological sex assigned at birth go through a certain transition, in which psychotherapy is a significant support throughout the process—both for the individual experiencing it and for family members, who need to accept it in a healthy way.
How can we recognize when these questions begin to arise during development?
Gender dysphoria can usually be identified as early as during early childhood, particularly during the preschool period when a child begins to develop a sense of “self” and recognizes their gender—that they are a boy or a girl. When there is a different understanding—when the child does not feel like a boy or girl and is confused and does not adapt to gender-conforming roles—this can be a sign of either a homosexual orientation in later sexual development or gender dysphoria.
Society socializes children by prescribing how they should dress, what games they should play, and how they should behave. Boys are expected to “play sports, wear blue or black, and show aggressive behavior, which is often positively reinforced,” while girls are expected to “play with dolls, wear red or pink, avoid aggressive behavior, and be polite.”
If a boy plays with dolls or wears pink clothes, he may be ridiculed by peers, just as a girl who plays football with boys or engages in “boyish” mischief may be mocked. During adolescence, individuals explore gender roles and attitudes. In adulthood, gender identity is often formed based on career achievements and family or romantic life.
Feminist movements have contributed to more women working and achieving professional success than ever before. However, this also brings added social pressures and stressful situations, as women—despite their efforts—still tend to be underpaid, degraded, or viewed negatively when they outperform men professionally.
To build a society that avoids gender stereotyping and encourages gender equality, we must change the fundamental “dichotomous” way of thinking and the division of the world into two opposites: “good – bad.”
Body Image / Perception of One’s Own Body
The way we perceive our body greatly contributes to our personal sense of satisfaction. In psychosexual development, we begin in our youth to get used to the changes occurring in our bodies, and this transition period from childhood to adulthood is one of the most challenging. However, the final formation of the body does not end with youth; our body image continues to evolve as our body changes under different circumstances.
Our lifestyle, body care, and psychological well-being all influence how we perceive our body. In a sexual context, one of the key reactions is how we experience our own genitals—i.e., the primary sex characteristics—and then the secondary ones as well. For men, concerns may revolve around erectile dysfunction or the size and shape of the genitals, which they may find unsatisfactory. For women, questions often relate more to how they perceive their own genitalia.
What often brings couples or individuals to psychological evaluation and counseling are questions related to certain sexual activities they practice within their intimate relationships. Sometimes, these questions come down to whether the partners engage in oral sex. In practice, it is observed that men perform oral sex on women less frequently than they expect women to perform it on them. Also, some men believe that their wives should not engage in oral sex because they are “the mothers of their children,” and then they practice such sexual activities with prostitutes or mistresses instead.
Some women may feel ashamed of their genitalia—its shape, smell, or simply feel “ashamed” due to the upbringing they had—therefore not allowing their partner to perform oral sex on them, even though they might enjoy it. Oral sex should be considered a part of sexual activity as foreplay, and sometimes, oral sex alone can lead both partners to orgasm. A practical example is the so-called “69 position,” in which partners perform oral sex on each other simultaneously.
Young men, due to watching pornography or comparing their own genitals, as well as because of numerous advertisements suggesting “penis enlargement,” may develop a “small penis complex.” This issue can lead to various other difficulties in psychological functioning, such as low self-esteem, depressive mood, avoidance of sexual contact, and more.
The truth is that preferences regarding the size of genitalia vary and depend on the individual. This largely depends on the anatomy of the genital organs themselves and the elasticity of the vaginal muscles and/or the anal opening, if anal sex is practiced.
The body self-image does not refer only to the genitals, but also to other secondary sexual characteristics. For example, girls and women will try to minimize “masculine traits” such as body hair on certain areas, while men will try to reduce “feminine traits” and may become preoccupied with whether their “chest” is larger than it should be.
Men tend to appear more masculine through the expression of muscle mass, body hair, and also through behavioral aspects such as energy, dominance, and taking the lead in sexual activity. Women, on the other hand, often express themselves in different ways, through a more “submissive” approach to sexual activity—although these are stereotypes, and there are individual variations and differences.
Body image is especially important among young people, as this is when various eating disorders can develop—and such an image can persist into adulthood. Eating disorders themselves can also be characteristic of adults. Some women experience changes in their bodies due to hormonal shifts during pregnancy and must adjust to their new appearance.
Women often develop insecurities related to weight gain or obesity, which can lead to numerous health problems—not just psychological ones. Obesity in men can also lead to cardiovascular problems and, as a consequence, erectile dysfunction, which significantly weakens sexual performance. This, in turn, reduces self-confidence and may lead to depressive and anxious states.
Love and Intimacy
Love and the ability to form loving, caring, and intimate relationships with others are of great importance to our psychophysical well-being. Throughout life, we fall in love, fall out of love, and fall in love again—or we may think we will never fall in love again after a failed relationship or marriage.
In essence, we all seek love, trying to understand why we are attracted to certain people and why we feel drawn to those who are “wrong” for us—which is where the mystery of love lies. Romantic love comes with feelings of excitement and anxiety, sexual desire, physical attraction, and social pressure or stress, especially when that love is “forbidden.”
In our society, young people from different ethnic groups are very often “forbidden” from falling in love with one another, as if the brain and heart recognized ethnic identities. In our organic systems, we are all equal—we all have a brain and a heart—but society has assigned us different “belongings.”
In some cultures, love is forbidden because of skin color, and in others because of financial status. For example, children from wealthy aristocratic families are often advised not to fall in love or start relationships with those from poorer communities.
Even in our own culture, there are very few mixed communities between the “non-Roma” and “Roma” populations. Thus, we too have prohibitions based on “skin color,” that is, stereotypes and prejudices. Young people often face problems when their families don’t accept their love for each other. Behind such “forbiddance” often lie other reasons: negative experiences from the past, traditional values, and many other cultural factors.
This means that love is deeply influenced by the culture in which we live. A significant number of people choose to conform to cultural norms and live unhappy love lives, often putting themselves and their families in risky or dangerous situations.
When falling in love, there is initially a tendency to idealize the partner, and any mistakes that occur in this newly found emotional and sexual joy are ignored. At that point, love flourishes, and if it is mutual, it will continue to grow. However, it often happens that one partner, for some reason, “cools off,” sexual encounters become less frequent, and the relationship enters a new phase that requires acceptance—especially when it involves family life.
When partners fail to adapt, this often leads to the breakdown of every aspect of the relationship, simply because the sexual aspect has not been adequately addressed.
Sexual love frequently transforms into a true partnership or shared relationship, which is characterized not only by physical intimacy—dominant in the beginning—but also by emotional closeness, mental and emotional intimacy with another person.
Some people are luckier in love than others, just as they may be luckier in other areas of life (some are healthier, more attractive, more intelligent, or wealthier than others).
In romantic love (as this “intimate erotic” love is called in professional literature, which does not necessarily have to be “cliché romantic” with candles and sunset walks), we find elements of passion (the physical aspect of love, which is the first to be awakened at the beginning of the relationship), intimacy (connection, closeness, and emotional bonding, which represents the psychological aspect of love), and commitment (another psychological dimension of love, referring to the long-term dedication needed to maintain love).
Love and the capacity for loving and intimacy develop throughout the stages of our personal growth. In childhood, the first bonds are formed with our parents or caregivers (guardians, adoptive parents). If love during those early years is not reciprocated, it creates a foundation for psychological difficulties in establishing emotional and intimate relationships in adulthood. In adolescence, we separate from our parents and begin experimenting with how adults love. Depending on our emotional attachment styles developed in childhood, our adult attachment styles are formed, and these often cause problems in romantic and family relationships. Different emotional styles are precisely what lead to divorces and the breakdown of marriages and families. Forming and maintaining intimate relationships in adulthood is a crucial task—if we are not equipped for this, we may suffer from certain psychological issues. Life can start to feel hopeless, meaningless, “as if it leads nowhere,” which reflects dissatisfaction with oneself, either due to internal or external causes—this is where psychological support can help initiate change.
As we enter later adulthood and old age, passion becomes a less important factor in intimate relationships, and we care more about how committed we are in the relationship, how much the other person is committed to us, and how satisfied we are with other aspects of the relationship—since different people have different needs in a relationship. The sexual aspect is more important in the beginning, and there are intimate relationships in which only the sexual part works, while other aspects don’t—though, more often, relationships don’t function on either level. However, when sexuality works, other psychological issues are easier to resolve. Conversely, when many problems are present, sexual desire often decreases—although possibly only in one partner, not both—so this needs psychological assessment and treatment.
Partners who continue to communicate with one another, remain committed to each other, stay interested in each other, further deepen their intimacy, and form a lasting and strong bond between them. Partners who do not communicate may feel isolated and dissatisfied, which can sometimes last for years. Although passion may fade over time, love does not have to decline along with passion, as other values in the relationship—those of a non-sexual nature—become more important.
Many people will experience the loss of a loved one at some point in their lives. This can create a deep sense of sadness and loss. After the end of a romantic relationship, some partners blame themselves, their self-confidence and trust in others decrease, and some may strive to immediately start another emotional relationship in order to replace the previous partner. Most people can be restored to their previous state with the help of psychological methods and counseling techniques, because some individuals find it difficult to cope with the stress of losing a loved one, either on their own or even with the help of friends. Loss is especially painful if it occurs suddenly or violently (a car accident, murder, illness), in other words, when it results from something unexpected and unanticipated.
Sex can be an expression of sensuality and intimacy without involving passionate love. People may engage in sex purely for sexual pleasure, not only for reproduction. Sex can also be a way of expressing love in a romantic and emotionally affectionate erotic relationship. People often get confused between the decision to be sexual and the decision to love, which is why it is important to clarify the value systems of partners before a sexual relationship begins.
Love can also take on negative aspects, and one of the most common examples among people is the problem of jealousy. This complex emotion troubles many individuals in their relationships—sometimes it is justified, but very often it is not. In a healthy emotional relationship, there is no room for jealousy, and over time, jealousy can turn into delusion and develop into persecutory ideas, which already represent serious psychological issues.
Some people exhibit a dependency on love, especially those with Dependent Personality Disorder. In such cases, individuals enter one “love” relationship after another in an almost self-destructive manner.
Some people may use love as a means to manipulate or control others. Possessiveness usually indicates problems with self-confidence and personal limitations, and it can lead to behaviors referred to as “stalking.”
Childhood Sexuality
Childhood sexuality is occasionally a concern for which parents seek help. Children in the preschool developmental stage may display certain sexualized behaviors, and parents may interpret these behaviors as “strange.” Boys may “imitate” sexual intercourse with surrounding objects, girls may rub against parts of furniture to achieve a kind of stimulation, and both boys and girls may at times undress inappropriately or show their genitals to strangers or house guests—putting parents in “uncomfortable” situations. However, these are usually transient childhood phases which, from a psychoanalytic perspective, may indicate sexuality as a more pronounced personality trait in later stages of development, such as adolescence and adulthood.
Parents should pay attention to such behaviors but should not punish them inappropriately. Punishing children’s sexualized behaviors can lead to the development of paraphilic disorders in adulthood (since “punishment” becomes associated with “expressing sexuality”).
In some cases, children’s sexualized behaviors may also suggest certain sexual experiences with other children or adults. It’s important to talk openly with children about sexuality, but since many parents feel embarrassed—often because these topics were not discussed in their own families of origin—they may choose to seek professional (e.g., psychological) help.
Children are also increasingly victims of sexual abuse, which is legally classified as “lewd acts” or “sexual intercourse,” referring to any sexual activity involving a child when there is a significant age disparity between the child and the perpetrator. In fact, it is not only a matter of age difference—sometimes a 15-year-old brother may sexually abuse his 10-year-old sister, which constitutes a deeply pathological relationship.
Pathological dynamics in sexually incestuous families are among the most tragic cases, and such families are generally very dark and dysfunctional. All members are affected by the incestuous relationship between a parent and child, or by other forms of incest (e.g., between siblings). Victims of incestuous abuse often remain hidden from both the public and professionals, as families keep them silenced, and the abusers are rarely brought to justice.
It is essential to promote open discussions about sexuality with children and youth in schools, as a means of preventing such crimes. The belief that children will engage in sexual activity earlier if they learn about sexuality is a misconception propagated by religious institutions and lacks scientific basis.
Educating children (in a developmentally appropriate way, suited to their cognitive and mental capacities to understand scientific concepts) about sexuality can only help them recognize when they are in danger or have become victims of abuse—and enable them to report it immediately. This could potentially save the lives of some children.
More than half of children engage in some forms of sexual activity before reaching adolescence. Boys are capable of achieving erections, just as girls can experience vaginal lubrication. For children, the most important issue is gender identity, which develops by the age of three and becomes more stable from that point on—that is, the child understands that their gender will not change over the course of their life, except in cases involving gender dysphoria.
In the preschool period, children often engage in role-playing games imitating adult behaviors, including romantic and sexual ones (especially if they have been exposed to such behaviors, even unknowingly, as children sometimes “peek” at what adults are doing when adults think they are not being observed).
At this age, children are taught that genitalia are private parts of the body and should not be shown in public. Boys are more frequently educated about the penis, while girls are less often taught about the clitoris or other parts of the female genitalia—this is likely due to the anatomical nature of male versus female genitals, which are more “visible” in boys and “less visible” in girls.
School-age children between six and twelve years old are generally in a sexually “latent” phase, showing less interest in their bodies and in sexual activities or games compared to the curiosity they displayed during the preschool years. During that earlier phase, children learn more about the body than they might ever again.
Some school-aged children begin to experience the early signs of puberty. It is increasingly common for girls to get their first period as early as age ten or even nine, which represents early sexual maturation and often comes with certain risks and vulnerabilities in the sexual development of girls.
Early sexual development in girls may signal pathological changes within the body or issues within the family system, and is frequently linked to genetic factors (for instance, mothers of girls who menstruate early often experienced early menstruation themselves).
Boys, on the other hand, typically lag behind girls in both sexual and cognitive development during puberty and childhood. While they are sexually inactive and generally incapable of initiating sexual acts, they can still become victims of sexual predators and pedophiles, just as girls can.
Gender non-conforming behaviors in children can be problematic both for the children themselves and for their parents, sometimes leading to family conflicts. Specifically, when a child behaves in ways that do not align with their biological sex, parents often try to conform to cultural and social norms, treating the child as society would — attempting to “correct” the child’s feelings. This can cause significant psychological distress for the child.
A child might outwardly conform to social norms, but this adaptation can last only until puberty and adolescence, when changes become more intense and visible, and the awareness of one’s own sexuality becomes stronger.
Peer pressure can also be overwhelming and difficult for a child to handle if they cannot conform to peer expectations. This is a particularly sensitive issue in the development of boys who display feminine characteristics, as other boys often act more aggressively toward them. Gender-nonconforming boys are more frequently victims of peer bullying, as their peers perceive them as “strange.”
In contrast, girls who show gender-nonconforming behaviors tend to adapt more easily. They are accepted by boys, who often treat them protectively rather than violently — although other girls may reject them. Girls also tend to accept friendships with gender-nonconforming boys who display feminine traits, often seeing them as gender-conforming to themselves — in other words, perceiving them as “just like girls.”
Parents may have a negative attitude toward such gender-nonconforming behaviors and punish the child for being that way — even though the parents themselves, through their genetic combination and psychological traits, have contributed to the child’s development. This must be acknowledged: it is wrong to blame the child for any “nonconforming” behaviors they exhibit, since such behaviors cannot arise solely from learning, but also stem from biological inheritance — which comes from the parents themselves.
Adolescent Sexuality
Adolescent or youth sexuality is the most complex and problematic stage in psychosexual development, as this is when the psychosexual identity is formed—an identity that will likely remain consistent throughout life or change only slightly in certain areas based on experience, but essentially retain the same core structure.
This period marks a biological flourishing of sexuality, with numerous primary and secondary sexual changes, and alongside solitary activity (masturbation), a desire for interactive sexual relationships begins to emerge. Adolescents are open to experimenting and experience high levels of sexual arousal, which will peak in early adulthood and then sustain for a period—depending on how much effort a person invests in maintaining a fulfilling sexual life and overall psychosexual well-being.
In adulthood, new responsibilities, worries, and life activities arise—factors that were absent during youth—giving life a new dimension. The need for sex often becomes replaced by the need for intimacy, for loving and being loved, and for caring for others while receiving care in return.
In partner relationships, differences in the expression of sexuality may arise, where one partner desires less and the other more sex, and sexual preferences may vary. For women, sexual intercourse can sometimes be painful. The same can apply to men, particularly if they are anally receptive.
Issues related to sexual orientation also commonly emerge during adolescence and often remain problematic if the orientation is not accepted—especially if it is non-heterosexual. Individuals in such situations may lead “double lives”, which can cause significant difficulties in both their personal and family lives. This tends to be a more frequent issue among men than women, as women are often better able to accept their non-heterosexual orientation, and female non-heterosexuality is somewhat more socially accepted than male non-heterosexuality.
A particularly vulnerable population consists of members of sexual minorities, who frequently seek psychological help. Due to social stigmatization, they may experience problems that heterosexual individuals do not typically face. Issues related to the acceptance of one’s own sexuality are of great importance for all people, and especially for those with non-heterosexual orientations, who—due to rejection or lack of acceptance—may behave in socially inappropriate ways, thus provoking even greater hostility from those who are intolerant.
On the other hand, it is necessary to educate both young people and adults about the diverse aspects of human sexuality. The most vulnerable category within sexual minorities are transgender individuals, whose psychological difficulties tend to be even more complex than those of other sexual minority groups.
During puberty, the body is essentially preparing for adult sexuality, and the ability to reproduce emerges. Adolescence is a period of emotional, social, and cognitive reactions to the changes brought on by puberty, which are mostly physical in nature. Some of the first signs of puberty in girls include breast development, the appearance of pubic hair, body shaping, and the onset of menstruation.
Girls whose development occurs “on time” tend to have a more positive body image compared to those who experience delays in these aspects of sexual development and may retain more infantile characteristics. Menarche (the first menstruation) is considered one of the most important milestones in the lives of women and girls. The way this moment is experienced by a girl can vary depending on how her cultural context explains or frames it.
In boys, the first signs of puberty also include the growth of pubic hair, although this occurs a few years later than in their female peers. “Spermarche” (the first ejaculation of semen) can cause feelings of surprise, confusion, curiosity, and pleasure in boys, and they usually do not talk to anyone around them about this event.
In preadolescent period, children start to explore their bodies, touching their genitalia and other body parts, and they start developing sexual plays and fantasies. They learn about sexuality based on relationships formed with people from their surroundings – family members, peers, etc. Sexual contacts between children can emerge through sexual play, and this is possible even between siblings. However, sometimes these contacts escalate by violent sexual acts, where older siblings request from younger ones to engage in some kind of sexual activity with them. Psychological consequences can emerge when there is a big age range between siblings involved in sexual activities or when violence is used.
Adolescents begin to develop an interest in intimate relationships with their peers, often imitating adult sexuality. The issue of sexual orientation becomes a central concern, and heterosexual normativity is generally regarded as acceptable by the majority of peers, while any deviation from that normativity tends to be rejected. Non-heterosexual adolescents may subsequently develop a range of psychological issues due to rejection by parents and peers, which in some cases leads to substance use. Questions of sexual identity become particularly significant, especially among members of the LGBTIQ population, notably in communities where such sexual orientations are not socially or culturally accepted. Individuals who fail to adequately integrate their sexual identity may go on to live double lives in adulthood. In cultures where homosexuality is not accepted, many people remain trapped in unfulfilling marriages simply to conform to cultural norms. Family reactions to an LGBTIQ identity, combined with personal expectations, may lead to confusion and the development of depressive disorders, as well as other psychological issues such as Substance (Ab)use Disorders or Personality Disorders, and, less commonly, Psychotic Disorders—most frequently Delusional (formerly known as Paranoid) Disorder.
Girls’ body image tends to initially improve as they progress through adolescence, while boys’ body image often deteriorates (due to developmental delays compared to girls, which can lead to frustration). However, as they grow older, girls’ body image generally worsens, whereas boys’ body image tends to improve. Girls who enter puberty early are at increased risk of developing Eating Disorders.
Masturbation is a sexual activity that becomes dominant during adolescence, and tends to decline as the frequency of interactive sexual relationships increases. Most high school students engage in interactive sexual activity. Sometimes, young people engage in sexual activities with same-sex peers, regardless of their sexual orientation, which may result from sexual curiosity and experimentation. Approximately one in ten young individuals in Western cultures report being confused about their sexual orientation or identify as homosexual or bisexual. There is also a growing rate of the use of sexual coercion or violence to initiate sexual activity.
Young people who are more religious or who grow up under religious customs usually delay sexual behavior (often suppressing it) and tend to have fewer sexual partners. Mothers have a particularly significant influence on the initiation of sexual activity among heterosexual adolescent girls, and parental communication with children about their sexuality plays an important role in this process.
Early initiation of sexual activity and risky engagement in sexual behaviors among girls can lead to issues such as unwanted pregnancy. This includes school dropout, poorer physical and mental health, lower birth weight of newborns, reduced health and cognitive abilities, behavioral problems, and diminished educational opportunities.
Sexual Relationships in Adulthood
Every society has specific norms for regulating how individuals develop sexual relationships with others. Nowadays, people openly engage in various types of sexual relationships, including those with the same or opposite sex, casual, premarital, marital, extramarital, and polyamorous relationships. In essence, adult individuals are permitted to enter into intimate relationships with other adults, provided that all parties give voluntary consent. Young adults typically engage in “dating” before entering more serious, legally defined relationships, and this practice has become considerably more liberal in modern times compared to the past. Communication technologies have enabled long-distance relationships.
Sexuality is considered a key element in shaping romantic and intimate relationships, and levels of sexual satisfaction are similar among heterosexual and non-heterosexual couples. As people age, sexuality changes and can influence relationships and overall mental health. Sexual inactivity is a fundamental cause of weakened psychosexual functioning.
Relationships that are formed before the age of 25 are more likely to end than to develop into committed partnerships. A “cost/benefit” analysis is often necessary to determine whether one should stay in a relationship or leave it.
In modern times, there has been an increase in people’s engagement in casual sexual relationships with others. These sexual encounters sometimes happen only once, while in other cases, people continue the relationship for the sake of sexual functionality between two individuals, that is, due to sexual compatibility. People may engage in sex without expecting deeper emotional involvement. Men are generally more satisfied with such relationships than women due to the double standards in expectations of sexual satisfaction in casual sexual interactions. These sexual practices can lead to problems with ambivalence and sexual exploitation.
Cohabitation has become an increasingly common solution among young adults forming sexual and romantic relationships, which is considered good practice before entering marriage or before partners decide to continue with a serious relationship or start a family. Most young people want or believe they should eventually marry and form a family, but this does not happen for everyone who desires it—or it happens in unexpected or undesired ways.
Marital satisfaction is related to the social circle of friends, the frequency of enjoyable activities, how much partners are able to disclose about themselves to each other, physical and emotional intimacy, and the similarity in personality traits and value systems between partners. Partners may differ in how aware they are of their level of (dis)satisfaction with marriage or cohabitation. The quality of marital life peaks in the early years of the relationship, then declines, and tends to rise again during midlife. Marital or cohabitational happiness is greater before having children, then gradually declines until the children reach puberty, and increases again once the children leave home. In other words, couples report greater happiness without children than with children.
Almost all partners in romantic relationships expect so-called “sexual exclusivity,” meaning mutual sexual fidelity. However, engaging in sexual activities with others is relatively common, and infidelity is more prevalent among those with heightened sexual interests and desires, more liberal sexual value systems, and greater dissatisfaction with their current intimate relationship—especially if they have more opportunities for sex outside of the relationship. Some partners engage in “online” or “virtual” infidelity, which often escalates into real-life encounters, potentially devastating the existing relationship or opening new dimensions in the lives of those involved as well as those excluded from the infidelity. While women tend to be more concerned about emotional infidelity, men are generally more troubled by sexual infidelity. Some partners choose to engage in swinging, or partner swapping with other romantic couples.
A particular challenge in psychological practice is presented by individuals (primarily men) who engage in extramarital infidelity with other men, living a double life—either in a receptive or insertive role (i.e., passive or active in sexual relations). This behavior can have a significantly negative impact on their mental health as well as on that of their family members. Wives of such men may sometimes notice these behaviors and choose to tolerate them for the sake of their children, while in other cases the behavior may go unnoticed, placing them at risk of sexually transmitted infections and other primarily psychological consequences. Same-sex relationships between men are often based solely on the satisfaction of sexual urges—partly due to the evolutionary tendency toward male promiscuity, and partly due to fear of emotional attachment or of loving another man in the same way they might love a woman (or believe they do). Women with homosexual tendencies may request to introduce a third person—another woman—into their marriage, which may initially present a sexual novelty to the husband. However, as emotional bonds develop between the man and the second woman, between the two women, and continue between the original couple, the situation can become complex. Some individuals are bisexual and feel the need to have both a same-sex and opposite-sex partner in their lives to feel whole, which brings its own set of challenges and psychological stressors. In such situations, psychological support and counseling can play a crucial role.
Today, there is an increasing trend of marital divorce and child custody arrangements, which are issues of particular importance in Forensic Psychology and Psychopathology, specifically within the practice of forensic psychological evaluations in civil court proceedings. Several factors contribute to divorce, including:
- Entering into marriage during adolescence or before achieving emotional and social maturity (before the age of 25),
- Getting married due to an unplanned pregnancy,
- Lack of nonreligious worldviews (which can be symptomatic, as some individuals avoid divorce due to religious beliefs, remaining in unhappy marriages and subsequently developing various psychological disorders),
- Differences in religious affiliations,
- Communication problems between partners,
- Previous divorces (either their own or their parents’ experience of divorce).
In women, there is a noted increase in depressive disorders following divorce, whereas men are more likely to engage in substance abuse and experience poorer physical and mental health.
Sexuality in older adults tends to be less problematic, as most have already experienced all they desired in terms of sexuality. On the other hand, there are also younger individuals with gerontophilic tendencies, i.e., they are exclusively sexually aroused by older individuals, which is a legitimate preference and does not constitute prohibited sexual behavior, provided that the older person is mentally competent and able to give informed consent.
Older adults may still face challenges in expressing their sexuality due to biological limitations associated with aging. Individuals with mental illness or those who take psychotropic medications may also experience changes in sexual behavior, for which psychosexual counseling may be necessary. In some cases, psychological problems are rooted in sexual issues, and resolving these psychosexual concerns can also resolve the associated mental health symptoms. Therefore, thorough analysis is essential for addressing such problems.
Having problems in your marriage or relationship? Talk to a psychologist.
Sexual Behavior
Hormones play a very important role in the expression of sexuality (primarily estrogen and testosterone), but life experiences, social, cultural, and ethnic influences are also crucial for human sexuality. Hormone levels decline with age, causing various physical changes (e.g., increased vaginal dryness and reduced sensitivity in women, and weaker and less frequent erections in men). Social and religious influences significantly affect sexual behavior in adulthood. More religious individuals tend to have more conservative sexual behaviors compared to those who are less religious.
In women, the menstrual cycle can influence the sexual response cycle. Knowledge of sexuality affects the relationship between partners and the experience of orgasm, i.e., achieving sexual satisfaction. The sexual response must involve the phases of interest or desire, sexual arousal, activity, and climax (orgasm), followed by the so-called “refractory period”—a phase during which sexual arousal cannot be achieved for some time. This period is generally longer in men than in women after sexual activity. While women can engage in sexual intercourse again shortly after experiencing orgasm, men typically need some time to “rest” before becoming sexually aroused again. Some individuals do not require a refractory period, while others may be unable to have more than one orgasm—this depends on the individual’s sexual functioning.
Solitary sexual behaviors refer to masturbation and sexual fantasizing, which can also be used within interactive sexual relationships. Both men and women may use sexual fantasies to enhance sexual arousal. Some individuals are more, and others less, sexually imaginative. Numerous factors influence the formation of sexual fantasies, including religious beliefs, cultural influences, family relationships, abuse, gender, age, sexual orientation, and more.
Masturbation is considered a strategy to improve sexual health, reduce stress and the risk of unwanted pregnancy, and avoid sexually transmitted diseases. In certain life circumstances (such as the military or prison), masturbation becomes the only sexual outlet—unless one engages in prohibited same-sex sexual activity.
People engage in sexual activities for various reasons—not only to reproduce, but also to experience sexual pleasure, reduce stress, express love, improve social status, seek revenge, fulfill a perceived obligation, satisfy curiosity, or even as a form of exercise. These sexual activities may occur with different people and in various contexts—such as one-night stands, casual relationships, with acquaintances, strangers, or passersby.
Sexual activity does not necessarily imply penetration or coitus; instead, it can include a wide range of behaviors, such as kissing, touching, mutual masturbation, oral sex, and coitus. Couples who engage in sexual activity more frequently are generally more satisfied with both their sexual and mental lives, tend to have more frequent oral sex, achieve orgasm more consistently, and enjoy greater variety in their sex life, all of which contribute to a higher overall life satisfaction.
Couples may engage in certain forms of foreplay prior to sex, serving as a “prelude” to sexual activity, and in some cases, foreplay itself can become a form of sexual play. Various methods and techniques of sexual arousal are used, all aimed at enhancing intimacy, physical contact, and emotional exchange between partners. Sometimes, partners may wonder how best to satisfy their partners manually or orally, and if they are unable to communicate this effectively, professional guidance may be beneficial.
During sexual intercourse, adequate lubrication of the receptive partner is extremely important. In heterosexual couples, vaginal lubrication must be sufficient to allow penetration, otherwise the experience may become painful—especially in women who have been raised in more psychologically conservative environments and who may view sex superficially. In such cases, professional support is often very helpful. In anal sex, adequate lubrication is also required to facilitate the penetration of the penis into the anus. This can also be achieved through oral sex, but the risk of infections increases in such cases. Anal sex is generally associated with a higher risk of infection due to bacteria naturally residing in that area, which can be harmful if transmitted to other parts of the body. Therefore, anal sex should be practiced with caution.
Variations in Sexual Behavior
Social value judgments in society, more than scientific knowledge, influence which sexual behaviors are considered acceptable, although these attitudes can change over time and with experience.
Paraphilias or Paraphilic Disorders refer to recurrent, intense sexual arousal, fantasies, sexual urges, or behaviors that involve the desire for an erotic object that is inappropriate—such as a “non-human” entity—or the desire for humiliation and suffering of another person or oneself, as well as sexual desire toward children or other individuals who cannot give voluntary consent (such as mentally incapacitated persons).
Some individuals may have certain “atypical” sexual interests that do not constitute a Paraphilic Disorder—for example, engaging in consensual sadomasochistic practices with other adults, cross-dressing, or deriving arousal from watching others engage in sexual activity or being observed while doing so themselves. None of these activities necessarily represent sexual disorders or paraphilias, as they may reflect a personal lifestyle choice.
However, Pedophilic Disorder—which involves sexual activity with children under the age of 18 (or younger, depending on legal definitions)—is a specific and serious concern, as is Zoophilic Disorder, involving sexual activities with animals.
Paraphilic disorders may arise from various factors, but in psychological practice, common patterns include: childhood or later-life experiences of sexual abuse (with childhood trauma being especially harmful to long-term mental health), growing up in dysfunctional families, early exposure to family conflict, sexualization of traumatic experiences, and media influence interwoven with trauma.
If left untreated, paraphilic disorders can have severe consequences for the individual’s mental health and may violate social norms, laws, and community safety—such as in the case of zoophilia, pedophilia, necrophilia, or rape and sexual exploitation of others.
Compulsive Sexual Behavior
Compulsive sexual behavior represents a variation of sexual behavior that is still not officially classified as a disorder in current diagnostic systems, although it was previously referred to as “excessive sexual behavior” (satyriasis in men and nymphomania in women); and has also been labeled in the literature as “hypersexual disorder,” “sexual addiction,” “sexual impulsivity disorder,” or “sexual compulsivity.”
Individuals engage in sexual behaviors with varying intensity and frequency, but some people exceed normative patterns and become obsessed with sex. However, a healthy sexual life requires a degree of moderation, much like substance use (alcohol, drugs), gambling, and other behaviors that may provide a false sense of excitement or satisfaction. Compulsively sexual individuals often exhibit promiscuous behavior, frequently change partners, expose themselves to sexually transmitted infections, and commonly present with co-occurring mental disorders, such as depressive disorders or substance use disorders, along with various consequences (e.g., financial problems, neglect of family or work responsibilities).
Treatment for variations in sexual behavior must begin with a thorough psychodiagnostic assessment, including structured interviews, behavioral observation, psychological testing, and personality inventories. The primary goal is behavioral change, and treatment may include a family systems approach, pharmacotherapy, psychoeducation, and other appropriate therapeutic methods and techniques.
Variations in Sexual Behavior
Social value judgments in society, more than scientific knowledge, influence which sexual behaviors are considered acceptable, although these attitudes can change over time and with experience.
Paraphilias or Paraphilic Disorders refer to recurrent, intense sexual arousal, fantasies, sexual urges, or behaviors that involve the desire for an erotic object that is inappropriate—such as a “non-human” entity—or the desire for humiliation and suffering of another person or oneself, as well as sexual desire toward children or other individuals who cannot give voluntary consent (such as mentally incapacitated persons).
Some individuals may have certain “atypical” sexual interests that do not constitute a Paraphilic Disorder—for example, engaging in consensual sadomasochistic practices with other adults, cross-dressing, or deriving arousal from watching others engage in sexual activity or being observed while doing so themselves. None of these activities necessarily represent sexual disorders or paraphilias, as they may reflect a personal lifestyle choice.
However, Pedophilic Disorder—which involves sexual activity with children under the age of 18 (or younger, depending on legal definitions)—is a specific and serious concern, as is Zoophilic Disorder, involving sexual activities with animals.
Paraphilic disorders may arise from various factors, but in psychological practice, common patterns include: childhood or later-life experiences of sexual abuse (with childhood trauma being especially harmful to long-term mental health), growing up in dysfunctional families, early exposure to family conflict, sexualization of traumatic experiences, and media influence interwoven with trauma.
If left untreated, paraphilic disorders can have severe consequences for the individual’s mental health and may violate social norms, laws, and community safety—such as in the case of zoophilia, pedophilia, necrophilia, or rape and sexual exploitation of others.
Compulsive Sexual Behavior
Compulsive sexual behavior represents a variation of sexual behavior that is still not officially classified as a disorder in current diagnostic systems, although it was previously referred to as “excessive sexual behavior” (satyriasis in men and nymphomania in women); and has also been labeled in the literature as “hypersexual disorder,” “sexual addiction,” “sexual impulsivity disorder,” or “sexual compulsivity.”
Individuals engage in sexual behaviors with varying intensity and frequency, but some people exceed normative patterns and become obsessed with sex. However, a healthy sexual life requires a degree of moderation, much like substance use (alcohol, drugs), gambling, and other behaviors that may provide a false sense of excitement or satisfaction. Compulsively sexual individuals often exhibit promiscuous behavior, frequently change partners, expose themselves to sexually transmitted infections, and commonly present with co-occurring mental disorders, such as depressive disorders or substance use disorders, along with various consequences (e.g., financial problems, neglect of family or work responsibilities).
Treatment for variations in sexual behavior must begin with a thorough psychodiagnostic assessment, including structured interviews, behavioral observation, psychological testing, and personality inventories. The primary goal is behavioral change, and treatment may include a family systems approach, pharmacotherapy, psychoeducation, and other appropriate therapeutic methods and techniques.
Sexual Orientation
Sexual orientation refers to sexual attraction toward individuals of the opposite sex (heterosexual), the same sex (homosexual), or both sexes (bisexual orientation). However, although it is called “sexual orientation,” it does not necessarily refer only to sexual attraction—it may also include emotional, physical, and general intimacy. Sexual orientation is not defined solely by sexual behavior, but also by thoughts and fantasies. People may engage in heterosexual behavior because they are afraid to express their true sexual orientation due to social stigma.
It is not known how many people have diverse sexual orientations, but individuals with non-heterosexual orientations are commonly referred to as “sexual minorities” or the LGBTIQ population. Sexual behaviors do not necessarily correspond with sexual orientation—this is why we say it is not just about behaviors, but also about thoughts, fantasies, desires, and drives.
There is a growing trend of individuals identifying as LGBT. In the past, it was believed that up to 4% of men were gay, up to 3% of women were lesbian, and around 3% identified as bisexual. However, the actual percentage is significantly higher due to the social stigma associated with identifying as someone with a non-heterosexual orientation.
Many individuals with non-heterosexual orientations must cope with discrimination, prejudice, and legal systems that do not recognize same-sex partnerships. They are often rejected by family members, friends, and may face difficulties in the workplace. In some countries, such individuals are even sentenced to death. Although non-heterosexual behavior is not criminalized in our legal system, it is still reluctantly accepted—especially male homosexuality—by the broader social community. Individuals who engage in public homosexual behaviors may face negative societal reactions and consequences, which can lead to psychological distress and trauma-related experiences.
Non-heterosexual individuals undergo a process of accepting their sexual identity, commonly referred to as “coming out,” which is a central focus of psychotherapy for those seeking psychological help due to challenges related to sexual orientation and identity. It is therefore incorrect to claim that sexual orientation can be changed; it can only be accepted. Some individuals never come to terms with their non-heterosexual identity, and this unresolved identity confusion may persist into adulthood, creating significant psychological strain and negatively impacting mental health (e.g., low self-esteem, development of depressive disorders, substance use disorders, personality disorders, etc.).
More than half of parents react negatively to the non-heterosexual orientation of their children, with responses often characterized by disappointment, shame, and shock. As a result, the majority of non-heterosexual youth experience parental rejection linked to their sexual orientation, which is particularly pronounced in more conservative and religious environments that uphold traditional values. Older non-heterosexual individuals may face challenges in social adaptation due to having grown up in societies and legal systems that were dismissive and stigmatizing toward non-heteronormativity. Individuals who have never accepted their sexual identity may fall into isolation and loneliness, potentially developing depressive disorders due to internalized homophobia—that is, harboring negative feelings toward their own sexual orientation.
Homophobia refers to an excessive fear and avoidance of homosexual individuals, as well as the formation of extremely negative attitudes toward homosexuality and homosexual people. These attitudes can, in some cases, lead to violent criminal acts against sexually non-conforming individuals.
Most people within the LGBTIQ community have, at least once in their lifetime, experienced hate crimes or abuse, with victimization rates higher among boys and young men. Victimization typically begins during adolescence, although verbal attacks can start as early as the preschool years. Violence against LGBTIQ individuals tends to rise as their acceptance within society increases, provoking radical reactions from individuals and groups holding hateful or hostile attitudes. Society tends to tolerate female homosexuality somewhat more, which contributes to a greater fluidity in women’s sexual identities compared to men. Women are also more likely than men to identify as bisexual.
Pregnancy, Abortion, and Birth
Pregnancy, Abortion, and Birth
Learning that a girl or woman is pregnant affects each expectant mother differently. This realization is influenced by timing, psychological readiness, the circumstances in which the pregnant woman finds herself, and especially whether the pregnancy occurred with a partner whose child is wanted, who provides adequate genetic material, and offers psychological safety for the offspring.
If the pregnancy is accepted, the psychology of pregnancy begins—a process that can sometimes be quite complex and bring a certain level of stress not only for the pregnant woman but also for her partner or existing children, if any.
If the pregnancy is not accepted, considerations arise about terminating the pregnancy through medical methods, that is, abortion. This decision is primarily made by the pregnant woman, but it is possible to discuss the final decision with the partner or a professional (e.g., psychologist, gynecologist, psychiatrist). Typically, the opinion of several professionals is required, depending on the intensity of the dilemma experienced by the woman or the couple.
Sometimes, the man wants the pregnancy to be terminated, while the woman does not, and this, too, should be discussed before making a final decision.
The psychology of pregnancy is usually divided into three trimesters, as is common in scientific literature. In the first trimester, the most important aspects of embryonic development occur—the baby grows, and during these months the pregnancy may not even be noticeable. In the second trimester, the woman will begin to feel the baby’s movements in the womb, and this trimester is generally the most positive period of pregnancy for the expectant mother. In the third trimester, colostrum begins to leak from the nipples, and partners slowly prepare for childbirth, discussing practical matters such as the baby’s name, setting up the nursery, and whether the partner will be present during labor.
Women who are overweight or underweight may experience difficulties during pregnancy. The use of alcohol and drugs contributes to certain complications for the fetus. In recent years, there has been an increase in the number of mothers who use marijuana during pregnancy, which results in certain consequences. However, every organism is individual—some may not experience any adverse effects, but the risk is always present. Some married couples choose artificial insemination, which are procedures that require a significant financial investment, although the underlying issues may sometimes be psychological and could be addressed by improving communication between partners and working on enhancing their natural sexual intimacy.
Sexual activity is generally safe during pregnancy for most mothers up until the last few weeks in uncomplicated pregnancies. Experiencing orgasm is entirely safe, although sometimes painful uterine contractions may occur.
A spontaneous abortion or miscarriage is the natural termination of a pregnancy before the fetus is viable. Most miscarriages occur during the first trimester, but there are cases when they happen later. The realization that a miscarriage has occurred is accepted differently by each person and sometimes requires psychological intervention for the pregnant woman and/or the couple. Other issues include the birth of children with certain congenital anomalies, which can provoke feelings of shock, shame, and disappointment in parents, leading to a range of negative emotions. In some cases, parents may deny the existence of a problem.
During pregnancy, women often contemplate various possibilities and outcomes related to childbirth. Pregnant women also think about the act of delivery itself, and professional assistance is sometimes required immediately after childbirth due to conditions such as postpartum psychotic episodes. Women may also experience postpartum depressive episodes without psychotic symptoms, which resemble a Major Depressive Episode but are characterized by specific features due to their association with childbirth and the events surrounding it.
After pregnancy, the psychology of the postpartum period follows, which may also present its own challenges—particularly regarding whether the mother accepts her new role and motherhood itself. Motherhood can present difficulties later in life, especially if the mother lacks support from the child’s father or if there are problems in family relationships.
It is generally advised to abstain from sexual intercourse for up to six weeks postpartum, though other sexual practices are possible during this period. In cases of uncomplicated pregnancies and deliveries, sexual intercourse may resume as early as two weeks after birth, although most mothers are able to return to previous sexual activities by three months postpartum. This is evident in couples with children born one year apart, indicating early postpartum resumption of sexual relations. For mothers, this can sometimes be physically and emotionally demanding, so fathers need to be more involved in certain aspects of maternal life and respect the psychological state of new mothers—often referred to as a “different condition”—which many men have difficulty understanding or empathizing with, as they cannot experience pregnancy or childbirth themselves.
It is even debatable whether all husbands are capable of witnessing childbirth, particularly if they are not psychologically prepared for it.
Planning a pregnancy or currently expecting a child/have a pregnant partner? Do you have questions about maternal psychology?
Challenges of Sexual Functioning
Sexual health is vitally important for our overall mental and physical well-being, and vice versa. Healthy sexuality depends on good physical and mental health. Sexual problems arise when we do not feel sufficiently sexually aroused, when there is a reduced level of enthusiasm, or when we encounter difficulties in relaxing during sexual activity. Most couples experience occasional sexual difficulties, which usually resolve on their own without the need for professional help. However, in some cases, sexual problems persist and may contribute to other relational issues.
Psychological factors that may contribute to sexual (dys)function include unconscious fears, stress, anxiety, depression, guilt, anger, fear of intimacy, dependency, or abandonment, concerns about losing control, and performance anxiety. Other relationship issues that can lead to sexual difficulties include feeling unloved or disrespected, lack of trust, unresolved anger, insecurity, and conflict.
Sexual problems can be long-standing and present throughout a person’s life, or they may be situational and acquired later. In some cases, they are specific to certain contexts (e.g., a person can become sexually aroused alone but not with a partner). Persistent sexual problems often have both biological and/or psychological causes, while acquired difficulties (that did not exist previously) are frequently psychogenic in origin.
During psychotherapeutic treatment, it is crucial to identify the various contributing factors to the onset of sexual problems. This includes analyzing potential sexual difficulties of the individual partners, as well as their physical and mental health, vulnerability factors, relationship dynamics, cultural and religious influences, and biological or medical contributors.
In some individuals, sexual desire is triggered by behaviors that lead to the pursuit of sexual activities, while for others, sexual desire arises in response to engaging in sexual activity itself. Problems with sexual desire manifest as a diminished or absent interest in sexual activity, which can lead to both psychological and physical symptoms. People with low sexual desire rarely or never experience sexual fantasies, are less likely to initiate sexual activity, and seldom engage in self-stimulation. For such issues to be considered a sexual dysfunction, they must persist for at least six months and be present most of the time.
Health conditions, chronic illnesses such as diabetes, hypertension, and other autoimmune or cardiovascular diseases, heart attacks, strokes, and cancer can negatively affect sexual life. Breast cancer in women and the treatment of any type of cancer also negatively impact the physiological, psychological, and interpersonal aspects of sexual functioning and satisfaction. Similarly, prostate cancer in men can affect sexual functions. Neurological conditions and illnesses, alcoholism, mental, respiratory, gastrointestinal, and other disorders may impair sexual functionality, even though individuals with such conditions may still retain sexual desire—while their partners may lose it due to the partner’s disability.
People experiencing sexual problems should seek treatment as early as possible to prevent the issues from becoming more serious. When left unaddressed, these problems often lead to the development of new issues or worsening of existing ones.
Do you think you are experiencing sexual problems?
Schedule an appointment.
Sexually Transmitted Infections (STIs)
Contracting a sexually transmitted infection (STI) presents a range of psychological challenges—from accepting the diagnosis, undergoing treatment in medical institutions (where patients often face prejudice, including from specialists in dermatology and venereology), to dealing with societal stigma, particularly in the case of chronic sexually transmitted diseases such as AIDS (acquired immunodeficiency syndrome caused by HIV, the human immunodeficiency virus).
Learning that one has an STI can be highly stressful psychologically. However, what is encouraging is that all STIs can be effectively treated—bacterial infections can even be cured—or kept under control. These infections are caused by ectoparasites, bacteria, viruses, or fungi, although other microbes such as parasites can also be transmitted sexually.
University students are among the groups at highest risk of contracting STIs, as are members of the gay community and transgender individuals involved in sex work, as well as sexually compulsive individuals—those who frequently change partners. Young people often engage in sexual activities without using contraception and participate in high-risk sexual behaviors (such as group sex, sexual orgies, or frequently changing partners in rapid succession).
Ectoparasitic infections involve the transmission of parasites that live on the skin surface, most commonly pubic lice or scabies. Symptoms usually begin with itching and possible rashes, which can be particularly distressing if the ectoparasites appear during an ongoing relationship and are first noticed by one partner.
Bacterial and Viral Infections
Bacterial infections include gonorrhea, chlamydia, syphilis, and various vaginal infections. Early detection is crucial, as well as abstinence from sexual activity and simultaneous treatment of both partners. Vaginal infections in women may occur due to an imbalance in the vaginal flora, often as a result of multiple sexual partners.
Viral infections include herpes simplex virus (HSV), human papillomavirus (HPV), hepatitis viruses (hepatitis B is most commonly transmitted sexually, hepatitis C is primarily transmitted intravenously but can also be sexually transmitted, while hepatitis A is even more easily transmitted), and the human immunodeficiency virus (HIV). Recurrent viral infections may lead to a weakened immune system and the development of cancerous conditions.
Untreated bacterial and viral infections can result in serious physical and psychological consequences. HIV targets T-cells in the blood, which are responsible for antibody production and immune defense. As the immune system becomes compromised, opportunistic infections may develop, leading to additional psychological distress and social stigma, especially when infections become visible on the body. STIs can often be asymptomatic in their early stages, making individuals unaware of their infectious status. Ironically, this asymptomatic phase is when the risk of transmission is highest. Therefore, abstaining from sexual activity is the primary preventive measure.
HIV infection can progress into AIDS, a chronic condition frequently accompanied by psychological and social stigmatization. Although AIDS is often associated with the gay community, infectious agents do not discriminate by sexual orientation—they infect humans indiscriminately. STIs can affect anyone, including individuals with no apparent risk factors. For instance, sleeping next to a person with pubic lice is enough to transmit the infestation, similar to scabies and other parasitic infections. Bacterial and viral infections typically require more intimate contact, though some can also be transmitted through oral sex.
Condom use remains the most effective method of STI prevention. However, early detection also contributes to better psychological well-being, more effective treatment, and quicker recovery—facilitating a return to daily life, including sexual activity.
Do you suspect you may have a sexually transmitted infection, or have you already been diagnosed?
Seek psychological evaluation/support.
Sexual Violence and Exploitation
Sexual Violence and Exploitation
Sexual violence refers to any type of sexual act that is carried out against an individual’s conscious will. There are various forms of sexual violence, including: rape, sexual coercion, unwanted sexual contact, forced penetration, and non-contact unwanted sexual behaviors.
In professional and scientific terminology, rape is defined as an attempted or completed unwanted vaginal, anal, or oral penetration involving the use of physical force (e.g., restraining the victim in a position from which they cannot escape) or threats of violence—even when the victim is under the influence of alcohol or drugs. This also includes cases where a person has collapsed or is in an unconscious state due to intoxication or drug influence, rendering them incapable of resisting or giving consent. Penetration may be carried out with the penis, a body part (such as a finger or hand), or a suitable (e.g., sexual aids) or even unsuitable object (e.g., blunt or sharp instruments).
Sexual coercion involves pressuring someone into engaging in sexual activity when that person does not wish to participate. This form of coercion can include threats used to obtain sex or persistent demands for sexual activity until the person gives in to the pressure.
Unwanted Sexual Contact and Non-Contact Sexual Violence
Unwanted sexual contact includes non-penetrative sexual behaviors such as groping, fondling, touching, hugging, or kissing without consent. Touching may occur over clothing or directly on the skin and typically involves the genital area, buttocks, breasts, groin, or legs, though other body parts (such as the neck) may also be involved if used to provoke arousal or fulfill the perpetrator’s sexual desire. In legal contexts, this type of contact is often categorized as “lewd acts” or “indecent behavior.” In forensic psychosexological assessments, the “degree of consent or willingness” involved in the act is evaluated—both from the perpetrator and the victim.
Forced penetration refers to acts of sexual violence where an individual, using physical force, threats, or while the victim is under the influence of alcohol or drugs, compels another person to undergo vaginal, oral, or anal penetration, often involving a third party or indirect coercion (“via a proxy”).
Non-contact unwanted sexual behavior includes unwanted exposure to sexual situations such as pornography, verbal or behavioral sexual harassment, or creating a sexually hostile environment. For example, an individual may try to force someone to watch a sexual act between them and another person, even if the observer does not consent.
There are many variations of sexually dysfunctional behaviors that involve elements of sexual violence. Nearly half of victims do not report sexual violence. It is estimated that one in three women and one in six men experience some form of sexual violence in their lifetime. These statistics highlight how widespread and frequent sexual violence is in society, though it often goes unreported due to the difficulty of proving such acts or because of stigma and labeling, especially in more conservative or rural communities.
Do you believe you or someone you know may have been a victim of sexual violence?
Seek professional support.
Perpetrators of Sexual Violence and the Dynamics of Stalking
Perpetrators of sexual violence are primarily men, and they are not necessarily single or unmarried. There are various personality profiles among such individuals. Many possess sexist attitudes toward women or sexual minorities, display high levels of impulsivity and aggression, and demonstrate strong belief in rape myths (e.g., the false belief that victims “secretly want” to be raped).
Note: In the context of consensual sexual relationships, some couples may engage in so-called “rape role-play,” which occurs voluntarily and is based on mutual agreement between partners. In such scenarios, partners consensually decide who will enact the role of the “aggressor” and who will play the “victim.” These practices may involve elements of sadomasochism but are not necessarily indicative of sadism or masochism disorders—they are instead expressions of consensual sexual preferences.
Crucially, true sexual violence always involves the violation of a person’s will—that is, the act is committed against someone who has not given voluntary consent. This is the essential distinction between consensual role-play involving elements of aggression and actual sexual assault, which is inherently non-consensual and constitutes a serious psychological and legal violation.
Sexual offenders often have a personal history marked by experiences of sexual and/or physical abuse, both in childhood and adult relationships. They may also exhibit a pattern of other forms of violence.
Stalking represents another form of sexualized violence and may include unwanted phone calls, written or voice messages, videos, messages via social media or email, and the perpetrator physically appearing in locations where the victim is likely to be (such as school, workplace, home, or social venues). It also includes monitoring, following, or spying on the victim. In some cases, individuals may develop delusional beliefs that they are being stalked, which necessitates a comprehensive psychodiagnostic evaluation.
Rape Trauma Syndrome (RTS)
Rape Trauma Syndrome (RTS) represents a biphasic stress response pattern that includes a combination of sexual, psychological, behavioral, and/or physical problems. The first, acute phase, involves a wide range of emotional responses such as shock, fear, anger, self-blame, shame, guilt, distrust, humiliation, and other intense negative feelings. Victims may fear being alone, encountering strangers, or returning to the place where the assault occurred (such as the home, a vehicle, or a room). Emotional instability and extreme mood swings are common. Sleep disturbances and nightmares are frequent symptoms. These responses arise immediately after the assault and can last from several days to weeks or even months, depending on the individual, and may develop into Post-Traumatic Stress Disorder (PTSD), including its complex form.
The syndrome also depends on whether the sexual assault was committed by a known or unknown person, as psychological reactions may vary accordingly. Some survivors may blame themselves for what happened. This may be followed by depression, which can last up to a year or more and evolve into Persistent Depressive Disorder (dysthymia), Substance Use Disorders, or other disorders, such as Personality Disorders.
The second phase of RTS involves long-term reorganization, in which survivors work to rebuild and regain control over their lives. Symptoms in this phase can last up to two years after the assault, though their duration is highly individual. Some people recover after five years, depending on their personal resilience and support systems.
A specific manifestation of RTS is the so-called “silent reaction,” in which the victim never discloses the assault to anyone and carries the trauma internally. These individuals still experience symptoms such as fear, anger, depression, and physiological discomforts, although they keep them repressed or hidden. Generally, those who take longer to speak about what happened require a longer recovery period. In some cases, the trauma may resurface even ten or fifteen years later. Individuals who were sexually abused in childhood may become aware of that trauma only in adulthood, once they develop greater emotional and social maturity.
Different reactions to rape
It is important to note that false accusations of rape do occur in some cases, sometimes as a form of manipulation or retaliation. These cases must be distinguished through comprehensive forensic-psychological evaluations of both the alleged perpetrator and the reporting individual.
Men can also be victims of rape, whether by women or other men. While such cases occur more frequently in prison contexts, they also happen in the general population but are reported less often due to the stigma surrounding male victimization and homosexuality.
The likelihood of reporting rape increases if the perpetrator is a stranger, if there was physical violence, or if a weapon was used. Women who report tend to show fewer emotional symptoms than those who do not. However, many victims do not report the crime due to fear of retaliation, a desire to forget the event, compassion for the perpetrator, or a belief that the authorities will not respond effectively.
There is also a specific reaction in which the victim shows empathy toward the perpetrator, and may pursue professional roles that place them in contact with sexual offenders (e.g., in social services, prison institutions, courts). This reaction may represent an unconscious attempt to process or resolve their own trauma.
Child Sexual Abuse
Child sexual abuse refers to sexual contact between children and adolescents or adults, in which the child is in a subordinate position to the abuser. The fundamental characteristic is the powerful, dominant position of the adult or older adolescent, which allows them to coerce the child into sexual activity. These sexual activities may include touching and fondling of the genitals or breasts, forcing the child to fondle and touch the abuser, masturbation, voyeurism, exhibitionism, digital penetration or the use of sexual objects, as well as oral, anal, or vaginal intercourse. It may also involve exposing the child to pornography or sexually exploiting children (e.g., for the production of child pornography).
Many victims are too frightened to report the abuse. Victims of incestuous abuse by their fathers report such experiences the latest—if ever—while victims of abuse by stepfathers report them somewhat more often.
Children who do not report or hide the abuse may experience shame and guilt, as well as fear of losing beloved friends or family members. They tend to have low self-esteem and feel frustrated by their inability to stop the abuse. Male victims are more likely to develop substance use problems, while female victims are more likely to develop suicidal behavior, depression, anxiety, personality disorders, and often face significant difficulties in their sexual lives. Some victims re-experience the trauma by engaging in risky sexual behaviors or through a compulsion to be re-victimized.
Domestic Violence and Sexual Harassment
Domestic violence can include sexual forms of violence, in addition to physical, psychological, and economic abuse, stalking, the use of aggression, and controlling reproductive and sexual health. The risk of becoming a victim or perpetrator of domestic violence is often linked to overly immature or early parenthood (i.e., couples forming families during adolescence), substance abuse problems (alcohol or drugs) on the part of the perpetrator, extreme poverty, unemployment, and other social issues.
Sometimes, domestic violence is misused in our community; some women report their husbands even though they themselves also engage in reciprocal abusive behavior. Society is more likely to respond to reports made by women, while men often feel ashamed to report abuse by their wives due to the double standards related to gender and sexuality. Institutions tend to respond swiftly in such cases, even when the accused man poses no real threat, and impose restraining orders that often extend to the children as well. This may give the “victim” space to alienate the children from the “abuser”, which itself constitutes a form of psychological abuse of the children.
Very often, victims of domestic violence return to their abusers, developing a form of reciprocal sadomasochistic relationship.
Sexual harassment refers to making sexual jokes, unwanted sexual advances, “accidental” touching or bumping into a person, “accidental” placement of hands on someone, or creating situations that allow the harasser to sexually intimidate someone. Chronic or severe sexual harassment can cause psychological symptoms similar to those experienced by survivors of sexual abuse, and in extreme cases, it may lead to suicidal behavior.
Many victims never disclose that they have been harassed, but resolving such issues requires acknowledgment that the incident occurred. Sexual harassers often hold positions of power, which discourages victims from speaking out, and when they do, they are sometimes ridiculed again.
Have you experienced sexual harassment?
Schedule a session.
Pornography and Prostitution
Pornography and Prostitution
Various types of pornographic (sexually explicit) material are available at all times to children and the general public. Additionally, it has become increasingly popular among young people to identify with individuals from the world of pornography or reality shows and to create profiles on sex-oriented platforms where they share their intimate sexual lives, sometimes earning money in the process.
The average teenager spends more than 11 hours a day using electronic media (the recommended limit for children and adolescents is a maximum of two hours), which can reduce their ability to develop empathy and recognize the emotions of others.
Certain movements, religious institutions, and conservative politicians advocate for stricter bans and restrictions on pornography, although such measures are nearly impossible to implement in the current digital age. Their arguments typically center on the belief that pornography is destructive and negatively influences the mental and sexual attitudes of young people. On the other hand, pornography can be beneficial for some individuals—for example, those with low self-esteem or limited opportunities for sexual interaction with others in their environment.
There are also opponents of censorship who advocate for personal freedom, including the right to engage in or consume content of one’s choosing. Pornography may have both positive and negative effects, depending on how it is consumed. Some individuals may become “addicted to pornography,” meaning they can only achieve sexual arousal and orgasm through viewing explicit material.
Sex work involves the exchange of money or goods for sexual services. This may include pornography itself, although the pornographic entertainment industry is vast and highly developed in economically advanced countries. The less developed a country is, the less sophisticated its pornography industry tends to be. However, some countries with economically disadvantaged regions still produce high-quality and artistically simple pornography. Therefore, there are perspectives that view pornography as a form of social deviance and others that regard it as a form of modern artistic expression.
The sex industry includes sex workers of all genders, escorts, phone sex operators, strippers, and pornographic actors. The oldest form of sex work is prostitution. Economic motives are the primary reason individuals enter this field. Sex workers are often victims of sexual abuse and exploitation and may have experienced rape or early sexual encounters during their development. They may provide their services on the streets, in clubs, through escort agencies, independently, or under the control of criminal pimps. The most widespread category of sex workers includes street-based sex workers.
Human Trafficking
Male sex workers often view this line of work as a viable source of income. Many have had early sexual experiences or were victims of childhood abuse and coercive sexual behavior. These experiences are frequently associated with a homosexual orientation, with the first sexual encounter occurring before adolescence—i.e., during childhood—and they often develop dependencies on drugs and/or alcohol.
Pimps play a significant role in prostitution. They offer “protection,” recruit new sex workers, manage groups of male and female sex workers, and exert pressure on them to generate more income, deriving a sense of power from their role as a pimp.
Clients who use prostitution services often do so because sex is guaranteed, the likelihood of rejection is low, they receive undivided attention from the sex worker, or due to loneliness, curiosity, stress relief, or other personal reasons.
Clients and sex workers alike are at increased risk for contracting and spreading sexually transmitted infections (STIs) within the community. However, data suggest that STI rates tend to decrease in countries where prostitution has been legalized.
Sex trafficking is advancing as one of the most brutal forms of organized crime, involving sexual slavery. Victims typically come from impoverished countries—Bosnia and Herzegovina (BiH), for example, is considered vulnerable to recruiting sex workers for trafficking purposes. While some women willingly enter this line of work, the treatment they receive is often extremely violent and frequently includes drug use, poor living conditions, and reduced life expectancy. Many victims of sexual trafficking are drugged, beaten, and raped. Gang rapes and other brutal forms of sexual violence are commonly used to ensure the victim’s compliance and continued involvement.
Victims of sex trafficking may develop a range of psychological disorders, with Post-Traumatic Stress Disorder (PTSD) being most prevalent.
Have you been a victim of human trafficking? Schedule an appointment.
Book a Consultation
It’s easy and free!