Archives of Sexual Behavior

, Volume 28, Issue 4, pp 285–318 | Cite as

Unresolved Issues in Scientific Sexology

  • Nathaniel McConaghy


A number of unresolved issues in sexologyresearch and practice are reviewed. Penile volumeassessment of sexual arousal has consistently provedmore sensitive than penile circumference assessment andrequires much shorter exposure to the erotic stimulieliciting the arousal, reducing the subjects' ability tomodify their responses. Failure to acknowledge this hasallowed acceptance of evidence based on penile circumference assessment that behavioraltreatments such as directed masturbation can increasethe ability of sex offenders to be heterosexuallyaroused and aversive therapy can reduce their devianturges whereas penile volume assessment indicatesthese procedures are ineffective. A randomizedcontrolled trial of relapse prevention versus notreatment for sex offenders found more treated thanuntreated subjects reoffended after a mean follow-up period of 4years. Researchers and therapists accepted that a posthoc statistical manipulation of the results providedevidence of a treatment effect. Subsequently it has been recommended that randomized controlledevaluations of treatments of sex offenders be abandoned.Meta-analysis of outcome studies has been useduncritically. The majority of men and women who report homosexual feelings and/or behavior reportpredominant heterosexual feelings and behavior and donot identify as homosexual. These consistent findingsremain ignored. Studies of the etiology and development of homosexuality and heterosexuality treat themas distributed categorically rather than dimensionallyand investigate only self-identified homosexuals andheterosexuals. With this methodology the predominantly heterosexual majority are excluded ormisclassified. The belief that the European concept ofthe homosexual is a late 19th-century invention is basedon an inadequate reading of literature. Limitations of the DSM classification of sexual and genderidentity disorders are pointed out. The validity ofself-report of sexual behavior has been questioned onthe basis that men report a markedly higher average number of sexual partners than women. Possiblesex differences in reporting the number of partners whoare of the same sex, casual, or perpetrators or victimsof sexual coercion and child abuse have not been taken into account. Failure of sexology toprogress due to lack of resolution of conflicting issuesmay contribute to the low impact factor of itsjournals.

penile volume and circumference assessment sex offender treatment predominantly heterosexual homosexuals DSM classification of sexual disorders self-report of number of sexual partners 


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  1. Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., and Rouleau, J.-L. (1988). Multiple paraphilic diagnoses among sex offenders. Bull. Am. Acad. Psychiatry Law 16: 153–168.Google Scholar
  2. Adams, H. E., and Sturgis, E. T. (1977). Status of behavioral reorientation techniques in the modification of homosexuality: A review. Psychol. Bull. 84: 1171–1188.Google Scholar
  3. Altshuler, K. Z. (1984). On the question of bisexuality. Am. J. Psychother. 38: 484–493.Google Scholar
  4. American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures (1993). A report adopted by the Division 12 Board.Google Scholar
  5. Bailey, J.M., and Pillard, R. C. (1991). Agenetic study of male sexual orientation. Arch. Gen. Psychiatry 48: 1089–1096.Google Scholar
  6. Barbaree, H. (1997). Evaluating treatment efficacy with sexual offenders: The insensitivity of recidivism studies to treatment effects. Sex. Abuse J. Res. Treat. 9: 111–128.Google Scholar
  7. Barbaree, H. E., Bogaert, A. F., and Seto, M. C. (1995). Sexual reorientation therapy for pedophiles: Practices and controversies. In Diamant, L., and McAnulty, R. (eds.), The Psychology of Sexual Orientation, Behavior, and Identity: A Handbook, Greenwood, Westport, CT, pp. 357–383.Google Scholar
  8. Barr, R. F., and McConaghy, N. (1971). Penile volume responses to appetititive and aversive stimuli in relation to sexual orientation and conditioning performance. Br. J. Psychiatry 119: 377–383.Google Scholar
  9. Blanchard, R., and Bogaert, A. F. (1996). Homosexuality in men and number of older brothers. Am. J.Psychiatry 153: 27–31.Google Scholar
  10. Borzak, S., and Ridker, P. M. (1995). Discordance between meta-analyses and large-scale randomized controlled trials. Examples from the management of acute myocardial infarction. Ann. Intern.Med. 123: 873–877.Google Scholar
  11. Brecher, E. M. (1984). Love, Sex and Aging, Brown, Boston.Google Scholar
  12. Buhrich, N., and Beaumont, T. (1981). Comparison of transvestism in Australia and America. Arch.Sex. Behav. 10: 269–279.Google Scholar
  13. Buhrich, N., and McConaghy, N. (1977). Can fetishism occur in transsexuals? Arch. Sex. Behav. 6: 223–235.Google Scholar
  14. Bullough, B., and Bullough, V. (1997). Are transvestites necessarily heterosexual? Arch. Sex. Behav. 26: 1–12.Google Scholar
  15. Cleland, J. (1970). Fanny Hill, Memoirs of a Woman of Pleasure, Granada, St. Albans.Google Scholar
  16. Conrad, S. R., and Winzce, J. P. (1976). Orgasmic reconditioning: A controlled study of its effects upon the sexual arousal and behavior of adult male homosexuals. Behav. Ther. 7: 155–166.Google Scholar
  17. Day, K. (1994). Male mentally handicapped sex offenders. Br. J. Psychiatry 165: 630–639.Google Scholar
  18. Day, D. M., and Marques, J. K. (1998). A clarification of SOTEP' method and preliminary findings: A reply to Nathaniel McConaghy. Sex. Abuse J. Res. Treat. 10: 162–166.Google Scholar
  19. Earls, C. M., and Marshall, W. L. (1982). The simultaneous and independent measurement of penile circumference and length. Behav. Res. Meth. Instr. 14: 447–450.Google Scholar
  20. Finkelhor, D. (1985). Sexual abuse of boys. In Burgess, A.W. (ed.), Rape and Sexual Assault, Garland, New York, pp. 97–103.Google Scholar
  21. Foucault, M. (1978). The History of Sexuality, Pantheon, New York.Google Scholar
  22. Freund, K. (1963). A laboratory method of diagnosing predominance of homo-or hetero-erotic interest in the male. Behav. Res. Ther. 12: 355–359.Google Scholar
  23. Freund, K. (1971). A note on the use of the phallometric method of measuring mild sexual arousal in the male. Behav. Ther. 2: 223–228.Google Scholar
  24. Geddes, J. R., and Harrison, P. J. (1997). Closing the gap between research and practice. Br. J.Psychiatry 171: 220–225.Google Scholar
  25. Green, J. R. (1945). A Short History of the English People, J. M. Dent, London.Google Scholar
  26. Hall, G. C. N. (1995). Sexual offender recidivism revisited: A meta-analysis of recent treatment studies.J. Consult. Clin. Psychol. 63: 802–809.Google Scholar
  27. Hamer, D., and Copeland, P. (1994). The Science of Desire. The Search for the Gay Gene and the Biology of Behavior, Simon & Schuster, New York.Google Scholar
  28. Hamer, D. H., Hu, S., Magnuson, V. L., Hu, N., and Pattatucci, A. M. L. (1993). A linkage between DNA markers on the X chromosome and male sexual orientation. Science 261: 321–327.Google Scholar
  29. Hanson, R. K. (1996). Evaluating the contribution of relapse prevention theory to the treatment of sexual offenders. Sex. Abuse J. Res. Treat. 8: 201–208.Google Scholar
  30. Hanson, R. K. (1997). How to know what works with sexual offenders. Sex. Abuse J. Res. Treat. 9: 129–145.Google Scholar
  31. Heilbrun, A. B., and Leif, D. T. (1988). Erotic value of female distress in sexual explicit photographs.J. Sex Res. 24: 47–57.Google Scholar
  32. Hershberger, S. L. (1997). Book review: Modern homosexualities: Fragments of lesbian and gay experience. Arch. Sex. Behav. 26: 559–561.Google Scholar
  33. Howes, R. J. (1998). Plethysmographic assessment of incarcerated nonsexual offenders: A comparison with rapists. Sex. Abuse J. Res. Treat. 10: 183–194.Google Scholar
  34. Hudson, S.M., and Ward, T. (1996). Introduction to the special issue on relapse prevention. Sex. Abuse J. Res. Treat. 8: 173–175.Google Scholar
  35. Hudson, S. M., Marshall, W. L., Ward, T., Johnston, P. W., and Jones, R. L. (1995). Kia Marama: A cognitive-behavioural program for incarcerated child molesters. Behav. Change 12: 69–80.Google Scholar
  36. Johnson, A. M., Wadsworth, J., Wellings, K., Field, J., and Bradshaw, S. (1994). Sexual Attitudes and Lifestyles, Blackwell Scientific, Oxford.Google Scholar
  37. Knight, R. A., and Prentky, R. A. (1990). Classifying sexual offenders. InMarshall, W. L., Laws, D. R., and Barbaree, H. E. (eds.), Handbook of Sexual Assault, Plenum Press, New York, pp. 23–52.Google Scholar
  38. Lalumiere, M. L., and Harris, G. T. (1998). Common questions regarding the use of phallometric testing with sexual offenders. Sex. Abuse J. Res. Treat. 10: 227–237.Google Scholar
  39. Lalumiere, M. L., and Quinsey, V. L. (1994). The discriminability of rapists from non-sex offenders using phallometric measures: A meta-analysis. Crim. Just. Behav. 21: 150–175.Google Scholar
  40. Laumann, E. O., Gagnon, J. H., Michael, R. T., and Michaels, S. (1994). The Social Organization of Sexuality, University of Chicago Press, Chicago.Google Scholar
  41. Laws, D. R., and Marshall, W. L. (1991). Masturbatory reconditioning with sexual deviates: An evaluative review. Adv. Behav. Res. Ther. 13: 13–25.Google Scholar
  42. Laws, D. R., and Rubin, H. H. (1969). Instructional control of an autonomic sexual response. J. Behav.Anal. 2: 93–99.Google Scholar
  43. Lewontin, R. C. (1995). Sex, lies, and social science. N.Y. Rev. April 20: 24–29.Google Scholar
  44. Marques, J. K. (1995, September). “Does sex offender treatment work?” Paper presented at the International Expert Conference on Sex Offenders, Utrecht, The Netherlands.Google Scholar
  45. Marshall, W. L. (1996). Assessment, treatment, and theorizing about sex offenders. Crim. Just. Behav. 23: 162–199.Google Scholar
  46. Marshall, W. L., and Barbaree, H. E. (1988). The long-term evaluation of a behavioral treatment program for child molesters. Behav. Res. Ther. 26: 499–511.Google Scholar
  47. Marshall, W. L., and Eccles, A. (1991). Issues in clinical practice with sex offenders. J. Interpers.Violence 6: 68–93.Google Scholar
  48. Marshall, W. L., and Eccles, A. (1993). Pavlovian conditioning processes in adolescent sex offenders.In Barbaree, H. E., Marshall, W. L., and Hudson, S. M. (eds.), The Juvenile Sex Offender, Guilford, New York, pp. 118–142.Google Scholar
  49. Marshall, W. L., and Pithers, W. D. (1994). A reconsideration of treatment outcome with sex offenders.Crim. J. Behav. 21: 6–9.Google Scholar
  50. Marshall, W. L., Earls, C. M., Segal, Z., and Darke, J. (1983). A behavioral program for the assessment and treatment of sexual aggressors. In Craig, K. D., and McMahon, R. J. (eds.), Advances in Clinical Behavior Therapy, Brunner/Mazel, New York, pp. 148–174.Google Scholar
  51. Mavissakalian, M., Blanchard, E. B., Abel, G. G., and Barlow, D. H. (1975). Responses to complex erotic stimuli in homosexual and heterosexual males. Br. J. Psychiatry 126: 252–257.Google Scholar
  52. McAnulty, R. D., and Adams, H. E. (1992a). Validity and ethics of penile circumference measures of sexual arousal: A reply to McConaghy. Arch. Sex. Behav. 21: 177–186.Google Scholar
  53. McAnulty, R. D., and Adams, H. E. (1992b). Behavior therapy with paraphilic disorders. In Turner, S. M., Calhoun, K. S., and Adams, H. E. (eds.), Handbook of Clinical Behavior Therapy, John Wiley and Sons, New York, pp. 175–201.Google Scholar
  54. McConaghy, N. (1967). Penile volume change to moving pictures of male and female nudes in heterosexual and homosexual males. Behav. Res. Ther. 5: 43–48.Google Scholar
  55. McConaghy, N. (1974). Measurements of change in penile dimensions. Arch. Sex. Behav. 3: 381–388.Google Scholar
  56. McConaghy, N. (1975). Aversive and positive conditioning treatments of homosexuality. Behav. Res.Ther. 13: 309–319.Google Scholar
  57. McConaghy, N. (1976). Is a homosexual orientation irreversible? Br. J. Psychiatry 129: 556–563.Google Scholar
  58. McConaghy, N. (1977). Behavioral treatment in homosexuality. In Hersen, M., Eisler, R.M., and Miller, P. M. (eds.), Progress in Behavior Modification, Vol. 5, Academic Press, New York, pp. 309–380.Google Scholar
  59. McConaghy, N. (1978). Heterosexual experience, marital status and orientation of homosexual males.Arch. Sex. Behav. 7: 575–581.Google Scholar
  60. McConaghy, N. (1980). Behavior completion mechanisms rather than primary drives maintain behavioral patterns. Activitas Nerv. Super. (Praha) 22: 138–151.Google Scholar
  61. McConaghy, N. (1987). Heterosexuality/homosexuality: Dichotomy or continuum. Arch. Sex. Behav. 16: 411–424.Google Scholar
  62. McConaghy, N. (1990). Can reliance be placed on a single meta-analysis? Aust. N.Z. J. Psychiatry 24: 405–415.Google Scholar
  63. McConaghy, N. (1993). Sexual Behavior: Problems and Management, Plenum, New York.Google Scholar
  64. McConaghy, N. (1997a). Science and the mismanagement of rapists and paedophiles. Psychiatry Psychol. Law 4: 109–123.Google Scholar
  65. McConaghy, N. (1997b). Sexual and gender identity disorders. In Turner, S.M., and Hersen, M. (eds.), Adult Psychopathology and Diagnosis, 3rd ed., Wiley and Sons, New York, pp. 409–464.Google Scholar
  66. McConaghy, N. (1998a). Assessment of sexual dysfunction and deviation. In Bellack, A. S., and Hersen, M. (eds.), Behavioral Assessment: A Practical Handbook, 4th ed., Allyn and Bacon, Boston, pp. 315–341.Google Scholar
  67. McConaghy, N. (1998b). Sexual dysfunction. In Hersen, M., and Van Hasselt, V. B. (eds.), Handbook of Clinical Geropsychology, Plenum Press, New York, pp. 239–271.Google Scholar
  68. McConaghy, N. (1999). Methodological issues concerning evaluation of treatment for sexual offenders: Randomization, treatment dropouts, untreated controls, and within-treatment studies. Sex. Abuse J. Res. Treat. 11: 183–193.Google Scholar
  69. McConaghy, N., and Blaszczynski, A. (1991). Initial stages of validation by penile volume assessment that sexual orientation is distributed dimensionally. Compr. Psychiatry 32: 52–58.Google Scholar
  70. McConaghy, N., and Silove, D. (1991). Opposite sex behaviours correlate with degree of homosexual feelings in the predominantly heterosexual. Aust. N.Z. J. Psychiatry 25: 77–83.Google Scholar
  71. McConaghy, N., and Zamir, R. (1995). Heterosexual and homosexual coercion, sexual orientation and sexual roles in medical students. Arch. Sex. Behav. 24: 489–502.Google Scholar
  72. McConaghy, N., Armstrong, M. S., Blaszczynski, A., and Allcock, C. (1981). Controlled comparison of aversive therapy and covert sensitization in compulsive homosexuality. Behav. Res. Ther. 19: 425–434.Google Scholar
  73. McConaghy, N., Armstrong, M. S., Blaszczynski, A., and Allcock, C. (1983). Controlled comparison of aversive therapy and imaginal desensitization in compulsive gambling. Br. J. Psychiatry 142: 366–372.Google Scholar
  74. McConaghy, N., Armstrong, M. S., and Blaszczynski, A. (1985). Expectancy, covert sensitization and imaginal desensitization in compulsive sexuality. Acta Psychiatr. Scand. 72: 1176–187.Google Scholar
  75. McConaghy, N., Blaszczynski A., and Kidson, W. (1988). Treatment of sex offenders with imaginal desensitization and /or medroxyprogesterone. Acta Psychiatr. Scand. 77: 199–206.Google Scholar
  76. McConaghy, N., Blaszczynski A., and Frankova, A. (1991). Comparison of imaginal desensitization and other behavioural therapies for pathological gambling. Br. J. Psychiatry 159: 390–393.Google Scholar
  77. McConaghy, N., Buhrich, N., and Silove, D. (1994). Opposite sex-linked behaviours and homosexual feelings in the predominantly heterosexual male majority. Arch. Sex. Behav. 23: 565–577.Google Scholar
  78. Miner, M. H. (1997). How can we conduct treatment outcome research? Sex. Abuse J. Res. Treat. 9: 95–110.Google Scholar
  79. Minton, H. L., and McDonald, G. J. (1983/1984). Homosexual identity formation as a developmental process. J. Homosex. 9: 91–104.Google Scholar
  80. Muehlenhard, C. L. (1988). Misinterpreted dating behaviors and the risk of date rape. J. Soc. Clin.Psychol. 6: 20–37.Google Scholar
  81. Muehlenhard, C. L. (1989). Young men pressured into having sex with women. Med. Aspects Hum.Sex. 23: 50–62.Google Scholar
  82. Murray, S. O. (1995). Southwest Asian and North African terms for homosexual roles. Arch. Sex.Behav. 24: 631–654.Google Scholar
  83. Nokes, D. (1997). Jane Austen, a Life, Fourth Estate, London.Google Scholar
  84. Palmer, C. T. (1988). Twelve reasons why rape is not sexually motivated: A skeptical examination.J. Sex Res. 25: 788–790.Google Scholar
  85. Person, E. S., Terestman, N., Myers, W. A., Goldberg, E. L., and Salvadori, C. (1989). Gender differences in sexual behaviors and fantasies in a college population. J. Sex Marital Ther. 15: 187–198.Google Scholar
  86. Pillard, R. C., and Weinrich, J. D. (1986). Evidence of familial nature of male homosexuality. Arch.Gen. Psychiatry 43: 808–812.Google Scholar
  87. Prentky, R. A. (1998). In reply (letter to the Editor). Sex. Abuse J. Res. Treat. 10: 339–341.Google Scholar
  88. Rice, M. E., Quinsey, V. L., and Harris, G. T. (1991). Sexual recidivism among child molesters released from a maximum security psychiatric institution. J. Consult. Clin. Psychol. 59: 381–386.Google Scholar
  89. Rosen, R. C., and Keefe, R. J. (1978). The measurement of human penile tumescence. Psychophysiology 15: 366–376.Google Scholar
  90. Sakheim, D. K., Barlow, D. H., Beck, J. G., and Abrahamson, D. J. (1985). A comparison of male heterosexual and male homosexual patterns of sexual arousal. J. Sex Res. 21: 183–198.Google Scholar
  91. Searles, J. S. (1985). Amethodological and empirical critique of psychotherapy outcome meta-analysis.Behav. Res. Ther. 23: 453–463.Google Scholar
  92. Sell, R. L. (1997). Defining and measuring sexual orientation: A review. Arch. Sex. Behav. 26: 643–658.Google Scholar
  93. Sell, R. L., Wells, J. A., and Wypij, D. (1995). The prevalence of homosexual behavior and attraction in the United States, the United Kingdom and France: results of national population-based samples.Arch. Sex. Behav. 24: 235–248.Google Scholar
  94. Sennett, R. (1995). “Sex, lies and social science”: An exchange. N.Y. Rev. Books, May 25: 43.Google Scholar
  95. Sulloway, F. J. (1996). Born to Rebel, Pantheon Books, New York.Google Scholar
  96. Templeman, T. L., and Stinnett, R. D. (1991). Patterns of sexual arousal and history in a “normal” sample of young men. Arch. Sex. Behav. 20: 137–150.Google Scholar
  97. Tollison, C. D., Adams, H. E., and Tollison, J.W. (1979). Cognitive and physiological indices of sexual arousal in homosexual, bisexual, and heterosexual males. J. Behav. Assess. 1: 305–314.Google Scholar
  98. Troiden, R. R. (1989). The formation of homosexual identities. J. Homosex. 17: 43–73.Google Scholar
  99. Van Wyk, P. H., and Geist, C. S. (1984). Psychosocial development of heterosexual, bisexual, and homosexual behavior. Arch. Sex. Behav. 13: 505–544.Google Scholar
  100. Wheeler, D., and Rubin, H. B. (1987). A comparison of volumetric and circumferential measures of penile erection. Arch. Sex. Behav. 16: 289–299.Google Scholar
  101. Wiederman, M. W. (1997). The truth must be here somewhere: Examining the gender discrepancy in self-reported lifetime number of sex partners. J. Sex Res. 34: 375–386.Google Scholar
  102. Wilson, R. J. (1998). Psychophysiological signs of faking in the phallometric test. Sex. Abuse J. Res.Treat. 10: 113–126.Google Scholar
  103. Zucker, K. J. (1997). Letter to the Editor. Arch. Sex. Behav. 26: 671–672.Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Nathaniel McConaghy
    • 1
  1. 1.School of PsychiatryUniversity of New South WalesKensingtonAustralia

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