Sexuality and Sexual Problems
Few topics are more difficult to discuss or engender more controversy in our society than sex, especially children and sex. Most recently, research in this area has centered around issues related to child sexual abuse. Although understanding sexual abuse is undeniably important, this narrow focus ignores other sexual problems that can arise during childhood and, if left untreated, can have a negative impact on a child's development. Indeed, identification and treatment of sexual problems during childhood can often prevent development of adult sexual disorders that are very distressing and difficult to treat (Borneman, 1994). It is only through a broad knowledge of normal sexual development, as well as of where things can go wrong, that the child clinician can come to a complete understanding of a presenting problem involving sexuality. This chapter provides the child clinician with empirically based information about the complex area of childhood sexuality. First, what is known about normal sexual development is reviewed. This is followed by a discussion of issues related to sexuality education. Childhood sexual problems, including precocious or delayed puberty, gender identity disorder (GID), and sexually aggressive behavior, are then discussed. Finally, child sexual abuse and its assessment and treatment are reviewed in detail.
The study of sexual development is clouded by cultural attitudes and values about sexuality in general, and about children and sexuality in particular (Rosenfeld & Wasserman, 1993). Much of the work in this area has come from Europe, especially the Scandinavian countries, where attitudes toward sexuality are more permissive than they are in the United States. Thus the conclusions resulting from this work may not always apply to children in the United States, where there are significant political, societal, and ethical restrictions on our ability to gather empirical data on children's sexual behavior and development. Moreover, methodological issues have led to inconsistencies across the results of various studies. Studies that rely on parental reports of children's sexual behavior, for example, give lower estimates of the frequency and nature of children's sexual experiences than studies that include self-reports. This inconsistency simply reflects the fact that much of children's sexual behavior, particularly after the preschool years, is undiscovered by adults. Finally, the participants involved in the studies are