Sources and References

This course draws entirely on peer-reviewed journal articles and book chapters accessed through course reserves. No single textbook is assigned. Key disciplinary traditions informing the readings include family studies, developmental psychology, sociology, feminist theory, queer theory, and critical sexuality studies. All claims made in these notes should be understood as contested — the purpose of this course is to interrogate, not resolve, these controversies.

Chapter 1: Foundations — Studying Human Sexuality as Controversy

1.1 Why “Controversy”?

Human sexuality has never been a neutral domain. Who has sex, with whom, how, and under what conditions has always been regulated — by law, religion, medicine, culture, and family. What makes a topic a sexual controversy is not simply that people disagree about it, but that the disagreement runs along deep fault lines: moral, political, empirical, and ideological.

SMF 305 treats controversy not as a problem to be solved but as a site of inquiry. The goal is not to arrive at consensus, but to understand why reasonable, informed people hold radically different positions — and what values, evidence, and power structures underlie each position.

1.2 Values Exploration and Positionality

A foundational exercise in this course is values clarification — identifying where you stand on various sexual issues and, crucially, why you stand there. Your positionality (your social location: gender, race, class, religion, sexuality, ability, etc.) shapes the questions you ask, the evidence you find compelling, and the solutions you find acceptable.

Positionality is not a confession of bias to be overcome. It is a starting point for reflective scholarship. Researchers who claim to speak from “nowhere” (a view from nowhere) often simply fail to account for how their particular standpoint shapes their work.

Key questions for values exploration:

• What do I believe about the relationship between sex and morality?
• How do I weigh individual freedom against community standards?
• What role should the state play in regulating sexual behaviour?
• What does “harm” mean in a sexual context, and who gets to define it?
• Whose knowledge do I treat as authoritative on sexuality questions?

1.3 The Historical Construction of Sexual Categories

Sexual categories are not timeless truths discovered by science — they are historically produced. The category “homosexual” did not exist before the late 19th century. “Heterosexual” was coined in the same period, and originally referred to pathological attraction to the opposite sex. The concept of “the sex drive” as a quantifiable, biological force became central to 20th-century sex science, but it has roots in 19th-century anxieties about industrialization and moral degeneracy.

Michel Foucault’s The History of Sexuality (1978) remains a touchstone: power does not simply repress sexuality, it produces it — creating categories, inciting confessions, and generating expertise. Medicine, psychiatry, law, and education are all technologies of sexual normalization.

1.4 Interdisciplinary Approaches

This course refuses any single disciplinary master narrative:

• Biology and neuroscience ask: what is the genetic, hormonal, or neurological substrate of sexual behaviour and identity?
• Psychology asks: how do individuals develop sexual identities, desires, and relationships? What are the mechanisms of trauma and resilience?
• Sociology asks: how do social structures, norms, and institutions organize sexual life? How does inequality shape sexual experience?
• Feminism asks: how does patriarchy shape sexuality? Whose pleasure is centred, whose is criminalized, and why?
• Queer theory asks: how do norms of heterosexuality and binary gender produce compulsory performances of identity? What would it mean to destabilize those norms?
• Critical race theory asks: how does race intersect with sexuality to produce racialized systems of desire, surveillance, and violence?

Each discipline brings legitimate insights. Each also has blind spots. Critical interdisciplinarity means drawing on multiple frameworks while remaining alert to their limitations.

Chapter 2: Sex Education

2.1 What Is Sex Education For?

Sex education is politically contested terrain because it embeds answers to deep questions:

• What should young people know about sex?
• At what age?
• Who has the right to teach it — parents, schools, or the state?
• Is the goal of sex education to prevent harm, or to enable flourishing?
• Whose values should it reflect?

The answers given by abstinence-only programs and comprehensive sexuality education programs are radically different.

2.2 Abstinence-Only Education

Abstinence-only (or “abstinence-only-until-marriage,” AOUM) programs became dominant in the United States through federal funding streams established under the Welfare Reform Act (1996) and expanded under the George W. Bush administration. By 2007, the U.S. was spending over $170 million annually on AOUM curricula.

Core features of AOUM programs:

• Sexual abstinence outside of heterosexual marriage is presented as the only morally acceptable and health-protective choice
• Contraception is often discussed only in terms of failure rates
• LGBTQ+ identities are typically absent or pathologized
• Marriage is treated as the natural telos of adult sexual life

The evidence base for AOUM is weak. A comprehensive 2007 federally commissioned study (Mathematica Policy Research) found that students who went through AOUM programs were no more likely to delay sexual initiation than those who did not. They were, however, less likely to use contraception when they did become sexually active — with implications for STI and pregnancy rates.

2.3 Comprehensive Sexuality Education

Comprehensive sexuality education (CSE) covers a broader range of topics: anatomy and physiology, puberty, consent, healthy relationships, contraception, STI prevention, sexual orientation and gender identity, media literacy, and pleasure.

CSE is grounded in a public health model that treats young people as capable of making informed decisions when given accurate information. It is also grounded in a rights-based model: access to accurate sexuality information is a component of sexual health, which is recognized by the World Health Organization as a dimension of overall health.

Evidence supports CSE’s effectiveness. Students who receive CSE tend to:

• Delay sexual initiation compared to those who receive no sex ed
• Use contraception more consistently when they do become sexually active
• Report higher rates of consent-seeking behaviour
• Feel more comfortable discussing sexual health with partners and healthcare providers

2.4 Canadian vs. American Approaches

Canada does not have a national sex education curriculum — education is a provincial responsibility. Provincial curricula vary significantly:

• Ontario revised its curriculum in 2015 to include comprehensive content on consent, gender identity, and sexual orientation, but the Ford government reversed many updates in 2018 before partially restoring them
• Alberta has been a site of ongoing conflict over LGBTQ+ inclusion
• Quebec introduced mandatory comprehensive sexuality education in 2018

The Canadian context differs from the American in several key ways: there is no equivalent of federal AOUM funding, the absence of a dominant religious lobby comparable to the U.S. evangelical movement, and stronger public health infrastructure.

2.5 Age-Appropriateness Debates

What counts as “age-appropriate” is deeply culturally contested. Research in developmental psychology shows that children begin forming concepts of gender by age 2–3, have a stable sense of gender identity by age 5–6, and begin experiencing sexual attractions in early adolescence (with significant variation). Developmental appropriateness is therefore not simply a moral claim — it is an empirical one.

Arguments for earlier sex ed:

• Abuse prevention: children who can name their body parts and understand consent concepts are better equipped to identify and report inappropriate contact
• Puberty preparation: children need information before puberty begins, which for some begins as early as 8–9
• LGBTQ+ inclusion: queer youth report earlier awareness of their identities than is often assumed

Arguments for later sex ed:

• Parental authority over values formation
• Risk that early information “sexualizes” children prematurely

The research does not support the claim that comprehensive sex ed sexualizes children or encourages earlier sexual activity.

2.6 LGBTQ+ Inclusive Curricula

Research consistently shows that LGBTQ+ youth in Canadian and American schools face elevated rates of harassment, bullying, and mental health challenges. LGBTQ+-inclusive sex education — which affirms diverse sexual orientations and gender identities as normal, teaches relationship skills for same-sex couples, and includes LGBTQ+ people in health information — has been shown to reduce homophobic and transphobic bullying and improve mental health outcomes for LGBTQ+ students without negatively affecting heterosexual students.

Opposition to LGBTQ+-inclusive curricula typically comes from religious communities who believe it conflicts with their moral teachings, and from parents who assert the right to be the primary teachers of sexual morality to their children.

Chapter 3: Nature vs. Nurture in Sexual Orientation and Gender Identity

3.1 Framing the Debate

Few questions in sexuality studies are more contested — or more politically charged — than whether sexual orientation and gender identity are biologically determined, socially shaped, or some interaction of both. The question is not merely academic: it has been used to argue for or against the rights of LGBTQ+ people, the legitimacy of conversion therapy, and the treatment of intersex children.

3.2 Biological Perspectives

Research on the biological bases of sexual orientation has pursued several avenues:

Genetics: Twin studies consistently show higher concordance of sexual orientation among identical twins than fraternal twins, suggesting a heritable component. However, concordance is not 100%, meaning genes do not determine orientation. A 2019 genome-wide association study (Ganna et al., Science) identified several genetic variants associated with same-sex sexual behaviour but concluded that no single “gay gene” exists — and that genetics accounts for only a fraction of the variance.

Hormones: The prenatal hormone hypothesis holds that exposure to atypically high or low levels of androgens during fetal development shapes brain organization in ways that influence sexual orientation. Evidence includes research on women with congenital adrenal hyperplasia (CAH), who have elevated prenatal androgen exposure and show higher rates of same-sex attraction.

Brain structure: Simon LeVay’s 1991 study claimed that a nucleus in the hypothalamus (INAH-3) was smaller in gay men than straight men. The finding has been difficult to replicate and is subject to methodological critique.

Fraternal birth order effect: Ray Blanchard’s research suggests that each additional older brother increases the probability of homosexuality in later-born males — proposed to result from a maternal immune response to male fetal antigens.

3.3 Social Constructionist Perspectives

Social constructionism, drawing heavily on Foucault, argues that the categories of “homosexual” and “heterosexual” are historical inventions, not natural kinds. In many non-Western and pre-modern cultures, same-sex acts did not constitute an identity. Men who engaged in same-sex acts were categorized by the role they played (active/passive), not by the gender of their partner.

Social constructionism does not claim that attraction is consciously chosen. It claims that the way attraction is categorized, experienced, and understood is shaped by cultural context. This has implications for:

• How research questions are framed (asking “what causes homosexuality” presupposes a natural category to be explained)
• How universalist claims about sexuality should be evaluated
• How identity categories travel across cultures

3.4 Queer Theory Perspectives

Queer theory, associated with Judith Butler, Eve Kosofsky Sedgwick, and Michael Warner, pushes further. Butler’s concept of performativity holds that gender and sexuality are not expressions of an inner essence — they are constituted through repeated, regulatory performances. “Woman” is not something one is; it is something one does, under the compulsion of social norms.

From a queer theory perspective, the nature/nurture debate itself is suspect: it accepts the category of “homosexuality” as a stable, universal object of explanation, when the more interesting question is how that category was produced and how it functions to organize social life.

Queer theory is also interested in the concept of heteronormativity — the assumption that heterosexuality is normal, natural, and default, and that all other sexualities are deviations requiring explanation.

3.5 Gender Identity and Transgender Experience

The debate around gender identity parallels — but is distinct from — the debate around sexual orientation. Gender identity (one’s sense of oneself as a man, woman, both, or neither) is distinct from sexual orientation (the pattern of one’s attraction to others).

Biological research on transgender experience has explored:

• Genetic markers
• Prenatal hormone exposure
• Brain structure (several studies have found that transgender individuals’ brain structures in certain regions more closely resemble those of their identified gender than their birth sex)

These findings are preliminary and contested. More robust is the evidence on outcomes: gender-affirming care (social, hormonal, and/or surgical transition, depending on age and individual circumstances) is associated with significantly better mental health outcomes for transgender youth and adults. Opposition to gender-affirming care often rests on religious conviction, concerns about irreversibility, or contested claims about “rapid onset gender dysphoria.”

Chapter 4: Censorship, Pornography, and Sexual Expression

4.1 The Freedom of Expression Framework

Freedom of expression is a foundational liberal value, enshrined in the Canadian Charter of Rights and Freedoms (s. 2(b)) and the U.S. First Amendment. The liberal argument for protecting sexual expression is that:

1. Adults have the right to produce and consume material they choose
2. Government restriction of expression is inherently dangerous — today’s target is pornography, tomorrow it may be political dissent
3. The harms attributed to pornography are empirically unestablished

However, freedom of expression is not absolute in Canadian law. Section 1 of the Charter allows limits that are “reasonable” and “demonstrably justified.” Obscenity law, child sexual abuse material, and hate speech are excluded from protection.

4.2 Legal Frameworks for Pornography

Canada: Under R v Butler (1992), obscenity is defined by the community standards of tolerance test: would the Canadian community tolerate others being exposed to this material? The Supreme Court clarified that the standard is not what Canadians like, but what they would tolerate others having access to. Material depicting degrading or dehumanizing sex acts is presumed harmful. Notably, the Butler decision was partly engineered by feminist anti-pornography activists — and was subsequently used by Canadian customs to seize gay and lesbian material.

United States: The Miller test (1973) defines obscenity based on: (1) whether the average person, applying contemporary community standards, would find the work appeals to prurient interest; (2) whether it depicts sexual conduct in a patently offensive way; (3) whether it lacks serious literary, artistic, political, or scientific value.

4.3 Feminist Debates on Pornography

Feminist debates on pornography are among the most bitter and productive in sexuality studies.

Anti-pornography feminism (Dworkin, MacKinnon): Pornography is not expression — it is an act. It silences women by sexualizing their subordination. In consuming pornography, men rehearse the domination of women. MacKinnon and Dworkin’s model ordinance defined pornography as a civil rights violation enabling women harmed by it to sue producers and distributors.

Arguments in favour:

• Pornography production involves real women who may be coerced
• Pornography shapes sexual scripts in ways that normalize aggression
• The aggregated effect of pornographic imagery is a culture of sexual violence

Pro-sex/sex-positive feminism (Vance, Rubin, Sprinkle): Anti-pornography feminism replicates patriarchal anxieties about women’s sexuality. Women who work in pornography can be agents, not merely victims. Censorship, historically, has been used against women — not for them. The feminist project should be to contest bad pornography, not to cede ground to state censors.

Arguments in favour:

• Women’s sexual autonomy includes the right to produce and consume sexual material
• Anti-pornography legislation disproportionately targets queer and BDSM content
• The research linking pornography to violence is methodologically contested

4.4 Internet Pornography and the Contemporary Debate

The internet has transformed the pornography landscape. Pornography is now ubiquitous, free, and increasingly extreme. Concerns include:

• Youth access: Studies suggest many adolescents first encounter pornography around age 11–12, often unintentionally
• Pornography “addiction”: Some clinicians argue for recognizing compulsive pornography use as a behavioural addiction; this remains controversial and is not included in DSM-5 (though “compulsive sexual behaviour disorder” appears in ICD-11)
• Consent in production: The rise of platforms like OnlyFans has complicated distinctions between professional and amateur production; questions remain about economic coercion and the content removal rights of performers
• Deepfake pornography: AI-generated non-consensual intimate imagery presents new legal and ethical challenges

Chapter 5: Surrogacy and Assisted Reproduction

5.1 Overview and Definitions

Assisted reproductive technologies (ARTs) include in vitro fertilization (IVF), intrauterine insemination (IUI), egg donation, sperm donation, and surrogacy. These technologies have enabled new forms of family-building — and new forms of ethical controversy.

Surrogacy occurs when a woman carries a pregnancy on behalf of intended parent(s). Two types:

• Traditional surrogacy: The surrogate’s own egg is used; she is the genetic mother
• Gestational surrogacy: An embryo created via IVF (using the intended parent’s or a donor’s genetic material) is implanted in the surrogate; she has no genetic connection to the child

Altruistic surrogacy: The surrogate receives no payment beyond reimbursement of expenses. Legal in Canada and many other jurisdictions.

Commercial surrogacy: The surrogate receives payment for her services. Illegal in Canada (under the Assisted Human Reproduction Act, 2004). Legal in some U.S. states, Ukraine, Georgia, and historically in India and Thailand (both of which have since restricted or banned the practice for foreign nationals).

5.2 Arguments For and Against Commercial Surrogacy

Arguments in favour of commercial surrogacy:

• Reproductive autonomy: surrogates should be free to contract for the use of their bodies
• Economic opportunity: for surrogates in economically disadvantaged positions, compensation represents meaningful income
• It enables family-building for those who cannot otherwise have children (same-sex couples, single parents, those with medical barriers to pregnancy)

Arguments against commercial surrogacy:

• Commodification: placing a market price on reproduction — on the labour of women’s bodies — transforms children into products and women into vessels
• Exploitation: surrogates in commercial arrangements, particularly in Global South contexts, may face significant economic pressure that compromises voluntariness
• Unequal power: surrogates are typically less economically powerful than intended parents, raising questions about the authenticity of consent
• Feminist concerns: commercial surrogacy may represent a new form of reproductive labour extraction from women’s bodies by capital

5.3 Legal Frameworks

Canada: The Assisted Human Reproduction Act prohibits commercial surrogacy and the purchase of eggs or sperm. It permits altruistic surrogacy but has limited enforcement mechanisms. Legal parentage of children born through surrogacy is governed by provincial law, which varies significantly — Quebec does not recognize surrogacy contracts at all; British Columbia has the most permissive framework.

United States: There is no federal law. State laws vary enormously. California has the most permissive and well-developed legal framework. Some states prohibit surrogacy contracts entirely. Intended parents typically seek pre-birth or post-birth parentage orders to establish legal parenthood.

International: The Hague Conference on Private International Law is developing an international instrument to address cross-border surrogacy and the legal status of children born through these arrangements.

5.4 Commodification and Relational Ethics

Beyond legal questions, surrogacy raises deeper philosophical questions about whether commercial reproduction is ethically acceptable at all.

The commodification objection (following Sandel and Anderson) holds that some goods have a value that is corrupted by market exchange. If we pay for reproduction, we signal that children are products — valued for their specifications, returnable if defective. This conflicts with the unconditional character of parental love and the dignity of children.

The relational autonomy response holds that this objection is paternalistic toward women who freely choose surrogacy, and that what matters is not the absence of market relations but the quality of care and respect within the arrangement. Many surrogates report positive experiences and meaningful relationships with intended parents.

Chapter 6: Sexual Abuse

6.1 Definitions and Scope

Sexual abuse encompasses a broad range of behaviours involving non-consensual sexual contact or coercion. Key categories include:

• Child sexual abuse (CSA): Any sexual contact or behaviour between an adult (or significantly older/more powerful individual) and a child. Children cannot consent to sexual contact with adults
• Sexual assault: Non-consensual sexual touching or penetration, often distinguished by degree of severity in law
• Intimate partner sexual violence (IPSV): Sexual coercion or assault within an intimate relationship
• Sexual harassment: Unwanted sexual behaviour in the context of a power relationship (workplace, educational institution)

Prevalence estimates are difficult to establish due to significant underreporting. Canadian data (Statistics Canada) suggest approximately 1 in 3 women and 1 in 8 men experience sexual assault in their lifetime. CSA prevalence estimates in Canada range from approximately 25–33% for girls and 12–16% for boys, depending on definition.

6.2 Societal Myths about Sexual Abuse

Myths about sexual abuse are not merely incorrect beliefs — they function as mechanisms of victim-blaming that protect perpetrators and deter reporting.

Common myths and their corrections:

6.3 Trauma-Informed Approaches

Trauma-informed practice acknowledges the pervasive impact of trauma on individuals and systems, and integrates knowledge about trauma into all aspects of service delivery. Principles include:

• Safety: Ensuring physical and emotional safety for survivors
• Trustworthiness: Making policies and practices transparent and consistent
• Choice: Restoring control to survivors — over what happens to them and in what sequence
• Collaboration: Working with survivors rather than on them
• Empowerment: Centring survivor strengths and fostering self-determination
• Cultural humility: Recognizing how culture, race, gender, and other factors shape trauma experience and response

The concept of retraumatization is central: many institutional responses to sexual abuse (criminal justice processes, child protection investigations, clinical interviews) can themselves be traumatizing, particularly when they involve disbelief, victim-blaming, or loss of control.

6.4 The Criminal Justice System and Sexual Abuse

The criminal justice response to sexual violence has been extensively criticized from multiple directions:

Attrition: Of all sexual assaults, only a fraction are reported to police. Of those reported, only a fraction result in charges. Of charges, only a fraction result in conviction. This funnel is sometimes called the “attrition problem.”

Rape shield legislation: Canada’s rape shield provisions (Criminal Code ss. 276–277) restrict the use of a complainant’s prior sexual history as evidence. These were enacted in response to defence tactics that turned trials into an examination of the victim’s credibility and character.

Myth-based instructions: Courts have had to grapple with jurors applying rape myths in deliberation. The Supreme Court of Canada has been required to overturn acquittals where trial judges applied stereotypical reasoning about how “real” victims behave.

6.5 Prevention Models

Primary prevention of sexual violence focuses on changing the social conditions that produce it, rather than advising potential victims to protect themselves (which inadvertently reinforces the idea that prevention is the victim’s responsibility).

Effective prevention approaches include:

• Bystander intervention programs: Training individuals to recognize and safely interrupt situations that may lead to sexual violence (e.g., Green Dot, Bringing in the Bystander)
• Comprehensive consent education: Teaching active, enthusiastic, ongoing consent as the standard for sexual interaction
• Social norms work: Challenging misperceptions about how common sexual coercion is (most people do not endorse coercive behaviour; making this visible reduces its social license)
• Engaging men and boys: Prevention programs that work with male-identified individuals to examine masculinity norms that contribute to sexual violence

Chapter 7: Sexual Orientation — Identities, Politics, and Power

7.1 The Spectrum of Sexual Orientation

Sexual orientation is typically conceptualized along a dimension from exclusive attraction to one’s own gender to exclusive attraction to other genders, with various points in between. Alfred Kinsey’s 7-point scale (0 = exclusively heterosexual; 6 = exclusively homosexual) was groundbreaking in its recognition that most people do not fall at the extremes. Contemporary models are more multidimensional, distinguishing between:

• Attraction (who one is sexually and/or romantically drawn to)
• Behaviour (who one has sex with)
• Identity (how one identifies oneself)

These three dimensions do not always align. A person can identify as heterosexual and have had same-sex experiences; identify as gay and have had opposite-sex experiences; be attracted to multiple genders without identifying as bisexual.

7.2 Heteronormativity

Heteronormativity (Warner, 1991) refers to the set of norms, institutions, and practices that treat heterosexuality as the natural, normal, and universal form of sexuality — and that organize social life accordingly. Heteronormativity operates through:

• Assumption: The default assumption in most social contexts is that everyone is heterosexual
• Institution: Marriage (historically restricted to opposite-sex couples), family law, immigration, and inheritance have all been structured around heterosexual coupledom
• Language: Everyday language assumes heterosexuality (“do you have a boyfriend/girlfriend?”)
• Erasure: Non-heterosexual lives and histories are rendered invisible in education, media, and culture

Heteronormativity harms not only LGBTQ+ people but also heterosexual people whose relationships, families, or desires do not conform to the normative model.

7.3 Bisexuality and Biphobia

Bisexuality — attraction to more than one gender — is one of the least understood and most stigmatized sexual orientations. Bisexual individuals face:

• Bi-erasure: The invalidation or invisibility of bisexual identity, often by both heterosexual and gay/lesbian communities
• Bisexual stereotypes: Bisexual people are commonly stereotyped as confused, promiscuous, incapable of monogamy, or “really” straight or gay
• Monosexism: The assumption that attraction must be to one gender only

Research consistently finds that bisexual individuals report worse mental health outcomes than both heterosexual and gay/lesbian individuals — outcomes attributable in large part to the unique stigma they face from multiple directions.

7.4 Conversion Therapy

Conversion therapy (also called reparative therapy, ex-gay therapy, or sexual orientation change efforts, SOCEs) refers to any attempt to change a person’s sexual orientation or gender identity through psychological, spiritual, or other means. Practices have included talk therapy, aversion conditioning, prayer, and exorcism.

The consensus of major medical and psychological organizations — the Canadian Psychological Association, the American Psychological Association, the American Medical Association, and many others — is unequivocal:

• Sexual orientation and gender identity cannot be changed through conversion therapy
• Conversion therapy is associated with serious harm, including depression, anxiety, suicidality, and PTSD
• The practice is predicated on the false assumption that LGBTQ+ identities are disorders in need of cure

Canada banned conversion therapy for minors in 2015 and enacted a federal ban on conversion therapy for all ages in 2022 (Criminal Code amendments). Several U.S. states have enacted partial or full bans; however, federal legislation has not passed.

7.5 Queer Theory and Beyond Identity

Queer theory, as a political and intellectual project, is not simply the academic study of LGBTQ+ people. It is a critique of the regime of the normal — the set of norms that define some bodies, desires, and lives as acceptable and others as deviant. From this perspective, fighting for the right to marry or serve in the military (homonormativity) may reinforce rather than challenge the institutions that produce sexual normalization.

Queer politics, in its more radical formulations, asks: what would sexuality look like if we dismantled the binary of normal and deviant altogether? Who benefits from normalizing some LGBTQ+ lives (married, monogamous, gender-conforming, middle-class) while continuing to marginalize others (sex workers, transgender people of colour, those with non-normative relationship structures)?

Chapter 8: Sexual Difficulties and Dysfunction

8.1 Medicalizing Sexuality

The medicalization of sexuality refers to the process by which aspects of sexual experience are defined as medical problems requiring clinical intervention. This process has intensified since the late 19th century, when the emerging disciplines of sexology and psychiatry began classifying and treating sexual “disorders.”

Medicalization has benefits: it can provide legitimacy, access to treatment, and relief from shame for people who struggle with sexual difficulties. But it also has costs:

• It locates the “problem” in the individual body rather than in relationships, social conditions, or cultural norms
• It creates markets for pharmaceutical and therapeutic interventions
• It defines what counts as “normal” sexuality in ways that pathologize variation
• It often reflects gendered assumptions about what sexuality should look like

8.2 DSM Categories of Sexual Dysfunction

The Diagnostic and Statistical Manual (DSM-5, 2013) includes the following sexual dysfunction categories:

Desire and arousal disorders:

• Female sexual interest/arousal disorder (FSIAD) — combined disorder reflecting research showing desire and arousal are less distinct in women
• Male hypoactive sexual desire disorder (MHSDD)
• Erectile disorder

Orgasm disorders:

• Female orgasmic disorder
• Delayed ejaculation
• Premature (early) ejaculation

Pain disorders:

• Genito-pelvic pain/penetration disorder (GPPPD) — combining former diagnoses of vaginismus and dyspareunia

Notably, the DSM-5 requires that symptoms cause “clinically significant distress” — acknowledging that low desire, for example, is not a disorder unless the individual is distressed by it.

8.3 Feminist Critiques of Sexual Dysfunction Categories

Feminist scholars have raised several critiques of how sexual dysfunction is defined and treated:

The “normal” baseline problem: Definitions of dysfunction implicitly construct a norm of sexual function against which individuals are measured. Research on female sexual response has been shaped by male-centred models (spontaneous desire, linear arousal, penetration-centred intercourse) that may not reflect typical female sexuality.

The pharmaceutical industrial complex: The development of Viagra (sildenafil) in 1998, marketed for erectile dysfunction in men, was enormously profitable. There have been sustained efforts to develop equivalent treatments for women. Critics argue that pharmaceutical companies have worked to expand the definition of female sexual dysfunction in order to create a market for products. The case of flibanserin (Addyi), FDA-approved in 2015 for low sexual desire in women, illustrates this: it was approved despite modest effects and significant side effects, following a campaign that framed its rejection as a gender equity issue.

Gendered double standards: Some feminist scholars argue that women’s sexual complaints (low desire, difficulty with orgasm) are often dismissed by clinicians as psychosomatic, while men’s sexual complaints (erectile dysfunction) are taken seriously and treated medically.

8.4 Treatment Approaches

Treatment for sexual difficulties typically involves some combination of:

• Psychoeducation: Providing accurate information about sexual anatomy, response, and diversity
• Cognitive-behavioural approaches: Addressing negative cognitions and anxiety around sex
• Sensate focus: A structured series of exercises (developed by Masters and Johnson) that reduce performance pressure by prohibiting intercourse and gradually reintroducing physical intimacy
• Mindfulness-based approaches: Research suggests mindfulness improves sexual desire and arousal, particularly for women
• Pharmacological treatments: For erectile dysfunction (PDE5 inhibitors), hormonal approaches, and others
• Pelvic floor physiotherapy: For pain disorders

The most effective approaches are typically integrated, addressing biological, psychological, and relational factors simultaneously.

Chapter 9: Variations in Sexual Expression

9.1 Normative and Non-Normative Sexuality

What counts as a “normal” sexual practice or desire is culturally and historically relative. Practices that were criminalized in one era (sodomy, oral sex) have been decriminalized in another. Practices that are stigmatized in one community (premarital sex, masturbation) are unremarkable in another.

Sociologist Gayle Rubin’s concept of the charmed circle (from “Thinking Sex,” 1984) maps the moral hierarchy of sexuality: at the center are “good” sexualities (heterosexual, married, monogamous, reproductive, non-commercial, in pairs, vanilla), and at the margins are “bad” sexualities (homosexual, unmarried, promiscuous, non-reproductive, commercial, multiple partners, BDSM). Rubin’s point is that this hierarchy is not morally coherent — it is a product of social power, not ethical reasoning.

9.2 BDSM and Kink

BDSM (bondage/discipline, dominance/submission, sadism/masochism) encompasses a diverse range of consensual erotic practices involving power exchange, sensation play, role-playing, and/or restraint.

Key principles within BDSM communities:

Safe, Sane, and Consensual (SSC): All BDSM activities should be physically and emotionally safe, undertaken by people with the capacity to consent, and explicitly negotiated.

Risk-Aware Consensual Kink (RACK): An alternative framework acknowledging that some BDSM activities carry inherent risks, and that informed, explicit consent is the relevant standard, not the absence of risk.

Research on BDSM practitioners (Richters et al., 2008; Wismeijer & van Assen, 2013) does not support pathological characterizations. Practitioners score higher than the general population on some wellbeing measures, report lower levels of anxiety, and tend to be more conscientious about communication and consent in sexual contexts.

DSM-5 and BDSM: The DSM-5 distinguishes between paraphilias (intense, persistent, atypical sexual interests) and paraphilic disorders (paraphilias that cause distress or harm). Sadism and masochism are not disorders unless they involve non-consent or cause the individual significant distress. This distinction is an important recognition that atypical sexuality is not inherently pathological.

9.3 Paraphilias

A paraphilia is an intense and persistent sexual attraction to atypical objects, situations, or individuals. The DSM-5 lists several, including exhibitionism, voyeurism, fetishism, transvestism, frotteurism, pedophilia, sexual masochism, and sexual sadism.

It is essential to distinguish:

• Non-consensual paraphilias: Exhibitionism (exposing oneself to non-consenting others), voyeurism (observing non-consenting others), frotteurism (touching non-consenting others), and pedophilia (attraction to children, who cannot consent) are harmful because they involve or require the violation of others
• Consensual paraphilias: Fetishism, consensual sadism/masochism, and transvestism (when involving consenting partners or no partners) do not involve harm to others and should not be considered disorders unless they cause personal distress

9.4 Consensual Non-Monogamy

Consensual non-monogamy (CNM) refers to relationship structures in which all partners are aware of and consent to involvement with multiple people simultaneously. CNM encompasses:

• Polyamory: Emotional and/or sexual relationships with multiple partners, with the knowledge and consent of all
• Open relationships: Committed primary relationships with agreed-upon permission for outside sexual (and sometimes emotional) connections
• Swinging: Recreational sexual activity with other couples or individuals, typically with a primary partner present
• Relationship anarchy: Rejection of hierarchical structures in relationships; all relationships are defined by those involved rather than by pre-set categories

Research on CNM relationships finds no evidence of lower relationship satisfaction or mental health compared to monogamous relationships. CNM relationships do require higher levels of communication and explicit negotiation. Practitioners report stigma, discrimination, and the need to conceal their relationships as significant challenges.

9.5 Sex Work

Sex work refers to the exchange of sexual services, performances, or products for material compensation. It encompasses a wide range of activities: in-person sexual services, erotic dance, cam work, pornography performance, phone sex, and others.

Legal models for sex work vary significantly:

Canada’s current model: The Protection of Communities and Exploited Persons Act (PCEPA, 2014) criminalizes the purchase of sex, communication in public for the purpose of selling sex in certain circumstances, advertising sexual services on behalf of others, and receiving material benefit from sex work. Selling sex itself is not criminalized. This is modelled on the Nordic approach.

Sex worker perspectives: Advocacy organizations composed of sex workers (SWOP, SPOC, Stella) consistently argue that criminalization — including partial criminalization — increases harm by pushing sex work into unsafe spaces, deterring sex workers from screening clients, making it harder to access health services, and enabling police surveillance and harassment. They advocate for full decriminalization on harm reduction grounds.

Feminist debates: Anti-prostitution feminists (radical feminist position) argue that sex work is inherently exploitative — that no woman freely chooses to sell sex except under conditions of economic or other coercion, and that the institution of sex work perpetuates the commodification of women’s bodies. Sex worker rights advocates (many of whom identify as feminist) argue that this position strips sex workers of agency, ignores their voices, and leads to policies that harm them.

Chapter 10: Special Topics and Diverse Perspectives

10.1 Indigenous Sexualities and Two-Spirit Identities

Colonial violence has profoundly shaped Indigenous sexualities in Canada. Residential schools systematically disrupted Indigenous sexual and gender knowledge, imposed European binary gender norms, and committed widespread sexual abuse. The ongoing impacts of this violence include intergenerational trauma, disrupted family systems, and the loss of Indigenous frameworks for understanding gender and sexuality.

Many Indigenous cultures had pre-colonial frameworks for understanding gender diversity — individuals who embodied both masculine and feminine qualities, or who occupied a distinct gender role beyond the binary. The English term Two-Spirit (adopted in 1990 at an Indigenous LGBTQ+ gathering) is used by some Indigenous people to describe their gender and/or sexual identity in relation to these traditions. It is important to recognize that Two-Spirit is not equivalent to “LGBT” — it is a culturally specific term rooted in Indigenous frameworks and is not available to non-Indigenous people.

Decolonizing sexuality studies means:

• Centring Indigenous perspectives and knowledges, rather than interpreting Indigenous experience through Western frameworks
• Recognizing that Indigenous gender and sexuality diversity existed long before European contact
• Understanding how colonialism created the sexual oppressions that many Indigenous communities now face

10.2 Disability and Sexuality

Sexuality and disability have an uneasy relationship in dominant culture. Disabled people are often desexualized — treated as asexual, as incapable of having meaningful sexual lives, or as inappropriate sexual subjects. At the same time, disabled women are at significantly higher risk of sexual violence than non-disabled women, while being less likely to be believed when they report it.

The social model of disability holds that disability is produced by the interaction between impairment and disabling social environments — rather than being located in the individual body. Applied to sexuality, this model asks not “how can disabled people accommodate to sexual norms?” but “how can sexual norms, practices, and spaces be made more accessible?”

Key issues include:

• Access to sexuality education for people with intellectual disabilities
• Access to sexual health care for people with physical disabilities
• The contested ethics of sexual assistance for people who require support to have sexual experiences
• The regulation of sexuality in care facilities

10.3 Aging and Sexuality

Dominant culture treats sexuality as the province of the young — older adults are routinely desexualized, and their sexual lives are rendered invisible or treated as inappropriate. Research tells a different story: sexual interest and activity continue throughout life, though they change in character. Many older adults report their most satisfying sexual relationships in later life.

Issues specific to older adults include:

• Access to sexual health information and care (health providers often fail to ask older patients about sexual health)
• The intersection of aging with chronic illness, mobility changes, and disability
• The specific challenges and possibilities of sexuality after loss of a partner
• Sexuality in care facilities, where privacy is often compromised
• The increased vulnerability of older adults to sexual exploitation

10.4 Religion, Culture, and Sexual Diversity

Religious and cultural traditions provide frameworks of meaning for sexuality that many people find indispensable. Sexuality research and sexuality policy that fails to take these frameworks seriously will fail to reach the communities it serves.

At the same time, religious and cultural traditions have been used to justify:

• Criminalization of LGBTQ+ identities
• Female genital mutilation/cutting (FGM/C)
• Child marriage
• Honour-based violence

The challenge is to engage respectfully with religious and cultural diversity without relativism: without treating all practices as equally valid simply because they are culturally situated. This requires:

• Listening to the voices of those inside communities, particularly dissenting and marginalized voices
• Distinguishing between respecting people’s right to practise their faith and respecting specific practices that harm others
• Recognizing that communities are not monolithic — there is significant internal diversity and contestation within every religious and cultural tradition

10.5 Intersectionality and Sexuality

Kimberlé Crenshaw’s concept of intersectionality describes how different dimensions of social identity — race, gender, class, sexuality, disability, age, immigration status — interact to produce distinct experiences that cannot be understood by examining any single dimension in isolation. Black women’s experience of sexual violence, for example, is shaped by the intersection of racism and sexism in ways that make their experiences distinct from those of white women and of Black men.

Applied to sexuality studies, intersectionality demands:

• Attention to how race shapes the experience of sexual identity, including the ways in which LGBTQ+ communities can reproduce racism
• Analysis of how class shapes access to reproductive autonomy, sexual health care, and legal protection
• Recognition that “women’s experience” is not uniform — the category is internally differentiated by race, class, disability, and other factors
• Awareness of how immigration status shapes vulnerability to sexual exploitation and barriers to accessing services

Chapter 11: Critical Thinking, Evidence, and Controversy

11.1 Evaluating Evidence in a Contested Field

Human sexuality is a field in which claims are routinely made with more confidence than the evidence warrants. Critical evaluation of research requires attention to:

Study design:

• Experimental vs. correlational: Does the study establish causation or association?
• Sample: Who is in the study? Is the sample representative? (Much early sex research relied on clinical samples or convenience samples of university students)
• Measurement: How are key concepts defined and measured? (Self-report of “sexual dysfunction” tells us something different than clinician-assessed diagnosis)
• Comparison group: What is the relevant baseline?

Interpretation:

• Does the conclusion follow from the data?
• Are alternative explanations considered?
• Is the effect size meaningful, or is a statistically significant but tiny effect being exaggerated?

Context:

• Who funded the research?
• What are the theoretical commitments of the researchers?
• How has this research been used in policy debates?

11.2 Competing Frameworks and Incommensurability

Some debates in sexuality studies are not simply empirical disagreements that could in principle be resolved by better data. They are disagreements about values, frameworks, and what questions matter.

The debate between anti-pornography feminism and sex-positive feminism, for example, is partly empirical (what are the effects of pornography on behaviour?) but also partly about what values should structure sexuality (is women’s liberation better served by restricting sexual commodification or by expanding women’s sexual freedom?). These questions cannot be resolved by data alone.

Similarly, debates about commercial surrogacy turn not only on empirical questions about harm to surrogates but on deep disagreements about whether some goods (reproduction, human life) should be organized by market relations at all.

Recognizing when a debate has this character — when it involves genuine value conflicts, not just factual disputes — is itself a critical thinking skill.

11.3 Positionality and Reflexivity in Sexuality Research

Feminist standpoint epistemology holds that knowledge is produced from a position — and that the position of the researcher shapes what is visible, what questions are asked, and what counts as evidence. This does not mean all standpoints are equally valid, or that research is merely subjective. It means that reflexivity — awareness of one’s own positionality and how it shapes one’s research — is a methodological requirement, not an optional extra.

Applying this to the course: your engagement with the controversies in SMF 305 will be shaped by your own experiences, values, and social locations. The goal is not to eliminate this influence but to become conscious of it, to understand how it shapes your readings and responses, and to remain genuinely open to perspectives that emerge from different social locations.

11.4 Communicating About Sexuality Respectfully

This course requires students to discuss sexuality in ways that are simultaneously rigorous, respectful, and open to disagreement. This requires:

• Precise language: Terms like “prostitute,” “promiscuous,” “deviant,” and “lifestyle” carry normative freight that can foreclose analysis. Preferred terms (sex worker, non-monogamous, sexually diverse) are not merely matters of political correctness — they reflect more accurate and less prejudicial conceptual frameworks
• Distinguishing description from evaluation: Being able to describe a practice or belief without immediately evaluating it is a prerequisite for understanding it
• Recognizing the personal stakes: For many students, these topics are not merely academic. LGBTQ+ students, survivors of sexual violence, people who have experienced crisis pregnancies, and sex workers may be present in any classroom. Language that treats their experiences as abstract objects of debate can cause harm
• Managing disagreement productively: It is possible to disagree fundamentally with someone’s values or conclusions while still engaging respectfully with their argument. The goal of intellectual debate is not to defeat the other person but to think more clearly together

Chapter 12: Synthesis — Themes Across the Course

12.1 Consent as Organizing Principle

Across virtually every controversy addressed in this course, consent emerges as a central concept — and a contested one. The liberal framework treats consent as the primary criterion distinguishing acceptable from unacceptable sexual behaviour: what consenting adults do is their business; what is done to non-consenting people is everyone’s concern.

But consent is more complicated than a simple yes/no:

• Consent requires information (you cannot consent to something you do not understand)
• Consent requires freedom (agreement given under significant coercion is not genuine consent)
• Consent is dynamic (it can be withdrawn)
• Consent is context-dependent (power differentials between parties may compromise its voluntariness)
• Some forms of consent may be structurally constrained in ways that liberal frameworks underestimate

The challenge across the course has been to take consent seriously as a value while also acknowledging its limitations as an analytical tool.

12.2 The Individual vs. the Social

Many of the controversies in this course involve a tension between individualist and social framings:

• Individualist: Sexual behaviour is primarily a matter of individual choice, preference, and autonomy. The relevant questions are about consent and harm to identifiable others
• Social: Sexual behaviour is embedded in, and shaped by, social structures, norms, and power relations. Individual “choices” about sex are never made in a vacuum — they reflect the conditions of unequal social arrangements

Both framings are necessary. A purely individualist framework cannot account for how social structures shape desire, constraint, and possibility. A purely social framework can deny the real agency and diversity of sexual actors. The most useful analyses hold both in tension.

12.3 Who Counts as an Expert?

In a field as contested as human sexuality, the question of whose knowledge counts is political. Academic researchers, clinicians, lawyers, and policy-makers have traditionally been treated as the experts. This course challenges that default in two ways:

• Lived experience as knowledge: People who have lived experience of sex work, BDSM, disability, transgender identity, or sexual violence have knowledge about these topics that academic researchers do not — regardless of credential. This knowledge should be engaged with, not merely described
• Community-based expertise: Advocacy organizations, peer support networks, and community health centres produce knowledge about sexuality that is often more ecologically valid than laboratory or survey research

This does not mean all claims are equally well-supported. It means that the circle of relevant expertise is wider than traditional academic gatekeeping acknowledges.

12.4 Power, Privilege, and Sexual Norms

Throughout the course, a recurring theme is that what counts as “normal” or “healthy” sexuality is never simply a biological or statistical fact — it is a social judgment that reflects the interests and values of those with the power to define it.

The psychiatric establishment that once listed homosexuality as a disorder was not simply wrong in a technical sense — it was wrong in a political sense: it was inscribing the prejudices of a heterosexist society into the language of medicine. The same can be said of the treatment of masturbation, “nymphomania,” and “female hysteria” in earlier periods.

This historical track record is a reason for epistemic humility: the sexual norms of our own time are likely to look different in retrospect. The question is not what the mainstream finds acceptable, but whether the analysis of harm is grounded in evidence and attentive to power — including the power to define what counts as harm in the first place.