Archives of Sexual Behavior

Trans people tend to utilize health care at rates lower than cisgender people, which commonly results in short-term and long-term unfavorable health outcomes. Theoretically informed by Andersen's behavioral model of health services use and Lerner and Robles’ adapted behavioral model of health services use for transgender people, the current study examined how individual characteristics of trans people along with the external environment and health care service environment they must navigate impact their health care utilization. Binary logistic regression was used to analyze data from the 2015 United States Trans Survey (N = 27,715), the largest trans sample to date. Perception of health care provider (HCP) knowledge, health insurance status, and health care costs each produced the strongest effect on visiting a doctor or HCP in the past year. The results showed that having a provider that had some level of knowledge about trans people was potentially most critical to increase utilization. Discussion points include increasing trans-focused curriculum in health professional schools, utilizing trans standardized patients in health professional schools, and holding insurance companies accountable to provide trans affirming care.

Twenty-four male patients presenting with the request for change-of-sex surgery were studied. They were asked to estimate the strength of their sexual interest in men as compared with sexual interest in women. An independent and objective measure of sexual orientation was obtained by measuring penile volume responses to film sequences of male and female nudes. With two exceptions, the patients stated that their predominant or exclusive sexual interest was in males. The two patients who claimed to have no homosexual desires showed significantly more positive penile volume responses to female than to male nudes. The remaining 22 patients showed more positive penile volume responses to males. Brief case histories of the two apparently heterosexual patients are presented.

The relationship among three objective measures of genital vasocongestion in women was evaluated both during and after an erotic film using simultaneous recording of both vaginal pressure pulse and vaginal blood volume responses by means of photoplethysmography and of labial temperature change by means of a thermistor clip. During the film each of the genital measures increased for most subjects, resulting in highly significant positive correlations between measures. However, following the erotic film presentation there was considerably less direct correspondence among the three measures; although the genital reactions of most subjects subsided to some extent following the film, none of the three measures consistently returned to prestimulation levels. Periodic estimates of subjective levels of sexual arousal were significantly correlated with each of the genital measures during the erotic film but were not significantly correlated with any after the film.

Daily self-reports of condom-protected intercourse were analyzed as a function of emotional states, alcohol consumption, and safer sex negotiations in a sample of single, low-income Hispanic students. The sample included 15 women and 17 men who reported a minimum of four sexual episodes as well as inconsistent condom use over a 3-month self-reporting period. The analyses focused on 829 days out of 2,586 daily self-reports on which sexual intercourse was reported. Hierarchical linear modeling was used to predict condom-protected intercourse as a function of mood states, substance use, and safer sex negotiations. Safer sex negotiation was the strongest positive predictor of condom use. Contrary to expectation, unprotected intercourse was less likely to occur in episodes characterized by greater negative affect and more likely in episodes in which greater positive mood was reported. No main effect of alcohol consumption on safer sex was observed; however, an interaction between alcohol consumption and positive mood emerged, indicating that unprotected intercourse was most likely to occur when positive mood was combined with alcohol consumption. The results contradict the assumption that emotional distress predicts engagement in more risky sexual behavior and indicate that safer sex negotiations are likely to outweigh any effects of mood or alcohol consumption on subsequent condom use.

Men’s sexual arousal patterns are category-specific: Men typically display significantly greater physiological responses to sexual stimuli depicting members of their preferred gender category. Category-specific patterns of sexual arousal have not been consistently reported in natal women. We used vaginal photoplethysmography to examine patterns of sexual arousal in 11 male-to-female (MtF) transsexuals following sex reassignment surgery (SRS) and in 72 natal women. Subjective arousal was measured with a continuous response lever. Video clips depicting sexual activity between two males, two females, or one male and one female were used as erotic stimuli. All transsexual participants displayed category-specific sexual arousal. Five homosexual transsexual participants (attracted exclusively to males before sex reassignment) showed greater genital and subjective responses to male than to female stimuli, while six nonhomosexual transsexual participants showed the opposite pattern. Vaginal pulse amplitude (VPA) was lower in transsexual participants than in natal women. The mean correlation between VPA and subjective responses was high in nonhomosexual transsexuals, but was significantly lower in homosexual transsexuals and in natal women. One transsexual participant who reported a change in sexual orientation following sex reassignment displayed VPA and subjective responses consistent with her pre-reassignment sexual orientation. We conclude that male-to-female transsexuals display male-typical category-specific sexual arousal following SRS, and that vaginal photoplethysmography is a promising methodology for studying patterns of sexual arousal in postoperative transsexuals.

The origin of male political power has been sought in the dominance behavior of the nonhuman primates. Data from the living hunting and gathering peoples offer a corrective to this viewpoint. Several theorists have developed models of early human groups that placed males at the center and females drawn in from outside through exchange networks. These models contradict the known facts about hunting and gathering peoples, among whom we find a social grouping consisting of both males and females at the center. The burden of the hunter-gatherer evidence (along with that from primate field studies) favors a model of early human society in which females wielded considerable political power as a result of their economic independence and their ability to exercise discretion in their choice of spouse.