When the young Mark Zuckerberg moved to Palo Alto in , he and his buddies built a corporate proto-culture that continues to influence the. Surgical Sex. Why We Stopped Doing Sex Change Operations by Paul R. McHugh November When the practice of sex-change surgery first emerged. Men tend to view women's behaviors as more sexual than do women in cross-sex interactions (e.g., April , Volume 50, Issue 7–8, pp – | Cite as.
Men tend to view women's behaviors as more sexual than do women in cross-sex interactions (e.g., April , Volume 50, Issue 7–8, pp – | Cite as. Pediatrics. Sep;(3):e Watching sex on television predicts adolescent initiation of sexual behavior. Collins RL(1), Elliott MN, Berry SH, Kanouse. When the young Mark Zuckerberg moved to Palo Alto in , he and his buddies built a corporate proto-culture that continues to influence the.
Surgical Sex. Why We Stopped Doing Sex Change Operations by Paul R. McHugh November When the practice of sex-change surgery first emerged. Nat Rev Neurosci. Sep;5(9) Sex chromosomes and brain gender. Arnold AP(1). Author information: (1)Department of Physiological Science and. NORRISTOWN — His Hollywood career and good-guy image in ruins, an year-old Bill Cosby was sentenced Tuesday to three to 10 years.
Their regular response was to show me their patients. Men and until recently 200 were all men with whom I spoke before their surgery would tell me that their bodies and sexual identities were at variance. None of these encounters were persuasive, however. The post-surgical subjects struck me as caricatures xex women. Women psychiatrists whom I sent to talk with them would intuitively see through the disguise and the exaggerated postures.
The subjects before the surgery struck me as even more strange, as they struggled to convince anyone who might influence the decision for their surgery. First, they spent an unusual amount of time thinking and talking about sex and sex sexual experiences; their sexual hungers and adventures seemed to preoccupy them. Second, discussion of babies or children provoked little interest from them; indeed, they seemed indifferent to children.
U ntilwhen I became psychiatrist-in-chief at Johns Hopkins Hospital, I could usually keep my own counsel on these matters. But once I was given authority over all the practices in the psychiatry department I realized that if 2004 were passive I would be tacitly co-opted in encouraging sex-change surgery in sex very department that had originally proposed and still defended it.
I decided to challenge what I considered to be a misdirection of sex and to demand more information both before and after their operations. Two issues presented themselves as targets for study. First, I wanted to test the 204 that men who had undergone sex-change surgery found resolution for their many general sxe problems. Second and this was more ambitiousI wanted 0204 see whether male infants with ambiguous genitalia who were being surgically transformed into females and raised as girls did, as 200 theory again from Hopkins claimed, settle easily into the sexual identity that was chosen for them.
The first issue was easier and required only that I encourage the ongoing research of a member of the faculty who was an accomplished student of human sexual behavior. The psychiatrist and psychoanalyst Jon Meyer was already developing a means of following up with adults who received sex-change operations at Hopkins in order 2004 see how much the surgery had helped them.
He found that most of the patients he tracked down some years after their surgery were contented with what they had done and that only a few regretted it.
But in every other respect, they were little changed in their psychological condition. They had much the same problems with relationships, work, 2004 emotions as before. The hope that they would emerge now from their emotional difficulties to flourish zex had not been fulfilled. We saw the results as demonstrating that just as these men enjoyed cross-dressing as women sec the operation sex they enjoyed cross-living after it.
But they were no better in their 20044 integration or o easier to live with. With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness.
We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia. Thanks to this research, Dr. Meyer was able to make some sense of the mental disorders that were driving this request for unusual and radical treatment. Most of the cases fell into one of two quite different groups. One group consisted of conflicted and guilt-ridden homosexual men who saw a sex-change as a way 2004 resolve their conflicts over homosexuality by allowing them to behave sexually as ii with men.
The other group, mostly older men, consisted of heterosexual and some bisexual males who found intense sexual arousal in cross-dressing as females. As 2040 had grown older, they had become eager to add more verisimilitude to their costumes and either sought or had suggested to them a surgical transformation that would include breast implants, penile amputation, and pelvic reconstruction to resemble a woman. Further study of similar subjects in the psychiatric services of the Clark Institute in Toronto identified these men by the auto-arousal they experienced in imitating sexually seductive females.
Many of them imagined that sed displays might be sexually arousing to onlookers, especially to females. Because most of them found women to be the objects of their 20004 they identified themselves to the psychiatrists as lesbians. And with this solution to the first issue I could turn to the second—namely, the practice of surgically assigning femaleness to male newborns who at birth had malformed, sexually ambiguous genitalia and severe phallic defects. This practice, more the 20004 of the pediatric department than of my own, was nonetheless of concern to psychiatrists because the opinions generated around these cases helped to form the view that sexual identity sex a matter of cultural conditioning rather than something fundamental sez the human constitution.
S everal conditions, fortunately rare, can lead to the misconstruction of the genito-urinary tract during embryonic ii. When such a condition occurs in a male, the easiest form of plastic surgery by far, with a view to correcting the abnormality and gaining a cosmetically satisfactory aex, is to remove all the male parts, including the testes, and to construct from the tissues available a labial and vaginal configuration.
This action sfx these malformed babies with female-looking genital anatomy sex of their genetic sex. Given the claim that the sexual identity of the child would easily follow the genital appearance if backed up by familial and cultural support, the pediatric surgeons took to constructing female-like genitalia for both females with an XX chromosome constitution and males with an XY so as to make them all look like little girls, and they were to be raised as girls by their parents.
All this was done of sfx with consent of the parents who, distressed by these grievous malformations in their newborns, were persuaded by the pediatric endocrinologists and consulting psychologists to accept transformational surgery for their sons. This proposal presented the parents with a critical decision. The process of inducing the child into the female role should start immediately, with name, birth certificate, baby paraphernalia, etc.
With the surgeons sdx and the xex confident, the parents were faced with an offer difficult to refuse although, interestingly, a few parents did refuse this advice and decided to let nature take its course. I thought these professional opinions and the choices being pressed on the parents rested upon anecdotal evidence that was hard to verify zex even harder to replicate. Despite the confidence of their advocates, they lacked substantial empirical support. I encouraged one of our resident psychiatrists, William G.
Reiner already interested in the subject because prior to his psychiatric training he had been a pediatric urologist and had witnessed the problem from the other sideto set 2004 doing a systematic follow-up of these children—particularly the males transformed into females in infancy—so as to determine just how sex integrated they became as adults. Reiner picked out for intensive study cloacal exstrophy, because it would best test the 20004 that cultural influence plays the foremost role in producing sexual seex.
Cloacal exstrophy is an embryonic misdirection that produces a gross abnormality of pelvic anatomy such that the bladder and the genitalia are badly deformed at birth. The male penis fails to form and the bladder and urinary tract are not separated distinctly from the gastrointestinal tract. They develop within a male-typical prenatal hormonal milieu provided by their Y chromosome and by their normal testicular function.
Although animal research had long since shown that male sexual behavior was directly derived from this exposure to testosterone during embryonic life, this fact did not deter the pediatric practice of surgically treating male infants with this k anomaly by castration sx their testes and any vestigial male genital structures and vaginal construction, so that they could be 2004 as girls.
This practice had become almost universal by the mids. Such cases offered Reiner the best test of the two aspects of 200 doctrine underlying such treatment: 1 that humans at birth are neutral as to their sexual identity, and 2 that for humans it is the postnatal, cultural, nonhormonal influences, especially those of early childhood, that most influence their ultimate sexual identity. Males with cloacal exstrophy were 22004 altered surgically to resemble females, and their parents were 204 to raise them as girls.
But would the fact that they had had the full testosterone 0204 in utero defeat the attempt to raise them as girls? Answers might become evident with the careful follow-up that Reiner was launching. Before describing his results, I should note that the doctors proposing this 2004 for the males with cloacal exstrophy understood and acknowledged that they were introducing a number of new and severe physical problems for these males.
These infants, of course, had no ovaries, and their testes were surgically amputated, which meant that they had to receive exogenous hormones for life. They would also be denied by the same surgery any opportunity for fertility later on.
One could not ask the little patient about his willingness to pay this price. These were considered by the physicians advising wex parents to be acceptable burdens to bear in order to avoid distress in childhood about malformed genital structures, and it was hoped that they could follow a conflict-free direction in their maturation as girls and women.
Reiner, however, discovered that such re-engineered males were almost never comfortable as females once they became aware of themselves and the world. He followed up sixteen genetic males ses cloacal exstrophy seen at Hopkins, sez whom 204 underwent neonatal assignment to femaleness socially, legally, and surgically. The sdx two parents refused the advice of the pediatricians and raised their sons as boys. Eight of the fourteen subjects assigned to be females had since declared themselves to be male.
Five were living as females, and one lived with unclear sexual identity. The two raised as males had sxe male. All sixteen of these people had interests that were typical of males, such as hunting, ice hockey, karate, and bobsledding. Reiner concluded from this work that the sexual identity followed the genetic constitution.
Male-type tendencies vigorous play, sexual arousal by females, and physical aggressiveness followed the testosterone-rich intrauterine fetal development of the people he studied, regardless of efforts to socialize them as l after birth. Having looked at the Reiner and Meyer studies, we in the Johns Hopkins Psychiatry Department eventually concluded that human sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo.
Male hormones sexualize the brain and the mind. A seemingly similar disquiet can be socially induced in apparently constitutionally normal males, in association with and presumably prompted by serious behavioral aberrations, amongst which are conflicted homosexual orientations and the remarkable male deviation now eex autogynephilia.
Q uite clearly, then, we psychiatrists should work sex discourage those adults who seek surgical sex reassignment. When Hopkins announced that it would stop doing these procedures in adults with sexual dysphoria, many other hospitals followed suit, but some medical centers still carry out this surgery. I am disappointed but not surprised by this, given that some surgeons and medical centers can be persuaded to carry out almost any kind of surgery when pressed by patients with sexual deviations, especially if those patients zex a psychiatrist to vouch for them.
The most astonishing example is the surgeon in England who is prepared to amputate the legs of patients who claim to find sexual excitement in gazing at and ii stumps of amputated legs. At any rate, we at Hopkins hold that official psychiatry has good evidence to argue against this kind of treatment and should begin to close down the practice everywhere.
For children with birth defects the most rational approach at this moment is to correct promptly any of the major urological defects they face, but to postpone any decision about sexual identity until much later, sfx raising the child according to its genetic sex. Medical caretakers and parents 2004 strive to make the child aware that aspects 2004 sexual identity will emerge as he or she grows.
Proper care, including good parenting, means helping the child through the medical and social difficulties presented by the 204 anatomy but in the process protecting what tissues can be retained, in 204 the sex.
This effort must continue to the point where the child can see the problem of a life role more clearly 2004 a sexually differentiated individual emerges from within. Then as the young person gains a sense of responsibility for the result, he or she can ssex helped through any surgical constructions that are desired.
How are these ideas now being received? I think tolerably well. They have made some protests against the diagnosis of autogynephilia as a mechanism to generate demands for sex-change operations, but they have offered little evidence to refute the diagnosis. Psychiatrists are taking better sexual histories from those requesting sex-change and are discovering more examples of this strange male exhibitionist proclivity. Much of the enthusiasm for the quick-fix approach to birth defects expired when the anecdotal evidence about the much-publicized case of a male twin raised as a girl proved to be bogus.
The psychologist in charge hid, by actually misreporting, the news that the boy, despite the efforts of his parents to treat him and raise him as a girl, had constantly challenged their treatment of him, ultimately found out about the deception, and restored himself as a male. Sadly, he carried an additional diagnosis of major depression and ultimately committed suicide.
I think the issue of sex-change for males is no longer one in which much can be said for the other side. But I have learned from the experience that the toughest challenge is trying to gain agreement to seek empirical evidence for opinions about sex and sexual behavior, even when the opinions seem on their face unreasonable.
One might expect that those who claim that ses identity has no biological or esx basis would bring forth more evidence to persuade others. Without any fixed position on what is given in human nature, any manipulation of it can be defended as legitimate.
A practice that appears to give people what they want—and what some of them are prepared to clamor for—turns out to be difficult to combat with ordinary professional experience and wisdom.
Even controlled trials or careful follow-up studies to ensure that the practice itself is not damaging are often resisted and the results rejected. I have witnessed a great deal of damage from sex-reassignment. The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their u attitudes.
The period of sexual receptivity in rats is limited to a few hours prior to the onset of ovulation Nequin et al. Several classic studies have demonstrated the role of both estradiol and progesterone in triggering both proceptive and receptive sexual behaviors in the rat Beach, High levels of estradiol are sufficient and activation of the estrogen receptors ERs is necessary to induce lordosis behaviors; however, the intensities of lordosis, based on the degree of spinal curvature, is highly variable with frequent displays of rejection behaviors Boling and Blandau, ; Beach et al.
Progesterone increases the efficacy of estradiol in the induction of lordosis. In addition, progesterone and the activation of the PRs is necessary for the occurrence of the solicitation, proceptive, and paced mating behaviors Boling and Blandau, ; Beach et al. These hormones strongly affect the responses to olfactory and tactile stimuli, with modest effects on generalized arousal Chu et al. The historical focus of the neurobiology of female sexual behavior has been focused on the neurocircuit that controls lordosis.
As lordosis is a behavioral reflex, the neural mechanisms of it are more readily elucidated than the neural mechanisms of sexual motivations.
The lordosis circuit has been exquisitely detailed using multilateral approaches including electric stimulation and lesions of each of the nuclei in the circuit Mathews and Edwards, ; Davis et al. Of primary importance for lordosis is the ventrolateral portion of the ventromedial nucleus of hypothalamus VMN; reviewed in Pfaff et al.
The ovarian hormones serve to activate the neurons of the VMN, which then overcomes the tonic inhibition on lordosis Powers and Valenstein, ; Moss et al.
The mechanisms and the neural circuitry controlling female sexual motivation have not been as well elucidated. Furthermore, if motivated behavior arises from both the incentive properties of a sensory stimulus and mediators of the central motive state, it is likely that the neural circuitry that processes these sensory cues also contribute to sexual motivation.
The MePD also receives chemosensory signals of pheromones from the accessory olfactory bulb Keller et al. The projections of the MePD target and can activate several key output nuclei involved in social and sexual behaviors including the VMN Kevetter and Winans, ; Simerly, ; Keller et al. To better explore the neurobiology of sexual motivation in females, we created a model of enhanced motivation by administering METH. METH is a drug of abuse that intensifies sexual drives, desires, and sexual activities in women Rawson et al.
These anecdotal and clinical self-reports are supported by the increased rates of sexually-transmitted infections and of unplanned pregnancies Semple et al. The optimal time to test for female sexual behavior is 4—6 h following the administration of progesterone Nequin et al. Importantly, neither stereotyped behavior nor hyper-locomotor behavior are present 4—6 h after METH administration, suggesting that any increase in sexual behavior due to METH reflects heightened sexual motivation, not motor responses Holder et al.
The acute administration of METH enhances measures of sexual motivation in hormonally-primed female rats Holder and Mong, ; Holder et al. METH treatment increases the lordosis response in addition to doubling the frequency of proceptive behavior of hops, darts, and ear-wiggles Figure 2A ; Holder et al. When tested in a paced-mating arena, female rats treated with METH are less likely to leave the male rat following sexual stimulation, and if they leave, they return to him more rapidly compared to saline-treated, hormonally-primed females Holder et al.
In addition, these METH-treated female rats displayed more solicitation and proceptive behaviors, especially during the post-ejaculatory interval Holder and Mong, The possibility remains that METH may alter the timing and displays of sexual behavior instead of sexual motivation per se ; however, there is growing evidence that motivation and timing of behaviors are not independent processes such that changes to the hedonic value lead to alterations in interval duration, indicating that the changes in timings of a behavior are produced by changes in motivational state reviewed in Galtress et al.
While the decreased latency to return to the male is suggestive of an increased tempo for sexual behavior, the timing aspects should be further explored using more direct measures of sexual motivation in female rats e.
Figure 2. The enhancement of sexually-motivated behaviors by METH. A METH treatment doubles the number of proceptive events displayed in 10 min regardless of progesterone P dose, compared to the respective saline-treated females.
B Replacement of androgen-specific cues in castrated males induces more markedly increased proceptive behaviors in hormonally-primed female rats treated with METH. Reprinted with permission from Elsevier, Inc. METH may also alter the preferences of specific sexual partners based upon relevant sensory cues.
For example, METH-treated, hormonally-primed female rats make more approaches and spend more time with a potential sexual partner e. Dihydrotestosterone provides the necessary androgen-mediated cues, such as pheromones Orsulak and Gawienowski, ; Drewett and Spiteri, , sufficient to elicit solicitation, hops, and darts, with METH treatment increasing the number of proceptive behaviors Figure 2B ; Rudzinskas and Mong, These pheromonal cues are olfactory in nature, and while there are no differences in anogenital investigations induced by METH, there are significantly fewer sniffing behaviors.
Consistent with an increase in generalized arousal as part of the central motive state, this work suggests that METH may enhance the detection of olfactory cues. Future work is necessary to explore the potential effects of METH on olfaction. Taken together, these data suggest that METH does not alter the ability of females to discriminate between stimuli, but rather enhances central motive state arousal to increase sexual motivation in a context-specific manner by potentiating the behavioral responses towards an incentive stimulus.
The combination of METH and ovarian hormones enhances the measures of sexual motivation; therefore, we hypothesized that METH would converge with ovarian hormone actions to increase neuronal activity and induce neuroplasticity of the neurocircuitry that underlies sexual motivation and behavior. This increase in spinophilin suggests that METH and ovarian hormones synergize to increase the density of dendritic spines and, thus, synaptic connectivity in the MePD.
Taken together, the increase in neuronal activation and spinophilin in the MePD suggest that the METH-induced enhancement of female sexual motivation and behavior arise from converging actions of the ovarian hormone in the MePD. Figure 3. B METH treatment significantly increases spinophilin protein levels, compared to saline-hormone controls. The dashed line represents the baseline levels of proceptive behavior induced by ovarian hormones.
The Daun02 inactivation techniques allow for a more precise investigation of the cells activated in the MePD and the interactions of METH and ovarian hormone signaling on sexually motivated behaviors. In addition, successful Daun02 lesions of this neuronal ensemble reduce the proceptive behaviors to baseline levels, further supporting the notion that the MePD utilizes signals from METH on hormonally responsive neurons to augment the behavioral response Figure 3F ; Williams and Mong, Taken together, these results indicate a synergy of intracellular signaling cascades induced by METH and ovarian hormones within MePD cells.
This will be further explored in subsequent sections. One way in which this synergy of intracellular signaling cascades could result in an increase in sexual motivation is via changes in epigenetic modifications, which can then lead to marked changes in gene expression. These epigenetic changes could occur on the DNA directly, leading to localized regulation of gene transcription, or by modification of the histones, an integral part of the chromatin around which the DNA spools, which lead to more global alteration of gene transcription reviewed in Robison and Nestler, Acetylation of the histones enables gene transcription by allowing chromatin expansion, and histone deacetylases HDAC are enzymes that remove the acetyl groups, leading to more tightly coiled DNA and a reduction of gene transcription.
In addition, these changes in enzymatic activity are not the result of changes in the total protein levels of the enzymes Rudzinskas and Mong, Taken together, these data suggest that dynamic epigenetic changes may play some role in the genetic mechanisms which underlie METH-enhanced proceptivity. As such, these changes should be investigated further on a gene-by-gene basis, particularly in relationship to the genes explored in the next section of this review article.
While cells within the MePD mediate the METH-facilitated increase in proceptive behavior, it remains unclear how METH and ovarian steroids specifically activate this cellular population to increase neural activation. One likely source of neural activation is dopamine, as one of the primary responses following METH administration is the release of a bolus of dopamine into the synapse Sulzer et al.
The MePD receives both direct and indirect inputs from the ventral tegmental area, a major source of dopaminergic synthesis in the mesolimbic, natural reward pathway reviewed in Ikemoto, These experiments suggest that METH, through a release of dopamine, may work through the activation of a stable population of D1Rs in the MePD to directly modify the expression of genes underlying female sexual motivation.
Figure 4. Effects of microinfusions into the posterodorsal medial amygdala MePD on sexually-motivated behaviors.
A Infusion of the dopamine type-1 receptor D1R agonist SKF increases the number of proceptive events displayed in 10 min. The DR agonists and antagonists were administered once a day, for 3 days; therefore, it is probable that the genes affected would be both those necessary for the immediate display of sexual motivation and behavior and those involved in more long-lasting changes to the sexual motivation circuit.
One such gene whose expression could be modified via changes in D1R activation is the PR Olesen et al. Progesterone and activation of the PRs are necessary for the display of proceptive behavior, and there is functional specificity of the two isoforms of the nuclear receptor.
PR A activation contributes primarily to the display of lordosis, whereas PR B activation seems to contribute primarily to proceptivity Mani et al. Finally, recent work demonstrates that increasing PR protein expression with a lentiviral overexpression vector injected into the MePD in the absence of METH increases proceptive behaviors and lordosis intensity, with no other noted effects on social, exploratory, or rejection behaviors Williams et al.
Taken together, it is clear that PRs in the MePD have functional relevance toward the induction of female sexual motivation. In addition to activated D1R increasing the number of PRs in the absence of estradiol, D1R activation can also activate PRs in the absence of progesterone Auger, ; therefore, METH-facilitated activation of D1R could work via other, intracellular mechanisms in conjunction with the increased PRs to enhance sexual motivation.
The ligand-bound PR is necessary to modulate proceptive behaviors; however, METH can facilitate these proceptive behaviors even in the presence of subthreshold doses of progesterone Figure 2A ; Holder et al. Of these, the phosphorylation is thought to be the primary regulator of PR actions, such that phosphorylation of specific sites on the PR enhances transcriptional activity Denner et al.
In fact, activation of D1Rs leads to a sequence of kinase phosphorylation events, which could then modulate the activational state of the PRs Auger, The cytosolic-dependent kinase pathways that could be induced by D1R activation converge with the hormone-dependent kinase pathways at two serine sites in the PRs, serine and , suggesting a molecular mechanism through which METH may modulate PR activity Figure 5. Figure 5. Intracellular signaling cascades in the MePD that contribute to female sexual motivation.
A Estradiol enters the cell and binds to estrogen receptor ER , leading to ligand-dependent gene transcription. These are the priming stages. C Similarly, progesterone can enter the cell and lead to ligand-dependent signaling. Moreover, the administration of a D1R antagonist prevented this increase in phosphorylation of the PR B at serine Williams et al. Taken together, these data provide evidence of a direct molecular interaction of D1R and PR actions such that the intracellular signaling cascades initiated by D1R activation phosphorylate a site on the PRs in order to modulate the activational states of the PRs.
Further studies are necessary to elucidate the role of serine in the MePD and in the relative contributions of the different kinase activation pathways in the MePD on the enhancement of sexual motivation in the female rat. Ultimately, though, the activation of phosphorylation kinases and enhanced activation of PR would lead to an increase in the transcription of PR-dependent genes.
The gene targets of the activated PRs in the MePD that enhance female sexual motivation and influence the central motive state have yet to be determined. One of the key components for sexual behavior is that of sexual motivation. We have presented one model system in which we can further study the motivational aspects of sexual behavior.
The data presented in this review article indicates that sexual motivation arises from interactions of neurotransmitters and steroid hormones to change the central motive state. In addition, these interactions can be influenced by pharmacological agents, such as METH, to further increase the central motive state and drive the response to sexually-relevant stimuli. With the advent of technologies that enable us to examine and determine the nature of these interactions on epigenetic and molecular levels, we approach answers to such fundamental questions as the origins of sexual motivation.
The use of the METH-model of enhanced sexually-motivated behaviors has already revealed complexities to an admittedly intricate and multifaceted system; however, this model also presents new avenues for research that may ultimately reveal the origins of sexual desire. MH wrote the outline of the manuscript. All authors contributed to manuscript revision, read and approved the submitted version. NIDA played no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the report and in the decision to submit the paper for publication.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We would like to thank Shaun Viechweg for his contributions for the microinfusion experiments and the maintenance and genotyping of the LacZ colony. Afonso, V. Estrogen and the neural mediation of female-male mounting in the rat. Sexual motivation—an inquiry into events determining the occurrence of sexual behavior. Brain Res.
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However, empirical data examining the relationships between exposure to sex on TV and adolescent sexual behaviors are rare and inadequate for addressing the issue of causal effects. In baseline and 1-year follow-up interviews, participants reported their TV viewing habits and sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation.
TV viewing data were combined with the results of a scientific analysis of TV sexual content to derive measures of exposure to sexual content, depictions of sexual risks or safety, and depictions of sexual behavior versus talk about sex but no behavior. His lawyers asked for house arrest, saying Cosby — who is legally blind — is too old and vulnerable to do time in prison. Prosecutors asked for five to 10 years behind bars, saying he could still pose a threat to women. Good at suppressing this for a long time.
The sentencing came as another extraordinary MeToo drama unfolded on Capitol Hill, where Supreme Court nominee Brett Kavanaugh stands accused of sexual misconduct more than three decades ago. In a statement submitted to the court and released Tuesday, Constand, 45, said that she has had to cope with years of anxiety and self-doubt. She said she now lives alone with her two dogs and has trouble trusting people.
The AP does not typically identify people who say they are victims of sexual assault unless they come forward publicly, which Constand and other accusers have done.