The Adventure of Love

Sex education, pornography and religion. First chapter of the book La aventura del amor, Pablo Requena, Wenceslao Vial.

Sex education, Pornography and Religion

Authors: Pablo Requena & Wenceslao Vial[*]

English translation, First Chapter of the book La aventura del amor.

José María La Porte, Sergio Tapia-Velasco (editors)

Table of contents of the first chapter The Adventure of Love

1. The need for "sex Education".
2. Does the Use of Pornography Teach us Anything?
3. A Little Bit of History of Sexuality.
4. Does Medicine Have Anything to Say about Sex?
    4.1. Medical Counsel on Sexuality.
    4.2. How to Approach Homosexual Desire.
5. The Catholic Church and Sex

1. The need for “Sex Education”

A few decades ago, there was little talk of sex in the school environment, and nothing about gender. The only mention of gender in the classroom was that relating to grammar, i.e., whether words were masculine, feminine or neutral. Today all that has changed, and for a considerable time now there have been courses in sex education of varying structure and content. For some, this is seen as a positive expression of social and cultural liberation, mainly through the discarding of what were believed to be corrosive religious prejudices that, for centuries, viewed everything about sexuality with suspicion. For others, however, this development is perceived as a manifestation of a distressing and harmful degradation of cultural and moral norms, particularly harmful to children and of lasting negative consequence. Taking a balanced and thoughtful approach, however, one can perhaps view these changes as containing both beneficial and harmful aspects.

Education is, in principle, positive. So why should there be suspicion of so-called "sex education"? Why are thousands of parents protesting in the streets of many European capitals against the teaching of gender in schools? The problem is not so much about giving information about sexuality which, after all, is much akin to teaching human history or mathematics. The problem is not in teaching the biology of the process of reproduction. The underlying concern here is with the ideology behind the understanding of sexuality that is being taught, which is fundamental to understanding the role sexuality plays in human personhood. There is also another concern surrounding the stages of maturation and growth in children and adolescents, which sees all stages of new information and skills acquisition as having their proper moment. Why are Third Grade mathematical equations not taught to nursery school children? Because they wouldn't understand them; their capacity to compute is not sufficiently developed to perform such calculations. Why are ten-year-old children not taught to drive? Because the consequences would be disastrous, resulting in many unnecessary accidents. Even in the field of sports, caution has been called for in the way training is programmed, as it has been shown that a child's body is not sufficiently developed for some exercises and that early specialisation of certain movements can lead to problems of growth and maturation at a skeletal-muscular level. Decades of experience have shown that inappropriate training can cause many adolescents to abandon their sporting activity altogether. Obviously, mathematics, driving or sport are not harmful in themselves. But what is not appropriate is to teach them in an untimely manner.

Something similar could be said about sexuality. It is an important subject, which must be taught in its proper time. Perhaps this is where the greatest diversity of opinions lies: some propose an early education while others advocate a later one. In 2010, the World Health Organization's Regional Office in Europe, in collaboration with a German federal health education centre, published its, "Standards for Sex Education in Europe". This guide was published as a response to the increasing rates of human immunodeficiency virus (AIDS) and other sexually transmitted diseases, as well as unwanted teenage pregnancies and the growing problem of sexual violence. Analysing the problem from a medical point of view, it was explained that "improving the health of children and adolescents is crucial for the improvement of sexual health in general. Young people need to know about sexuality, both in terms of risk and personal enrichment, in order to develop a positive and responsible attitude towards it, in a way that enables them to behave responsibly, not only towards themselves, but also towards others in the societies where they live”. The purpose of the document could not be made better: to develop a positive and responsible attitude towards sexuality, and to know the risks associated with certain behaviours associated with its exercise.

The document presents different models of education in this area and classifies them into three categories: a) "abstinence only" programs; b) "comprehensive sex education" programs; and c) "holistic sex education" programs. Category (a) simply promotes delayed sexual relations which, according to the document, has failed both to reduce unwanted pregnancies and to limit the spread of sexually transmitted diseases. “Comprehensive sex education” programs (b) teach abstinence as well as “safe sex” and provide information on the use of contraceptives. The third category (c), which includes the WHO document, goes a step further by adding a personal and sexual growth approach to the information provided by the second category.

The document correctly points out the central place that sexuality occupies in the lives of people, who "from birth are sexual beings and have the potential to develop their sexuality in one way or another. Sex education helps to prepare youth for life especially to build and maintain satisfying relationships that contribute to the positive development of personality and self-esteem". Furthermore, according to the document, young people have access, courtesy of the Internet, to a mass of information about sex that is often distorted. Think, for example, of the degrading presentation of women in pornography. All these factors make adequate sex education more urgent.

Some have expressed their fear that such education could encourage the early initiation of sexual relations, but - according to the document - it would be an unjustified fear, considering the current studies of UNESCO (2009). Moreover, according this research, it is clear that "sex education, according to many studies, tends to delay the onset of sexual relations, reduces the frequency of sexual contacts and the number of partners and improves sexual behavior".

Up to this point it might seem that the standards proposed by the WHO are an optimal tool to help parents and teachers; however, this is not the case. The problem begins when describing the means to be employed for the otherwise laudable intention of teaching a positive and responsible attitude towards sexuality. Those proposed means cover three areas of learning: information, skills and attitudes. The guide proposes a "matrix" divided by age, with objectives for the following fields: the human body and its development; fertility and reproduction; sexuality; emotions; relationships and lifestyles; sexuality-health-well-being; rights and sexuality; and social and cultural determinants of sexuality (norms and values). For children from 0-4 years old, the following informational points, among others, are proposed: to teach all the parts of the body and their functions; different bodies and different sexes; basic concepts of human reproduction (where babies come from); the enjoyment and pleasure when we touch our own body; early childhood masturbation; the fact that physical pleasure is one's own and is a normal experience of life; different types of love; different types of relationship; the right to ask about sexuality; the right to explore gender identity; and gender roles".

Despite the document stating that sex education should be age appropriate (we will consider this in a different section), there are problems with the objectives proposed in the document, which are only adequate for a certain way of understanding sexuality, namely, the importance of avoiding violence, disease and unwanted pregnancy. A concept of sexuality that focuses on preventing disease can only offer an impoverished paradigm when contrasted to an understanding that strives to show the beauty and greatness of the sexual dimension of the person and its role in interpersonal relationships.

This book tries to show some of that beauty from the perspective of anthropology, indicating also the positive vision of sexuality offered by Christian culture, a vision that has historically been clouded by poor presentations of its doctrine.

2. Does the Use of Pornography Teach us Anything?

Some might say that the problems pointed out in the previous section on ways of understanding sex education are simply a matter of approach. Each person, it is claimed, has his/her own vision of sexuality. Today there are many who think that taking a public health approach is sufficient, with the aim of simply avoiding unwanted pregnancy and disease. They argue that this approach would establish a minimum standard, from which individuals and groups could then construct the way forward that suits them best. Society, at large, and schools, in particular, would be enjoined to offer basic education on how to avoid abuse, disease and pregnancy. From these minimum standards, each group could then supplement with additional information that reflects their personal and religious vision. While this proposition seems quite reasonable on the surface, there is a problem, in that a minimum standard may be inadequate in providing a comprehensive formation for young people. For example, studies on the phenomenon of pornography show that, in principle, its use has little to do with abuse, disease transmission or possible pregnancy [2].

The exponential growth of pornography in the last few decades is largely a response to the liberal model of sexuality that has been widely accepted as a result of the so-called "sexual revolution". It is creating a huge social cost, not only for its victims - mainly women and children - but also for its users. The use of pornographic material on the Internet creates in many people an ‘ideal’ of sexuality that has little to do with real life. This ‘ideal’ then creates unrealistic expectations for couples [3]. The users of online pornography recognize that continued use results in a law of diminishing returns, with users needing to search for more extreme, shocking or impactful images to sustain their interest. Furthermore, male users acknowledge that the virtual world created by pornography makes it increasingly difficult for them to relate to actual women in the real world. The consequence is that pornography often degrades their ability to express bodily love, and most often traps them in a pathological addiction to sex.

A recent sociological journal article on this topic indicates that, in the United States, $4 billion is spent on pornographic videos every year. This expenditure is more than that spent on attending such sporting events as soccer, baseball and basketball games. The other findings of the study indicate that one out of four Internet users enters a pornographic website at least once a month, and 66% of men between the ages of 18 - 34 visit at least one of those pages every month. Texas A&M University psychologist Gary Brooks, who has been studying the phenomenon of pornography for a number of years, writes that "soft-core porn... has a very negative effect on men. The problem... is that it’s voyeurism - it teaches men to view women as objects rather than to be in relationships with women as human beings.” In addition, many women find themselves in a complicated and compromising situation: they do not know how to deal with their partners once they learn that pornography is being used. These women believe that, if they complain, it will be wrongly interpreted as prudishness or personal criticism. Mark Schwartz, Clinical Director of the Masters and Johnson Clinic in St. Louis, states that "pornography is having a significant effect on relationships on many levels and in many different ways, and outside the realm of sexual behavior and the psychiatric community, no one talks about it.” [4]

If using pornography harms adults, its influence is still worse on child and adolescent users, who lack the necessary maturity to interpret and make value judgments on the images they see. Pornography develops in them a distorted idea of sexuality and influences their relationships with girls or boys their own age. Disturbingly, in most cases, parents have no idea that their children are visiting pornographic websites.

The above information on the negative effects of pornography demonstrates that the sexual dimension of the person is far more sensitive than other human dimensions. Different human tendencies illustrate this: if, for example, we compare hatred and the desire for revenge with the sexual drive, it becomes immediately apparent that one can watch a movie in which the plot revolves around revenge, and then go to sleep without being particularly affected by negative feelings. However, this is not the case after watching a pornographic film, which does not leave the viewer indifferent. This is not to say that pornographic images are the only things that can negatively colour a film: certain kinds of violence, or even certain approaches which do not possess a transcendent view of existence can also do a great deal of harm. In any case, the influence of pornography on our innermost being and on our way of acting is far more impactful than the reactions triggered by other types of images or stories. This should caution us to take care when relating to anything concerning sexuality - not because we are being constrained by “artificial” socially-established moral norms or because of fears derived from a puritanical view of sex - but for the simple reason that it is a fragile and delicate dimension of human personhood.

3. A Little Bit of History of Sexuality

Sex hasn’t changed since the beginning of the world; in its biological and bodily aspects, little has changed since the appearance of homo sapiens. Have there been any changes worth mentioning? Yes, the ways of viewing, understanding and living sexuality have changed a great deal. While it is true that prostitution, adultery, homosexuality and pedophilia have always existed, it is also true that they have never been justified as they are today. This phenomenon is worthy of study. The “high” point in the history of sexual mores was the so-called sexual revolution of 1968. It marked the definite dissolution of a number of rules of social behavior in relation to sexuality, which had for a long time been losing their solid foundations. The phenomenon can be likened to what happens to mountains when years of rain erode the structure of the subsoil, causing it to lose adherence, resulting in a great landslide. The collapse of sexual mores is, therefore, not the result of a singular event, but of imperceptible movements that, over time, have managed to undermine its foundations.

The sexual revolution of 1968 had been fermenting over many decades [5]. In her book, Sexual Politics, Kate Millet speaks of a "first sexual revolution", which lasted for nearly a century (1830-1930). It was characterized by the vindication of women's equality and the fight against patriarchy. Subsequently, there was a latent period, which she calls the "sexual counter-revolution": this coincided with the years immediately prior to the Second World War and those of the post-war period, reaching the 1960s, when Freudian theory became widely disseminated.

The 1968 Sexual Revolution advocated "free sex". What were those things from which we were freed? Principally, freedom from moral norms, which were seen as ruining the beauty of sexuality by creating psychological complexes. It is interesting to look more closely at the concept of norms and morality as seen from this perspective. Moral norms were deemed as being contrary to freedom and seen as originating from certain social customs and religious views. Sexual morality was not viewed as something innate that enabled self-realization but, rather, as an extrinsic system that forced individuals to blindly follow a set of prescribed behaviors which had nothing to do with personal happiness. This approach to morality has long and deep historical and philosophical roots. Modernity ushered in the age of questioning, encouraging man to rely solely on reason. It demanded answers that “did not hide behind a sacralized idea” of the world and the person. It took for granted a preconceived ‘right way of behaving’ in all realms, including the sexual. Modernity did not find convincing answers to the questions surrounding the meaning of sexuality, procreation and marriage. And, in some cases, its self-justified anthropological foundation resulted in a radical nihilism, where the border between good and bad disappeared altogether. The consequence of this was the reduction of the human person to an autonomous agent, without telos, or end, and without direction. This vision of the person was seen as simply moving at the impulse of more or less elaborated passions [6].

In this context, the so-called "Masters of Suspicion" occupy a prominent place, namely, Freud, Marx and Nietzsche, who exercised a direct influence on the future of the sexual revolution. These authors were opposed to what they saw as an exacerbated rationalism, which they believed was merely a subterfuge for the intimate drives in persons that constitute their vital dynamism. For Marx, the focus was on economic interest; for Nietzsche, it was the will to power; and for Freud, it was the union between erotic and destructive tendencies. These authors shared a common desire to free personal conscience from social conditioning in order to enable a “harmonic development of natural impulses.” The indirect influence of Marx and Nietzsche passed through the theoretical weakening of the foundations of religious belief and its associated duties. Freud ranked libido as the primordial drive of the human person, and considered society to suffer from a generalized neurosis when this drive was repressed by social and moral norms. Without discrediting the work of the founder of psychotherapy, his intuitions about the origins of mental pathology and its proposed cure, it should be noted that Freud’s privileging of the nature of the sexual drive has been criticized by many - including some colleagues and collaborators - because it neglects many other important dimensions of the person.

The 20th century arrived with a strong influence of these ideas in the philosophical field. The century that also witnessed the Second World War gave rise to a series of thinkers who had a fairly direct influence on the emergence of the Revolution of '68. Some have been called the "Theoreticians of the Sexual Revolution": Reich and Marcuse in Germany, and De Beauvoir and Bataille in France. Wilhelm Reich is best known for his book "Sexual Revolution", which was published in English in 1945. He attempted a synthesis between the psychoanalytic theory of Freud, who was his teacher, and the revolutionary Marxist ideology, of which he had personal experience from his childhood and which had left its mark on him. Although he recognized that some moral norms were necessary to avoid the chaos that the free exercise of sexual impulse would produce in society, he thought that the existing norms were too strict, causing the sexual difficulties of the West. His proposed remedy was a "revolution" to separate sexuality from marriage. He affirmed that extramarital relationships were beneficial, and suggested - though it is not clear on what basis - that society freed from such repressive norms would thereby achieve a harmonious balance, so that moral regulation would no longer be necessary.

Another thinker who contributed to the Sexual Revolution was Marcuse, particularly through his attempt to establish a compromise between psychoanalysis and Marxism. In the essay Eros and Civilization, he completely accepts the Freudian thesis that sexuality obeys the pleasure principle. However, in contrast to Freud, who speaks of a “principle of reality” to which pleasure should be submitted, Marcuse endorses a sexuality without rules. He believes that if the limitations introduced by the principle of reality are removed, far from making us victims of aggressive impulses, a new, more creative and happier society will emerge. To this end, he proposed the free play of sexuality and the eroticization not only of the body but also of work. This was seen as a matter of opening eros to a more varied range of drives, of freeing it from the obsession of sex and, consequently, of leading it towards a non-repressive sublimation that allows the full sense of human reality to be expressed. A few years after the publication of his book, and the the hippie movement it inspired, Marcuse was forced to recognize that the longed-for, non-repressive sublimation of eros, once put into practice, had not only failed to liberalize love, but had reduced it to the pure sexuality of the "immediate erogenous zones" [7]. In short, Marcuse was forced to accept his mistake: sexual freedom, even the most unlimited, is not a real alternative to the repression of eros, but rather coincides more with its degradation [8]. If the path of the social sublimation of eros could be alienating, there was an even more repressive type of "desublimation": the transformation of eros into an object of consumption. The energy of eros, instead of being used for reproduction, was deemed by Marcuse to serve capital as opposed to serving reproduction and the increase of life. Eros was thus transformed into a strategic function of the market. [9]

Simone De Beauvoir is known for her writings in favor of a more determined feminism than the model proposed in previous decades, which gave rise in the 60s and 70s to so-called radical feminism. In De Beauvoir's opinion, it was not enough to abolish private property to achieve the ultimate goal of the revolution. Without property, differences between men and women and between parents and children would still exist, which she viewed as the source of countless abuses. De Beauvoir concluded that the transformation of society could not be total until the family disappeared [10]. In her major work, "The Second Sex," first published in 1949, she strongly criticized patriarchy as a social model responsible for the subjugation of women. For the author, liberation from this system required contempt for motherhood and an attack on the family as it had been conceived for centuries, which were seen by De Beauvoir as the essential elements of the patriarchal system. Her battle against marriage was not a battle against sex, but against a sexuality directed towards procreation. She reasoned thus: immediately after sexual union there is a struggle between the interests of the species and the individual woman. Thus, abortion was heralded as only the consequence of a free choice, in which the individuality of the woman stood triumphant over the atavistic force of the species. It naturally followed that the French philosopher was a great promoter of abortion and contraception.

Georges Bataille is a difficult author to frame, and his type of discourse is closer to a revolutionary vindication of '68. In his book "Eroticism" (1957), he proposes the transgression of social norms regarding sexuality, considering them arbitrary, subjective and, therefore, susceptible to change. In his historical conception of sexuality, eroticism appears in the transition from animal to man, when sex loses its connection with reproduction. The liberation from eros that he proposes does not consist merely in the search for venereal pleasure. Rather, it is a search that carries with it the transgression of the law. As has been mentioned earlier, this idea will play a great role in the sexual revolution. Furthermore, Bataille proposes the idea of the insufficiency of marriage as a catalyst for the sexual instinct, which is illustrated, among other things, by the phenomenon of orgies.

These authors have exercised a notable influence in changing the social perception of sexuality and its practice, both within and outside of marriage, with their approaches leading to the sexual revolution of 1968. Their ideas have permeated not only the academic sphere, but have also reached the general public through public health information, literature and film.

After 1968, literary and academic work in relation to sexuality carried on uninterrupted. Here we point out two strands that seem to us to be of greater interest in explaining the situation in which we now find ourselves: Michel Foucault's works on the history of sexuality, and the writings of certain radical feminists. Foucault’s project was an ambitious one: he only managed to finish the first three volumes before AIDS ended his life [11]. In his historical analysis, Foucault explains that the repression of sexuality in society changed radically in the 17th century, reaching its peak with Victorian morality of the 19th century. Socially, only sex in marriage and directed at procreation was accepted: extramarital and premarital sex were considered illicit. He maintains that the reasons for these social changes can be explained by two factors: (1) the economy, specifically capitalism, which forced a type of labor relationship that excluded women; and (2) religion, which, with its doctrine on sin and confession, proposed a more rigid morality. Foucault suggests a liberation from these oppressive structures which, to his mind, do not correspond to any objective truth, but are merely conventional, and therefore open to change. He cites the example of ancient Greek society as a culture in which homosexual behavior was widely accepted. However, Foucault maintains that, for such a revolution to triumph, it is necessary to gain power, since it is power that governs sexual mores.

Since 1968, the West has seen the emergence of feminists who, following in the footsteps of De Beauvoir, have assumed increasingly extreme positions. These authors, working mainly in the field of university education, have replaced the feminism of equality with the opposition of the sexes. Like the above-mentioned authors, new wave feminists consider patriarchy an enemy to be destroyed for its subordination of women to motherhood, depriving them of workplace opportunities, and therefore from positions of power in society. Three important books that illustrate this trend are Sexual Politics (Kate Millet, 1969), The Female Eunuch (Germain Greer, 1970) and The Dialectic of Sex (Shulamith Firestone, 1970) [12].

A chapter in this same history following the sexual revolution, is that of the "question" of gender, under its various names: gender studies, gender theory, or simply gender. The word gender used in relation to sexuality seems to have entered the academic field with the controversial article of Dr. John Money on hermaphroditism in 1955. He distinguished between biological sex and gender as a social role. Certainly, there is no problem in the use of this term, which can have its place, above all, in the field of sociology. The problem, rather, is in the type of relationship proposed between gender - as a self-perception of one's sexual dimension in relation to society - and biological sex. In discussions on this subject, one encounters opinions of all kinds. Basically, the differing views centre on the greater or lesser weight given to biology and culture in the configuration of the sexual dimension of the person. If it is a serious mistake to think that everything depends on biology, it is more so to consider that the differences between men and women are simply cultural.

In relation to gender, we have reached a cultural confrontation between those who speak of a dangerous gender ideology that seeks to impose upon school children the teaching that sexual differences between men and women do not exist and do not have to be linked to sex, and those who maintain that there is no gender theory (much less an ideology), which is nothing more than a fiction created by religious extremists, although no explanation is given for this assertion. Leaving aside these controversies, which do not seem to be very useful, it is true that, increasingly, there are manifestations in the public sphere of a presentation of human sexuality that does not conform to the binary model of masculine or feminine. Just think of the 58 options offered by Facebook in English for the "gender identity" box. To maintain that there are 58 different ways of considering one's own sexuality is practically the same as saying that sexuality is a personal self-construction.

All these ideas that exist on a theoretical level have practical repercussions that are not difficult to imagine, both at the level of ethical assessment of certain behaviors and at the legal level, when considering certain unions and their social framework.

Until this point, we have talked fundamentally about the intellectual and philosophical roots of the sexual revolution and ideas of gender. Now we must take a step back to consider other roots of these cultural and social changes, which are found in sociology and medicine. With regard to the former, we will point out two moments, which have their own name, and which correspond to a remote and proximate influence on the sexual revolution. The first is Thomas Robert Malthus (1766-1834) and his theory on the exponential growth of the population versus low growth in food production. Although his thesis was obscured during his lifetime by the optimism of the scientism of the second half of the 19th century, it reappeared with notable force starting in the 1920s. Malthus’ population thesis served as a basis for promoting an anti-birth mentality and, therefore, an exercise of sexuality separated from procreation, which would feature prominently in 1968.

The second player in the revolution was Alfred Kinsey (1894-1956) who, although a zoologist, managed in the 1950s to alter the social perception of the exercise of human sexuality. In two studies on male and female sexual behavior, which were published respectively in 1948 and 1953, Kinsey managed to shatter the idea of the Victorian moral proposal that the rightful place of sexuality was to be found only in marriage and open to procreation. The survey statistics cited by Kinsey described high percentages of practices of sex outside of marriage, including homosexual relations. His studies caused a great stir in public opinion and quickly became part of the "scientific" baggage of American society, notably influencing programs on sexual education that were developed in the following decades. For many years, no one questioned the results of his studies. However, from the 1990s onwards, critical analyses began to be conducted which revealed notable deficiencies in the scientific validity of his surveys and their results. The objections were of a methodological nature and referred fundamentally to the selection of survey sample populations, which included a high percentage of prisoners and prostitutes. There is also considerable confusion with regard to the categorization of behavior. For example, a simple attraction to another person is taken to be a "sexual act". The Kinsey studies also included a section on the sexual behaviour of pre-adolescents which, years later, had to be withdrawn when it became clear that the data came from Kinsey’s collaborator who abused children [13].

In the field of medicine, we would like to highlight a fact that is of capital importance in understanding both the sexual revolution and the current way of approaching and practicing human sexuality. This is the introduction and diffusion of the contraceptive pill. Since time immemorial, there have been ways of preventing the reproductive consequences of sex. Since the late 19th century, the use of condoms has been widespread. However, the "Pill" was a revolution since it achieved the goal of avoiding conception without the need to physically modify, in any way, the sexual relationship. What is more important is that it gave women dominion over the reproductive consequences of their sexual lives. Pharmacological research on the contraceptive pill led to its approval in 1957 by the FDA (Food and Drug Administration, the American agency in-charge of approving new drugs) as a drug regulating the menstrual cycle. Later, in 1960, it was marketed as an oral contraceptive.

We can conclude this section by pointing out that the "free sex" invoked in the revolution of ‘68 has had many practical consequences for sexual behavior and practices: it has greatly influenced the recent history of the institution of marriage, the exponential increase of divorce, and the ever-increasing number of children born out of wedlock. We will return to these issues later, but first we need to address the question of what medicine says about human sexuality.

4. Does Medicine Have Anything to Say about Sex?

A few decades ago, the sex of an expected baby was a surprise reserved for the moment of birth. With the availability and general use of ultrasounds before birth, few couples now decide to wait. Usually, after the 12th week of gestation, ultrasound makes it very easy to see the external sexual characteristics of the unborn child, therefore determining the sex. Nevertheless, at the time of delivery, one always hears the voice of someone announcing or confirming: it's a girl! or it's a boy!

There are some cases where sexual development has been adversely affected, making it impossible to know for certain the sex of the child, even after birth. This anomaly is known as ambiguous genitalia. It has many degrees and causes, to which we will return later. Sometimes it is a challenge for doctors to assign sex speedily enough, as delays can result in significant damage arising from the need to introduce hormonal treatment early on. This is to reduce the risk of tumors from hidden genital organs and improve growth and bone formation. Genetic tests are required to verify chromosomal sex, and hormonal and imaging studies are used to see if there are ovaries or testicles, the presence or absence of a uterus, etc.

These two situations summarize what is expected of health personnel in the area of sexuality and procreation: to facilitate the birth of a new human being and to try to resolve pathologies or complications that may arise at any time during development - including the many problems related to the practice of sexual function in adult life. With technological advances and a comprehensive knowledge of physiology and psychology, it is possible to help most people who request it.

When health professionals apply scientific knowledge, there are usually no difficulties, even if they have different conceptions of human sexuality because of their personal convictions. For some, man and woman are no more than an evolved animal that lives and dies, and that’s it; while for others, persons are seen as beings possessed of an eternal destiny. The absence of faith in a creator or in an afterlife does not imply that practical solutions are compromised, including in the field of sexuality. However, for years we have observed a new and dangerous phenomenon: medical science, in some environments, has allowed itself to be manipulated and influenced. Strangely enough, those who raise this issue are accused of religious prejudice in allowing extra-medical interests to take precedence over scientific data. For this reason, some give into environmental pressure and pronounce on or yield to issues that are not medical [14].

Set out below are descriptions of relevant pathologies and various conditions. The starting point, shared by generations of doctors, has been to respond to the request from society to prevent and cure disease, or at least to limit damage and reduce pain. In some cultures the preventive role is so important that doctors are even paid to dispense preventive advice. We will briefly mention five groups of anomalies: sexual dysfunctions, gender dysphoria or gender identity disorder, paraphilias, chromosomal alterations and intersex states [15].

The so-called dysfunctions are those irregularities that make the normal functioning of sexual activity difficult, preventing it from reaching its end in an adequate way. They are very common and can occur for biological or psychological reasons. Sometimes there are phobic rejections of sexuality, excessive tension or lack of knowledge by the couple, or of some differences in attitude and sensitivity that must be taken into account. A frequent example is anxiety or obsessive fixation on aspects related to pleasure, which slows down the organic stimulation necessary for the sexual act. When it happens in marriage, it is necessary to seek the help of a good doctor to avoid a deterioration in spousal relations.

We speak of paraphilias when the object of sexual desire or the situations that produce pleasure are inadequate. In the past they were called sexual perversions. They include exhibitionism, pedophilia, transvestism and other forms of abnormal use of sexuality, where fantasies, impulses or arousal behaviors are produced with inanimate objects (fetishes) or animals. Some patients seek their own suffering or that of others through sex, which is called masochism or sadism, respectively. The latest edition of the Diagnostic Manual of Mental Disorders, from the American Psychiatric Association (DSM-5), introduced a difference between paraphilia and paraphilic disorder. A diagnosis of disorder or illness is made only when the use of sexuality causes discomfort or harm to the individual, or puts the health of others at risk. For the authors of the manual, paraphilia itself would not justify or require the intervention of a physician.

Another abnormality is pedophilia, which consists in seeking sexual excitement with pre-pubertal children. Those who are involved in this are almost exclusively males with a history of childhood abuse. The most common environment for the acting out of this serious deviation is, in a broad sense, the family environment [16]. On many occasions, the medical conception of pedophilia is confused with other acts, no less harmful for that reason, which occur in homosexual relations with adolescents. There is a certain contradiction in the DSM-5 in its contention that pedophilia is not always a disease, while simultaneously saying that it meets the requirement they determine for naming it thus: to cause serious psychological damage in minors, which affects them for life, and sometimes physical injuries due to traumatic wounds. Perhaps an excuse can be made for this contradiction due to the fact that we are in a field in which the boundary between pathology and aberrant behavior is often not clear. Thus, the assessment of such behavior now usually calls not only for a doctor or a moralist but also a criminologist.

The third group we will mention is gender dysphoria, known as gender identity disorder until 2013, and which was previously called "trans-sexualism". The change of name was justified by the DSM-5 to emphasize the presence of an uneasiness in relation to one's sex. For the North American sensibility, calling them “sick” was seen as a form of "stigmatization”. The term sex was also considered inappropriate, only to be used in relation to reproductive health [17].

In the preparation stage of the Manual, some wanted to remove gender dysphoria from the list of mental illnesses. The idea prevailed to leave it, however, in order to allow those who wanted to change their sex to have access to health services, to seek hormonal therapies or to undergo expensive sexual-characteristics-modification surgery. By their own admission, though, the specialists who carry out such surgery maintain that these procedures are difficult and often do not solve the underlying problem in the long term [18]. The trans-sexual person is now considered a victim of a biological accident, trapped in a body that is incompatible with his/her gender identity; although from an organic and biological point of view, such sexual identity is unmistakable. In any case, it is important to acknowledge the suffering caused by this condition and to avoid any discrimination that would increase their pain. This is especially important in childhood and adolescence, when the problem usually first appears, accompanied by anxiety and depressive symptoms. Parents must support their children and seek specialists who can help and guide them in their various circumstances.

The last pathologies we will look at are abnormalities of the sex chromosomes and the intersex state. Let's remember that human beings have 46 chromosomes: males have one X and Y chromosome and females have two X chromosomes, which determines their chromosomal or genetic sex. Some chromosomal abnormalities include Turner's Syndrome (with a frequency of 1 out of 4,000 live-born females), which consists of a lack of one of the X chromosomes (45, X), leading to poor pubertal development. Another is Klinefelter's Syndrome  (present in 1 out of 800 live-born males), diagnosed as two or more X and one Y chromosome (47, XXY), which affects the development of secondary sexual characteristics, resulting in small or atrophic testicles. Finally, the 47, XYY Syndrome (occurring in 1 out of every 1000 males) causes an external male appearance or phenotype, with above-average height and a 10 to 15 point IQ reduction compared to the sibling, but usually within normal ranges.

In intersex states the appearance of the external genitalia (which have formed during the first three months of gestation) is ambiguous or does not coincide with the chromosomal sex or the presence of ovaries or testicles. There are many degrees and types of intersex which, as all doctors learn during their formal studies, should be recognized and treated as soon as possible [19]. The classic forms of presentation of the abnormality at birth are three. Female pseudohermaphrodites have XX chromosomes and ovaries but with ambiguous external genitalia resembling that of males. This is caused by an excess of male hormones, androgens. Male pseudohermaphrodites have XY chromosomes and testicles, with genitals that are either ambiguous or female in appearance. And finally, true hermaphroditism is where there is both testicular and ovarian tissue, and genitals with both male and female structures.

An abnormality that can lead to these conditions is the absence of a total or partial response of cells to male hormones, or androgens, known as Androgen Insensitivity Syndrome, which causes a lack of virilization of the fetus. This will occur in genetically XY male children who are born with a lesser or greater genital ambiguity; in mild cases, they will have a male appearance. When the insensitivity to androgens is total, the external genitalia will be female and they will develop as girls. The symptoms or difficulties of these conditions appear at puberty, when typical male secondary sexual characteristics manifest themselves. They will have developed a female appearance, even though there is a Y chromosome. Treatment of this rare condition includes surgical removal of the atrophic testicles, which may have been hidden in the abdomen, and supplementation with female hormones. There is also congenital adrenal hyperplasia which, in some cases, leads to virilization of female fetuses, who may be born with ambiguous genitalia.

In describing the above abnormalities or pathologies, there is no pejorative intent. There are, however, those who seek in the suffering of these people and their families an ally to defend ideologies, maintaining that such abnormalities should not be considered as pathologies, but as a demonstration that sex is nothing more than a gradual shift on a female/male continuum. The most extreme say that it is not advisable for newborns with ambiguous genitalia to be treated but, rather, that they should be left to choose for themselves in later life as adults. It is our hope that such an ideology will not prevail, lest we see something akin to the groups advocating for the legalization of pedophilia, calling it “intergenerational sex”.

Medical science has always maintained that a possible difficulty in recognizing sex at birth does not indicate a third sex. Even in the most complex and rarer cases, in which it is difficult to discover a dominant sex, one can assign one of only two of the human species. As in other medical decisions, there could be an error of assignment at birth, which becomes more evident with sexual development. In these cases a later re-assignment will be possible [20].

It is necessary to remember that those who experience a sexual desire towards people of the same sex, and those who declare themselves trans-sexual, rarely present chromosomal alterations or intersex states. We will return to homosexuality later.

4.1. Medical Counsel on Sexuality

Once it is acknowledged that medicine has much to say about sexuality, it is important to define those areas in which medical professionals can legitimately offer advice. What is usually observed is that some speak beyond their competence while others remain silent.

The first rule should be to advise according to the known science, adhering to the primary principle of all health professionals: to prevent and cure ill health in those who seek help. As has been said, while doctors may have their own beliefs or doubts, they may not impose them on their patients. The intrusion of extra-medical beliefs is highly dangerous: those who deny the essential difference between men and women move in this direction. The responsibility of doctors to distinguish between personal beliefs and sound medical practice is of utmost importance because the health of many is at stake.

A good cardiologist must know how the heart works, which arrhythmias are dangerous, which factors predispose to heart attacks, the best diets and the most appropriate exercises. Likewise, good doctors who specialize in the area of sexuality must know the technical aspects, the functioning of each organ and its complementarity, the role of hormones and the risks and benefits of certain behaviors. Their advice will impact in a far greater way than is often realized. Science reveals that sexuality is a dimension that involves the whole person, which includes not only the corporal and physiological aspects, but also the psychological and spiritual ones. Human sexuality clearly rises above its merely biological aspects: it is not like animal sexuality, which has a much more limited purpose. Human sexuality is the sexuality of a person. But this does not mean that "everything" in sexuality is open to modification according to personal preferences, as if biology were a mere accessory.

The way in which the generative faculty is exercised and pleasure is sought has important implications for health. Every astute observer will acknowledge that the mutual attraction in human beings differs from that of animals, in that it is not only present during the fertile period: this indicates that it does not play a merely functional role. The exercise of a healthy sexuality depends upon the human element, i.e. that dimension of the human person that transcends the merely animal; personal sexual acts are transformed into personal gestures, which overcome egocentric instincts, transforming them into signs of love.

Sex constitutes a basic identity, the abuse and manipulation of the which can lead to an increase in psychological pathology. When children are questioned and made to doubt whether they are male or female, the foundational developmental norms of personality are undermined. Disturbed and weakened foundations are thus created, causing insecurity, low self-esteem and an inability to give of oneself. It is not long before the entire edifice of personhood begins to collapse, with physical, psychic, social and spiritual wellbeing adversely affected.

The "liberation" of sex, which followed the so-called sexual revolution, has led in many cases to its trivialization but also, paradoxically, to its becoming once again a taboo subject. What would Freud say were he alive today? He would, no doubt, be surprised to see that it is no longer possible to talk about some subjects, such as homosexuality, and that the very term "sex" has been emptied of content, having been replaced by "gender". The understanding of gender is now something vague, seen more as a garment that can be worn, or not, and changed at will. Perhaps the founder of psychoanalysis would still feel compelled to ascribe this phenomenon to his archaic theories, particularly those that view man as being driven and enslaved by his irresistible instincts and the blind energy of pleasure.

From a medical point of view, it is essential that we value human freedom and agency, without which we are unable to pursue worthwhile life goals. The trivialization of sexuality leads many young people to abandon their goals, living only for short-lived aspirations. Both the search for easy pleasure, in masturbation, for example, and the initiation of sexual activity with others without waiting for the right and mature moment, paves the way for a number of disordered tendencies; when such behavior is not controlled by intelligence and the will, problems can be triggered. Many psychologists warn about the risks of such behaviors. To traverse the stages of intimacy too early has a deleterious effect on love and pleasure, causing them to diminish and ultimately disappear. Just as the exploited earth needs increasing amounts of fertilizer to become productive again, those who abuse their bodies as mere objects of pleasure become slaves to an unstoppable consumption of artificial stimulants, pills, images and instruments.

It cannot be confirmed from a scientific perspective that it is medically normal, or even healthy, to have sex with several people, and in various ways, or that gender is something to be chosen, as desired. While it is the case that not all unnatural sexual behavior results in disease, it is nevertheless good professional practice for a doctor to refrain from condoning behaviors whose benefit is less proven than their risk. Just think of the many social and health problems linked to the indiscriminate use of sex: infectious diseases such as AIDS, the difficulties of leading a normal life as a couple, crimes such as child pornography, prostitution or pedophilia, where economic interests reign: the "dance around the golden pig", as Viktor Frankl described it [21].

It is very important that parents, educators, spiritual directors and, of course, physicians remind those who seek their advice on these matters of the following psychiatric assessment: "any sexual act takes place in an interpersonal relationship with unpredictable emotional responses in both protagonists and inscription of each one in the history of the other. In a relationship between two people, lived as a free and conscious act, whether one wants it or not, it becomes ipso facto an object of moral evaluation" [22]. Many psychological problems and other types of illnesses, as well as difficulties in the spiritual life and social relationships could be prevented by being clear about this indisputable truth. The wounds left by sexual activity that does not follow the order of love are very difficult to heal, as has been witnessed in the most varied of cultures, in people from all five continents, including believers and non-believers.

Another obvious risk of uncontrolled sexual activity is addiction, which has a similar manifestation to that of alcohol, drugs or gambling. In the normal physiological process of sexual pleasure, which is very complex, when the peak of the sensory experience is reached, several substances are released into the blood. Some are related to opiate drugs, in this case endogenous, which cause an intense euphoria of short duration and can contribute to consolidating the vice or addiction in vulnerable subjects [23]. There are also people who live only for sex, in a clearly pathological way, and use others exclusively as objects of pleasure. A 2015 British Medical Journal editorial warned of the health dangers of so-called "chemsex", in which the use of certain drugs to prolong sex sessions is spreading among some homosexual groups [24].

It is incumbent upon the medical profession to spread a scientifically correct anthropological idea of sexuality. For this, it is necessary to see it in relation to love, which enriches the lover and the beloved. In this way, some sexual disorders, which often reflect an existential problem, can be prevented or cured [25]. When pleasure is sought without an openness towards the other, when people are used as objects, even pleasure itself disappears and mental illnesses emerge [26].

Therefore, it is key to make known the appropriate timing and circumstances of the expression of sexual love: only a stable union allows the transformation of sexual intimacy into a fully human relationship. The beginning, so to speak, of sexual activity must be at the appropriate age and not before. In a similar way, when one enters working life prematurely and fails, therefore, to have adequate preparation, "the young person who enters prematurely into an exclusively sexual relationship, consuming his sexual energies prematurely, will never find the path that leads to the harmonious synthesis of the sexual and the erotic." [27] “He/she will not go out of himself/herself towards the other, will not be able to truly love. There are studies that reveal that these young people have an important limitation in their interests and horizons, because they "cut the wings of the spirit" [28]. The pleasure they get at little cost absorbs and masks all kinds of worries, thoughts and even ideals.

“It is necessary to counteract,” says psychiatrist Frankl, “...the hypocrisy of those who proclaim freedom, but refer only to the freedom to do business with sex and spend money on it. The synthesis of eros, as a psychological tendency, and sexuality worthy of man, in which man satisfies his sexual desires exclusively when he loves, must be sought” [29]. If diseases such as AIDS, which continues to spread as an epidemic, are to be prevented more effectively, changes in attitudes and behavior regarding sexuality should be encouraged. The usual recommendations, however, are usually limited to mechanical or technical aspects that reduce contagion, and to the use of expensive drugs that are offered - in rich countries and to the rich people - as "protection" if one has sexual relations with many other people [30].

4.2. How to Approach Homosexual Desire

Although health professionals do not agree on what homosexual desire means, nor on how to deal with it, several considerations can be made from the scientific point of view. The first is that there is no doubt that the medical field has much to say about this type of desire. There are many physiological and psychological mechanisms involved in sexual stimulation and in the performance of one's own acts. The normal process involves a multitude of psychic mechanisms, such as thoughts, imagination and memory; perception and various sensory stimuli are present. From these a series of more or less automatic events are triggered. 

It is clear that sexuality possesses an instinctive force superior to that of other impulses. For this reason, it is not strange that it is triggered in numerous circumstances, and before diverse objects. Especially at the beginning of sexual maturity, at puberty, the impetus is greater. A wide variety of thoughts or images, even without erotic reference, can trigger the process of sexuality to its peak. It occurs, for example, in experiences linked to test anxiety, social fear or acute stress for other reasons.

It is also known that sexual desires towards persons of the same sex appear more frequently when there are no persons of the opposite sex, as is the case in prisons and boarding schools or, in the past, during extended sea voyages. In fact, the problem of sex in detention centers is enormous despite its being forbidden. This is why the World Health Organization has recommended that prisoners be allowed to have condoms [31]. Sexual behaviors towards the same sex are observed in numerous animals, usually as something isolated or circumstantial: from a female turtle that acts like the male, climbing over other females when she is about to lay eggs, to a young dog who, when not able to find a mate, seeks pleasurable stimulation in objects within its reach. In normal environmental circumstances, animals usually direct their instinct towards the opposite sex.

What about people who, experiencing an exclusive sexual desire (or not) for people of the same sex, choose homosexual relationships as a lifestyle? They too may have a stronger instinctual force and be unable or unwilling to master it. Evidence of an instinctive component is mentioned especially in male homosexuals [32]. Although, in reality, instincts in the strict sense do not exist in human beings. The impulses that lead to satisfaction of needs or to act in a certain way are called tendencies: to the irrational is added the knowledge of an object or purpose. In human sexual behavior, higher cognitive functions, with their substrate in the cerebral cortex, are key.

Men or women who choose to live sexually with persons of the same sex know what they want and why, unless they are actually impaired in their cognitive function. Their choice transforms what was perhaps initially only a blind impulse into a way of life. And they clothe it with rationality in an attempt to prove and demonstrate to themselves that their decision is coherent. Homosexual men tend to display a more pleasure-oriented behavior, with multiple partners (the number has decreased after the AIDS epidemic). Women, on the other hand, exhibit a more romantic search for intimacy and affection, tend to have fewer partners, use sex less, and live more satisfied lives [33].

Doctors considered homosexuality to be a mental illness until 1973. In that year it was decided by vote in the United States to remove it from the Diagnostic and Statistical Manual. Homosexuality as an illness disappeared completely in 1987. In the DSM-II of 1968, it was included among sexual deviations, within the personality disorders and other non-psychotic disorders [34]. The World Health Organization removed it from its list (ICD) in 1991. It is surprising that it was necessary to vote to include or remove a health topic, to give or not to give certain indications, etc., in such an important manual and with such a large number of experts. It is logical, however, that this should have been the case, based on the bibliography and data existing up to that time. The definition of diseases evolves over time due to changes in diagnostic criteria, new studies, and also as social customs change, as in the case of homosexuality [35]. In any case, it is likely to have been a wise stand, for sexual desire alone does not determine a person's health or illness. The causes of this type of attraction are manifold. In adolescence, for example, it is usually something transitory, indicating the search for identity so characteristic of that stage of development. 

However, a decision, guided by extra-medical principles, to prohibit any kind of professional help to those who wish to modify their sexual orientation towards persons of the same sex is, in our opinion, incoherent and harmful. As we said when talking about gender dysphoria (former identity disorders), the aim is to allow individuals the choice of changing their sex, at the cost of risky and expensive operations. On the other hand, those who simply wish to reorient their sexual desires, and not their entire sexuality, are discriminated against in an unjust way, causing great suffering and harm to people’s freedom. Perhaps in the past attempts were made to reorient sexual desire following behaviorist psychological models, with certain "therapies" that were clearly immoral. But this does not mean that there are no other sound methods of offering adequate help to people who do not feel comfortable with their homosexual tendency. There is no doubt that the rejection of sexual reorientation therapy is based upon good intentions, but its current stigmatization is striking in its refusal to allow reasonable discussion on the subject.

It is a fact that a good number of people with same-sex attraction would like to change their situation, to be able to marry and have children in a natural way. Until a few decades ago, even those who defended the goodness of a homosexual tendency and homosexual acts, recognized that "the mental balance between homosexuality-heterosexuality could sometimes change during therapy"[36]. Today, however, certain groups dismiss this as nonsense, going so far as to call it a crime to speak of “therapy”, since it implies that homosexuality is not innate, determined and definitive - a principle they consider to be a starting point [37].

On the other hand, it has been scientifically proven that it is possible to modify sexual desire. A significant number of people have been able to change their orientation by turning to competent professionals, especially if they have had a strong motivation to do so [38], although medical or psychological orientations are not clear or unanimous because it is no longer considered an illness. In almost fifty percent of people who personally sought professional help, sexual attraction towards individuals of the opposite sex developed. To achieve this goal, studies show that the person must have a strong motivation to want to change his or her situation or at least seek to integrate and understand it. A positive result of this kind was seen among people aged 35 years and younger who had previous heterosexual experiences [39].

There is still a lack of large population studies to show how and who are more suitable for this type of intervention because the polemics of debate prevent them from being carried out. What abounds are accusations from one side to the other. Intuitively, it seems easier to modify a desire, more or less instinctive, than the whole sexual structure of the person. Those who wish to do so, however, are prevented in some countries from accessing health personnel. Specialists are threatened just for opening their doors to those who suffer and seek help through reorientation therapy.

What has been said so far provides a premise for understanding how to deal with sexual desire towards people of the same sex, about which the physician also has a great deal to say [40]. In the first place, it can be stated that one is not born determined. As in many normal and abnormal circumstances - eye color, predisposition to diabetes, taste for wine or antisocial tendency - it can be expected that genetics can also influence sexual desire in some way. However, it is far from being mechanically determined or fixed [41].

Physicians, like parents or educators, know that many people can experience attraction for individuals of the same sex without its being a pathological or inevitable condition. It is not scientific to divide the human species according to the type of desires or preferences experienced by individuals, be they sexual, food, sports or political.

The frequency of sexual desires for persons of the same sex could be as high or as low as one wishes to consider. It is enough to leave the instinct unchecked, without any brakes whatsoever, to awaken a stimulus in almost any direction. For this reason it is more common to encounter people with indeterminate sexual desire than to encounter persons with an exclusive tendency towards persons of the same sex. Here we might also consider those who are simply looking for novelty, fun, change - with men, women, married or single. The ecstasy of an easy escape through an intoxicating transgression is made all too easy by access to the Internet.

At times, there is talk of deeply rooted homosexual tendencies, but it is not clear how they can be evaluated or what are their limits. One might consider a long duration of desire over time, the involvement of the whole person and his or her decisions, the practice of frequent homosexual acts and perhaps the degree of suffering and social maladjustment, with significant discomfort. But some will not exhibit these manifestations, even if they have an ingrained tendency. The criteria of time or duration is also impractical because it will only be useful a posteriori. If the person changes his/her sexual orientation, it can be said that it was only transitory; if the person does not change, it is then deemed to be a deeply rooted tendency.

It seems necessary to think of some signs suggesting an evolution towards stability or permanence. A certain occasional sexual desire for persons of the same sex may be normal and transient in certain periods - adolescence, for example - or due to life circumstances in which there are no persons of the other sex, as mentioned above. One could also speak of a true and false homosexual tendency. We will list some characteristics or criteria to distinguish a more stable homosexual desire, although they are subject to change. The complexity will be greater the more aspects are present together:

  • exclusive or very predominant emotional-sexual attraction to persons of the same sex, which persists after adolescence;
  • homosexual practice/activity without an external circumstance that generates sexual attraction to persons of the same sex, such as isolation or prison, or that caused by psychiatric illness;
  • homosexual fantasies or thoughts accompanied by acts in response to stimuli caused by persons of the same sex, including autoeroticism.

These are not signs of homosexuality:

  • if they are present in an isolated manner, the common worry of adolescents (the fear of being homosexual can cause them to become obsessive);
  • participation in erotic games with persons of the same sex in infancy and adolescence;
  • some occasional homosexual acts or the curiosity for some topics if there are also attractions for people of the opposite sex;
  • occasional homosexual behaviours under the influence of alcohol.

Homosexuality should also not be confused either with having some gestures, ways of speaking or tastes that are more common in the opposite sex, for example, effeminate men or women with masculine attitudes. On the other hand, when the affective developmental needs of children, such as affection and positive valuation, are satisfied by the family and peer group, it is rare for a homosexual tendency to manifest itself. It makes no sense, however, to blame parents, because they have usually done the best they knew or could. The complexity of situations and social contexts can make education in the home environment more difficult. For this reason, today it is even more important to offer parents the right guidance so that they can play their parental role well and accompany each of their children of all ages. To dedicate time to their children is the best inheritance parents can leave them. It is very useful for parents to know how to handle the bombardment of crude and immoral images that can enter the house through video games, the Internet, cinema and public entertainment. There are many people and non-governmental organizations, supporting the family and safeguarding children, which have this very important goal as their main objective [42].

In some cases, the ill-considered suggestions of a health professional or other figures of reference and authority make it easier for a momentary desire to turn into something habitual. Other catalyzing elements include childish games that are perpetuated and encouraged by older accomplices, the wide availability of homosexual pornography and the grave threat of sexual abuse by adults. Images and emotions for which they are not psychologically prepared are indelibly introduced into the malleable minds and affections of children. The gateway for these dangers is the curiosity of children and the greed of adults. The effect is overwhelming, like that of a river that finds no floodgates to slow its course and destroys everything in its path. These experiences create the many wounds that persons can carry with them into adulthood. Although pornography is legally prohibited in some countries, action is rarely taken against its promoters.

There are also numerous social factors that favor the increase of the homosexuality in its passage from desire to condition. Some of them have been mentioned: the disunited or non-existent family, the absence or affective distance of the father (more frequent in males) or of the mother, the defense of disordered and unrestrained sexuality, the attempts to suppress the differences between sexes, the misapplication of the term gender and the so-called “gay” culture that engages in propaganda and pressure tactics in its search for new affiliates [43]. From their ranks are also promoted "marriages" between people of the same sex (without a real interest in many cases for stable and lasting unions, which are very rare), and the possibility of adopting children. Society and research science do not remain indifferent, however. Among the few scientific studies on these issues, there is a large and rigorous one that has shown the significantly negative consequences of adoption of children by same-sex couples [44]. Entrusting children for adoption to homosexual couples, when there are thousands of heterosexual couples seeking to adopt, is a deprivation of the richness of the father and mother figure for the development of the child.

Many people with sexual desire towards the same-sex decide and manage to live stably and freely in continence. This can be considered a good thing, because homosexual acts (not the tendency) generate circles of frustration and disappointment that can diminish self-esteem, in addition to facilitating a series of diseases and physical discomfort [45]. If there is a sexual obsession or compulsion, or signs of desperation, it is most important to encourage consultation with a health professional. An experienced physician or psychologist is able to provide effective help.

It is evident that many people with homosexual tendencies possess highly attractive personality traits: they are kind, sensitive and creative. Homosexual activity, however, because it goes against the specific nature of human sexual acts, can be a sign of immaturity and become an enslaving vice. The same is true of anyone else who is not able to control his or her sexual activity. To place the practice of sexuality at the center of one's personal aspirations, particularly when such practice is unbridled and lacking a vision of authentic love and openness to life, indicates an important and significant deficiency.

Relatives, doctors, educators and priests cannot react with indifference or neutrality to someone who asks for help when he or she feels a homosexual desire. They cannot praise it as something positive nor can they encourage the person to continue on that path. Obviously, neither can they react with rejection. In addition to listening with understanding and affection, for as long as necessary, it may be a good time to remind same-sex attraced persons of some points that were made earlier about the dignity of the human sexual dimension.

It is never advisable to place all one’s effort or offer all one’s arguments relating to the practice of sexuality as if it were the only aspect of interest or the only difficulty: "it is essential to shift the discourse from sex to the meaning of oneself and one's life, which is what really counts"[46]. When a persistent homosexual tendency is suspected, the following advice can help anyone who asks for it, bearing in mind the utmost respect for the freedom of each individual:

  • to deepen an appreciation of the value of the differences between the male and female sex, discouraging the idea that, because they are experiencing a different sexual desire, they belong to a different species, as it were;
  • to remember that, like all other human beings, they are called to chastity and are possessed of the ability to strive for virtue, abstaining from sexual acts, which are only rich and fruitful between a man and a woman, in marriage. This attitude often produces great joy and opens the way to a possible change of orientation of desire. It will be useful to avoid homosexual environments, which provide occasions of relapsing into homosexual acts;
  • to favor interpersonal relationships with persons of the other sex; to emphasize the value of friendship;
  • not to isolate oneself in an environment where there are only men or only women;
  • in the case of mature adults, considering that it is difficult to expect a change in an already deeply-rooted tendency, these persons can be shown the value of orienting themselves towards life projects as a means of achieving self-fulfillment outside of marriage (e.g. volunteering, cultivating artistic talents, etc.);
  •  to develop other interests: culture, sports, music and various arts, etc.

If a physician would like to remain neutral on the subject of sexuality, he is obviously free to do so. He is not obliged to give moral lessons to his patients, nor is it his task. Religious convictions may well be left out of it. However, he must act according to his conscience, and therefore discourage rather than encourage premature or uncontrolled sexual activity. Young people who seek the advice of a physician should be discouraged from sexual intercourse if they are not fully mature, for "the satisfaction of sexuality without love implies a serious shortcoming."[47]. In this way, physicians are able to protect the physical and mental health of their patients. The guarantee of a dignified sexual life for human persons is in the context of true love, which implies the capacity for sacrifice, self-giving and waiting.

5. The Catholic Church and Sex

It is commonly thought that the Church speaks too much about sex and, more often than not, condemns it. It seems that the Church’s message is to say, "No, no, no" even before people finish asking the question of whether one can or cannot do this or that in the sexual realm. However, this is a poor and unfair caricature of Christian doctrine on sex. It is true that some ministers of the Church have not always approached the subject well in their pastoral work, but this fact should not close the door to at least a basic study of what Christian doctrine really teaches on the subject.

The first point of the Catechism of the Catholic Church on the Sixth Commandment of the law of God, "Thou shalt not commit adultery", starts from the consideration that God is love and then speaks of the vocation to love to which man is called. In his apostolic exhortation Amoris laetitia, Pope Francis writes: "The couple that loves and generates life is the true living 'sculpture' manifesting God the Creator and Savior, not a caricature of stone or gold which the Decalogue forbids. This is why fruitful love becomes the symbol of the intimate realities of God". And a modern-day saint like St. Josemaría Escrivá affirms that "The pure and clean love of spouses is a holy reality that I, as a priest, bless with both hands. Christian tradition has often seen in the presence of Jesus Christ at the wedding feast at Cana as a confirmation of the divine value of marriage: our Savior went to the wedding, writes St. Cyril of Alexandria, ‘to sanctify the beginning of human generation’” [48]. Sexuality is inserted, from the beginning, in what is most valuable in human life: the possibility of loving and being loved. In another point of the Catechism it is explained that, "Sexuality embraces all aspects of the human person, in the unity of his body and soul. It particularly concerns affectivity, the capacity to love and procreate and, more generally, the ability to establish bonds of communion with others" (CCC, 2332). For this reason, the Church’s invitation to chastity is not a denial of sexuality but an openness to "the successful integration of sexuality in the person" (CCC, 2337).

If the Church speaks of sexuality, it is fundamentally to remind man of the beauty of human love which includes the sexual dimension. It is in order to avoid the reductionism into which one easily stumbles when the search for pleasure obscures true human love, which should always be at the root of the exercise of sexuality. Certainly, it indicates some limits that should not be exceeded. However, these are not to limit the enjoyment of sexual pleasure as such but, rather, to limit the selfishness which in this area, as in others, clouds man's reason - pushing him to behave in a way that leads to his own degradation, or that of his/her partner. More than a century ago, Nietzsche accused Christianity of having poisoned eros with its moral norms, which suffocate the most beautiful pleasures of life. However, reviewing the history of humanity, we discover how every society has given itself its own rules in this area, precisely to avoid abuses - abuses that have almost always been aimed at women. Throughout the millennia, Christianity, together with many other religions, has established measures to avoid the trivialization of sexuality, which leads to the generalization of abuses. The sexual revolution, of which we have spoken before, has tried to "liberate" sexuality from moral norms and the influence of religion. In seeking to avoid possible abuses, it has limited itself to appealing solely to public health and criminal law. The results can be seen in our day, where the phenomena of gender violence, child abuse and sexual dependency have become more and more widespread.

The lack of chastity - that integrity of sexuality within the whole person relating to his or her capacity to love - leads not only to the abuses mentioned above, for they are only the tip of the iceberg. The lack of chastity, above all, obscures a person’s ability to "see". It prevents a man from discovering a woman's beauty, which certainly goes far beyond her sexed body. Men and boys, bombarded by pornography and pushed to the precocious practice of genital sexuality, lose the sensitivity to look at women and girls in their totality, and in the end, to know them as they truly are. By contrast, the virtue of chastity knows how to place the body, with its sexual values, in the context of a person, and not simply in terms of flesh. This ability to look and see, to discover the other as a person, to get to know his or her interior world, is what the Church proposes when she speaks of sexuality, and when she invites us to live chastity.

In his first encyclical, Deus Caritas Est, Benedict XVI taught, "Evidently, eros needs to be disciplined and purified if it is to provide not just fleeting pleasure, but a certain foretaste of the pinnacle of our existence, of that beatitude for which our whole being yearns". If the moral norm can at some point mean a "no" to a certain behavior, it is a "no" that opens the door to innumerably greater "Yeses". In this context we can understand the invitation of St. John Paul II, in one of his catecheses, to offer an integral vision of sexuality: "The purely ‘biological’ knowledge of the functions of the body as an organism united with the masculinity and femininity of the human person is capable of helping to discover the authentic spousal meaning of the body, only if it is united to an adequate spiritual maturity of the human person. Without this, this knowledge can have even opposite effects; and this is confirmed by the many life experiences of our time" [49].

In pagan religions, sexuality was partly divinized by the participation of gods and goddesses in its activity. For the People of Israel and later for Christians, the divinization of sexuality completely changed the paradigm. The God of Israel is the "totally Other": he does not participate in human things as do Zeus, Apollo, Aphrodite or Dionysus. Yet he is very present in the life of his people, for he consoles Israel as a mother consoles her child (cf. Is 66:13). With the Incarnation of the Word, the Son of God, everything human, and therefore also the sexual dimension of the person, has been elevated. In the words of the pastoral constitution "Gaudium et spes" of the Second Vatican Council, it has been elevated to unparalleled dignity. The Conciliar text continues, "The Son of God by his incarnation united himself, in a certain sense, with every human being. He worked with human hands, he thought with human intelligence, he acted with human will, he loved with human heart" (n. 22). Therefore, the exercise of human sexuality according to God's original plan is something not only good, but holy and divine.

[*] Pablo Requena is Professor of Bioethics at the Faculty of Theology of the Pontificia Università della Santa Croce in Rome. A physician and priest, Doctor of Moral Theology, he is also Delegate of the Holy See for the World Medical Association and Member of the Pontifical Academy Pro Vita.

Wenceslao Vial is Professor of Psychology and Spiritual Life at the Faculty of Theology of the Pontificia Università della Santa Croce in Rome. A physician and priest, Doctor of Philosophy, he combines his clinical knowledge and academic work with extensive pastoral activity in relation to different countries and cultures.

[2] The data in this section and textual citations are from J. R. Stoner, D. M. Hughes (ed.), Los costes sociales de la pornografía, Rialp, Madrid 2014. Also of great interest is the document of the U.S. Conference of Catholic Bishops, "The United States Bishops' Conference, “Create in Me a Clean Heart: A Pastoral Response to Pornography” (November 2015).

Publication is authorized provided the source is acknowledged.

[3] 66% of males and 80% of females think pornography is degrading (J. R. Stoner, D.M. Hughes (ed.), The Social Costs of Pornography, 31).

[4] Ibidem, 32.

[5] A brief presentation can be found at E. Colom, P. Requena, Cómo explicar la revolución sexual, Eunsa, Pamplona 2012.

[6] For further philosophical background questions, please refer to: M. Fazio, Historia de las ideas contemporáneas. Una lectura del proceso de secularización, Rialp, Madrid 2006.

[7] H. Marcuse, One-Dimensional Man, Beacon Press, Boston 1964, pp. 51-69.

[8] In this, Freud proved to be right when, speaking of the libido, he insisted on the need to subject it to rules, "an obstacle is required to push the libido to the top and there, where the natural resistances against erotic satisfaction are not enough, men have introduced conventional resistances to enjoy love".. (S. Freud, Beiträge zur Psychologie des Liebeslebens (1912), Internationaler Psychoanalytischer Verlag, Leipzig-Wien-Zürich 1924, p. 28). Certainly, such a vision of eros is reductive, since it is not enough for it not to be pornographic or consumerist, but it must above all be integrated into human love, which consists in the gift of self.

[9] As Erich Fromm noted in criticizing the mercantilist vision of sexuality, the model or criterion of love is that of exchange and the problem of love no longer consists in a way of being but in finding and loving the right object. (Véase E. Fromm, The Art of Loving, Harper & Row, New York 1956, pp. 83-107).

[10] De Beauvoir endorses a statement of the Soviet Komintern (November 16, 1924), "The revolution will be important as long as the notions of family and family relations exist" (November 16, 1924). (S. De Beauvoir, Le deuxième sexe, Gallimard, Paris 1976, p. 346 (1ª ed. 1949).

[11] "The Will to Know", "The Use of Pleasures" and "Self-Care".

[12] A critical analysis of these authors and the books cited can be found at J. Trillo-Figueroa, Una revolución silenciosa. La política sexual del feminismo socialista, Libroslibres, Madrid 2007.

[13] For a critical appraisal of the studies see: M. Tarasco, Considerations on the influence of the Kinsey Report., “Cuadernos de bioética” 8 (1997), 1385-1397; J. Reisman, Sexual Sabotage: How One Mad Scientist Unleashed a Plague of Corruption and Contagion on America, WND Books, Washington DC 2010.

[14] Para profundizar en el tema, se vea: W. Vial, Madurez psicológica y espiritual, Palabra, Madrid 2016, pp. 235-266; R. Zapata, J. Plá, “Trastornos psicosexuales”, en J. Cabanyes, M.A. Monge (eds.), La salud mental y sus cuidados, Eunsa, Pamplona 2010, pp. 345-356.

[15] Cfr. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), APA Press, Washington DC 2013; disfunciones: pp. 423-450; disforia de género: pp. 451-459; parafilias: pp. 685-705.

[16] Cfr. F. Di Noto, “Abuso sessuale di bambini (Pedofilia)”, en Enciclopedia di bioetica e sessuologia, Elledici, Leuman (To) 2004 pp. 7-12; I. Mastropasqua, “Abuso sessuale di bambini. Giustizia minorile”, en ibidem, pp. 15-19.

[17] Cfr. DSM-5, cit., p. 829; It is significant that the glossary of the manual contains only this definition of sex and seven terms related to the concept of gender, understood as the feminine or masculine role that is assumed..

[18] Cfr. R. Zapata, J. Plá, “Trastornos psicosexuales”, cit., pp. 350-351.

[19] Cfr. J. Achermann, L. Jameson, “Trastornos del desarrollo sexual”, en T. R. Harrison, Principios de Medicina Interna, McGraw Hill, 2012 (18ª), cap. 349.

[20] Cfr. A. Polaino-Lorente, Sexo y cultura. Análisis del comportamiento sexual, Rialp, Madrid 1992.

[21] Cfr. V. Frankl, Ante el vacío existencial. Hacia una rehumanización de la psicoterapia, Herder, Barcelona 1990 (6ª), pp. 26-27.

[22] F. Poterzio, Manuale di introduzione alla psicoterapia, Magi, Roma 2013, p. 184. Franco Poterzio es profesor emérito de psiquiatría de la Universidad de Milán.

[23] To go more in depth: W. Vial, “Responsabilità nelle persone con dipendenze patologiche”, in Annales theologici 29/2 (2015), pp. 373-393; C. Chiclana, Atrapados en el sexo. Cómo liberarte del amargo placer de la hipersexualidad. Almuzara, Barcelona 2013.

[24] H. McCall, N. Adams, D. Mason, J. Willis, “What is chemsex and why does it matter?” in British Medical Journal, 351 (2015).

[25] Cfr. V. F. Von Gebsatel, Antropología médica, Rialp, Madrid 1966, p. 277.

[26] Cfr. V. Frankl, La idea psicológica del hombre, Rialp, Madrid 1963, pp. 40-41.

[27] Idem, Psicoanálisis y existencialismo, Fondo de Cultura Económica, México D.F. 1967 (5ª), p. 209.

[28] H. Remplein, Tratado de psicología evolutiva. El niño, el joven y el adolescente, Labor, Barcelona 1971, p. 564.

[29] Cfr. V. Frankl, Psicoanálisis y existencialismo, cit., pp. 200-209.

[30] Cfr. A. S. Fauci, H. D. Marston, “Ending AIDS - Is an HIV Vaccine Necessary?” in The New England Journal of Medicine, 370 (2014), pp. 495-498.

[31] Cfr. S. Okie, “Sex, Drugs, Prisons, and HIV”, in The New England Journal of Medicine, 356 (2007), pp. 105-108. The drug is also very prevalent in prisons (and WHO advice has been to give prisoners clean syringes); and the rate of positivity for the AIDS virus is estimated to be about four times higher than in the general population.

[32] Cfr. D. Drayna, “Is Our Behavior Written in Our Genes?” in The New England Journal of Medicine, 354 (2006), pp. 7-9.

[33] Cfr. R. C. Friedman, J. Y. Downey, “Homosexuality”, in The New England Journal of Medicine, 331 (1994), pp. 923-930.

[34] American Psychiatric Association, DSM-II, Washington 1968 (V, 302), pp. 10 y 44. Out of 30,000 people eligible to vote, only 25% voted, and 60% of voters were in favor of removing homosexuality from the list of diseases: cfr. J. De Irala, Comprendiendo la homosexualidad, Eunsa, Pamplona 2006.

[35] Cfr. D. S. Jones, S. H. Podolsky, J. A. Greene, “The Burden of Disease and the Changing Task of Medicine”, in The New England Journal of Medicine, 366 (2012), pp. 233-2338. Three diseases that have been redefined by social changes are mentioned: homosexuality, masturbation and alcoholism.

[36] R. C. Friedman, J. Y. Downey, “Homosexuality”, cit., p. 927: the authors, citing articles of the time (pre-1994), point out that it can even change the identity of people with homosexual desire, towards heterosexuality, although they attribute this to a different perception of sexual fantasies. They conclude that more studies are needed, which is still valid today.

[37] Hence the efforts to discredit and attack anyone who thinks differently. For them, any attempt at change is not only useless but also detrimental to health. Even the editorial of a prestigious medical journal, which we have often quoted, is scandalized today (but not a few years ago) that medical help can be offered to people with homosexual tendencies, as if it were disrespectful, and advocates homosexual marriage even as a way to promote health. Cfr. E. W. Campion, S. Morrisey, J. M. Drazen, “Support of Same-Sex Marriage”, in The New England Journal of Medicine, 372 (2015), pp. 1852-1853.

[38] Cfr. J. Nicolosi, Como prevenir la homosexualidad: los hijos y la confusión de género, Palabra, Madrid 2009; G. Van den Aardweg, Homosexualidad y esperanza. Terapia y curación en la experiencia de un psicólogo, Eunsa, Pamplona 1997.

[39] Cfr. A. Camisassi, P. Cardinale, “Sindromi psicosessuali”, in F. Giberti, R. Rossi, Manuale di psichiatria, Piccin, Padova 2009, pp. 257-286.

[40] Cfr. W. Vial, Madurez psicológica y espiritual, cit., pp. 261-266.

[41] Cfr. N. López Moratalla, “Dinámica cerebral y orientación sexual. Se nace, o se hace, homosexual: una cuestión mal planteada”, in Cuad. Bioét. XXIII, 2012/2ª, pp. 373-420. The emphasis on finding a genetic explanation for homosexuality, which was once fashionable, has diminished also because of the "fear" of some groups that, if it were found, the situation could be "medicalized" again, including it again in the list of diseases.

[42] For example:,,,

[43] As a historical curiosity, one of the first to try to scientifically support the goodness of the homosexual tendency was the German physician Magnus Hirschfeld (1868-1935); even then there was an increase of young people who began to consider themselves homosexuals, feeling awakened in adolescence a sexual impulse not well differentiated, as warned an important medical treatise of the time: cfr. O. Bumke, “Predisposiciones psicopáticas”, in G. Von Bergmann, R. Staehelin, V. Salle, Tratado de medicina interna (Handbuch der inneren Medizin: 1925-1931 y siguientes), V, 2ª, Labor, Barcelona 1944, pp. 1865-1866.

[44] M. Regnerus, “How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study”, in Social Science Research 41 (2012), pp., 752-770. The author makes a large comparative study in the United States, with many variables (family life, gender identification, sexual abuse, work, prison, marijuana use, etc.) between children of intact biological families formed by a father and a mother (intact bio family), homosexual parents, divorced parents, adoptive parents and single parents. It shows how children raised in families that remain intact during childhood are more likely to succeed as adults.

[45] For the difference between act and trend, cfr. J. F. Harvey, Attrazione per lo stesso sesso, ESD, Bologna 2016, pp. 30-33. A comprehensive review on medical aspects of sexuality can be found in: L. Mayer, P. McHuge, Sexuality and Gender. Findings from the Biological, Psychological, and Social Sciences, in “The New Atlantis”, Nº 50, agosto 2016.

[46] A. Persico, Omosessualità, Tra scelta e sofferenza, Alpes, Roma 2007, p. 50.

[47] C. Bühler, Psicología de la vida activa: potencialidades y expectativas (Wenn das Leben gelingen soll: 1969), Psique, Buenos Aires 1976; quoted from the Italian edition: Psicologia e vita quotidiana, Garzanti, Milano 1970, p. 191.

[48] J. Escrivá de Balaguer, Christ is Passing By, 24, Rialp, Madrid 2012.

[49] Catechesis 8.04.1981.

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