Teaching content and encouraging acceptance in a human sexuality course.

Baugh, Stacey-Ann ; Van Camp, Debbie

The undergraduate experience is a time of learning, exploration, and growth for students, in part due to the exposure to large amounts of new information from a variety of sources. In addition to the knowledge gains inherent in an undergraduate education, there is also an important reference group effect (Kelley, 1952; Singer, 1981). Well supported by empirical data, the reference group effect refers to the influence that belonging to a group can have on an individual's attitudes and behaviors (Singer, 1981). Consequently, colleges and universities act as socializing institutions and as a result, students are likely to graduate with changed attitudes and values (Feldman and Newcomb, 1969). This effect can occur via the influence of peer groups as well as faculty reference groups and therefore can occur either in or out of the classroom. Furthermore, there is evidence that these effects are robust and long lasting. Newcomb's classic study of the attitudes of women at Bennington College in the late 1940's demonstrated not only a fundamental shift in their political attitudes but also that these new attitudes remained consistent for at least 25 years after graduation (Newcomb, 1943; Newcomb, Koenig, Flacks, & Warwick, 1967).

In addition to the broader reference group effect that might occur in undergraduate courses, experiences in particular classrooms might offer their own unique opportunities for change. Certain courses often have important secondary objectives in addition to their content specific goals. Diversity courses, for example, frequently have a goal of improving students' understanding of privilege, inequality, and prejudice with the aim of producing socially conscious citizens (hooks, 1994). Case and Stewart (2010) found that students in a diversity course expressed an increase in awareness of heterosexual privilege as well as greater support for same-sex marriage compared to their colleagues in other psychology or women's studies courses, suggesting that specific content may result in specific attitudinal changes.

A course in human sexuality has the potential to provide valuable information about the function of the sexual anatomy, pregnancy and childbirth, contraception, sexually transmitted infections, and sexual dysfunctions as well as to expose students to the range of sexual behaviors enjoyed by humans. Secondary goals might include increasing students' appreciation of sexual diversity, exposing them to different perspectives, increasing acceptance for other peoples' behaviors, and/or changing their attitudes regarding their own behaviors. Story (1979) was among the first to empirically examine the impact of a course on human sexuality on students' attitudes by asking students to rate how they felt about themselves and other people engaging in a variety of sexual behaviors (masturbation, oral sex, group-sex, sex during menstrual flow, etc.). Story (1979) found that students who took the human sexuality course developed attitudes that were more accepting and that this acceptance persisted far beyond the end of the semester. These results were in keeping with other researchers at the time who likewise found significant changes in general attitudes following human sexuality courses (Diamond, 1976; Garrard, Vaitkus, Held, & Chilgren, 1976; Gunderson & McCary, 1980; Rees & Zimmerman, 1974; Schnarch & Jones, 1981; Wanlass, Kilmann, Bella & Tarnowski, 1983).

Much of the initial research examining the impact of human sexuality courses was conducted in the 1970's and 80s. Since then, society has changed significantly in a number of ways that might diminish the impact of an undergraduate course focusing on sex and sexuality. The increase in sexuality education classes available at the middle and high school levels might make the knowledge gains of an undergraduate human sexuality course less compelling. In addition, compared to the 1970's and 80's, young people are exposed to more sexual content outside of the classroom. In particular, the widespread use of the internet has made a variety of sexual content and information more readily available (Doring, 2009). These changes result in a generation of students who likely know much more about sex than the generation of students that Story (1979) and other researchers examined. Therefore, this research aims to provide an up-to-date assessment of whether an undergraduate course on human sexuality can still significantly increase students' knowledge and whether it can influence their attitudes.

A variety of other social and cultural changes have taken place since the initial research in the 1970's and 80's. Notably, society has become more accepting of gays and lesbians (Newport, 2001) resulting in an increased number of openly homosexual individuals, increasing number of states allowing same sex marriage, and a push for greater acceptance of gays and lesbians serving in the US military. Despite these changes, the issue of equality for gays and lesbians remains a hotly debated and sensitive social topic. Consequently, many of the more recent studies examining the effect of human sexuality courses focus more exclusively on student attitudes towards this specific issue. Chonody, Siebert, and Rutledge (2009) found that participants reported more acceptance in their attitudes toward gays and lesbians following a prepared educational unit on sexual orientation. Likewise, Rogers, McRee, and Antz (2009) found that levels of sexual prejudice were significantly reduced following an undergraduate human sexuality course, which the authors suggest is at least partly due to the factual knowledge provided in the course curriculum. Certainly, sexual orientation is an important and socially relevant topic for a sexuality course to focus on. However, sexual orientation is not the only potentially controversial sexual behavior for which we might want to increase students' acceptance. Therefore, this research is focused on attitudes related to a wide range of sexual behaviors including masturbation, oral sex, and group sex in addition to attitudes related to homosexuality.

Although the majority of studies have found a significant effect of a human sexuality course on participants' attitudes, some research suggests that this influence is more apparent for specific groups. Weis, Rabinowitz, and Ruckstuhl (1992) found that females and younger students were more likely to experience shifts in their sexual attitudes to become more accepting, a finding they explain as due to the more restricted social norms of their younger, female, and religious participants. The link between students' attitudes towards specific sexual behaviors and their overall social norms is also suggested by Wright and Cullen (2001) who extended the assessment of a human sexuality course's impact and demonstrated that it influenced not only homophobia but also sexual conservatism and erotophobia--the learned tendency to respond negatively to sexual cues (Fischer, Byrne, White, & Kelley, 1988). This suggests that perhaps young women with more traditional social norms are the most likely to have their attitudes changed by a human sexuality course.

This research returns to a broader consideration of sexual attitudes and asks about the kinds of behaviors that Story (1979) and others asked about, for example oral sex, masturbation, and group sex. In addition, we included other behaviors such as using sex toys and watching porn, as well as more modern behaviors, such as "sexting." This study aimed to investigate whether an upper level seminar in human sexuality would increase students' content related knowledge and whether it would promote acceptance and a greater appreciation for the varieties of typical human sexual behavior in women.

Method

Like most undergraduate courses, the main purpose of our human sexuality course was to increase students' knowledge of the covered material, and for this increased knowledge to reflect on the students' performance on assessments. We considered it important to assess this most basic goal for the course, in addition to the secondary goals concerning attitudes. Therefore, the aim of this research is two-fold. First, to assess whether there was an increase in relevant knowledge and secondly to assess whether students who completed this class evidenced a shift toward more accepting attitudes of other people's sexual behaviors. It is important to take a moment to reflect on what we mean by accepting attitudes. We, like most researchers who have assessed the impact of such courses, did not ask our students about their actual behaviors, or even their intended behaviors. It was not the goal of this course to change behavior; indeed evidence suggests that this would not be successful even if it had been our goal (Eisen & Zellman 1987; Rees & Zimmerman, 1974). Likewise, it was not our goal to change any fundamental values or morals, which is equally unlikely as well as less desirable. Rather the hope was that in taking a human sexuality course our students would have the opportunity to become more open minded, tolerant, and accepting on a range of issues relating to sexuality.

Design and Procedure

This research employed a pretest-posttest (repeated-measures) design. Students completed a survey to assess their knowledge of content relevant to the course at the beginning of the semester and then again after completing the semester-long course. Students also completed a measure of their attitudes concerning typical sexual behavior in women at the beginning and end of the semester. All measures were completely anonymous and not tied to any credit in the class or any formal assessment of the students. To allow matching of student surveys while allowing for anonymity, students utilized a personal code that the researchers could not link to the student.

A female professor in the psychology department led the course. Using Human Sexuality Today (King, 2009) as a required text, the class explored a wide range of sexuality related content including male and female sexual anatomy, sexual response, sexual dysfunctions, atypical sexual stimuli, rape, pornography, prostitution, intersexuality, and sexual orientation. Students were encouraged to ask questions and engage in discussions to explore the topics further. In addition to prepared lectures and required reading, the instructor used videos and current events to increase student familiarity with the content. Students were assessed using exams, reaction papers, a research paper, and a group presentation of an assigned paraphilia. The University's Institutional Review Board reviewed the project and deemed it exempt as it involves typical and ongoing assessment of student learning within the context of a class. Since the responses were anonymous and the project deemed exempt by the institution's IRB informed consent was not necessary. Students voluntarily completed the pre and post tests and their participation was not linked to any course credit.

Participants

The current research was conducted at a small, all-women's religiously founded institution--a distinct environment for a human sexuality course. The participants are primarily of the type Weis et al. (1992) suggested are more likely to benefit from such a course. Furthermore, the fact that the classroom setting is all-female (including the instructor) is likely to encourage sharing and openness that may make the class more effective. Similarly, the small class sizes encourage intimacy and allows for the development of peer groups that can help strengthen the engagement with, and impact of, the material covered.

Sixty-eight students enrolled in three sections of the course and were eligible to take part in the study. Of these, 57 completed the pretest, 56 completed the posttest, and 43 completed both at least in part. The final sample used for all analysis is therefore 43. To adhere to institutional guidelines and to reassure participants of anonymity demographic information was not collected. However, the students enrolled at in the College of Arts and Sciences at the university are all-female, predominantly Black and Hispanic, and traditionally aged students. The course is an upper level component of the general education curriculum open to any student. However, the majority of the students are psychology and human relations majors in their junior or senior years. Each class section is limited to a maximum of 24 students to allow for adequate discussion and exploration of presented topics.

Materials

Knowledge. We used 24 items adapted from the required text (King, 2009) to assess students' knowledge concerning a range of topics including anatomy, sexual behaviors, contraception, sexually transmitted infections, and pregnancy. All items were either true or false and the students' score was the total number of items they got correct. Given the all-female student population we were particularly interested in the content areas of female biology as well as sexual behavior and so examined these specifically by creating subscales consisting of the relevant items. Seven of the 24 items asked about female biology, for example "menstrual discharge consists of sloughed off uterine tissue, blood, and cervical mucus" and "women's sexual desire decreases sharply after menopause." Five of the 23 items asked about sexual behavior, for example, "excessive masturbation can lead to medical problems" and "the frequency of sexual relations is highest for married couples aged 25-35." Therefore, at both pre and posttest each student has an overall knowledge score out of 24, a female biology score out of seven, and a sexual behavior score out of five.

Attitudes. We assessed students' attitudes towards a variety of sexual behaviors using 25 items modeled on Kite's (1990) exercise on defining normal behavior (see Table 1 for items). Kite (1990) notes that sexuality textbooks and curricula often include a consideration of what typical sexual behavior is, and that this is an issue of concern for many students as they grapple with the question of whether they are normal or not. Kite (1990) used the 25 questions as part of a classroom activity and discussion to help students appreciate how hard it is to define what normal is in reference to sexual behaviors. Additionally, even if students decide certain sexual behaviors are not for them, the exercise of considering whether behaviors are typical or not may lead to increased acceptance for the range of sexual behaviors practiced by other people, which is a primary goal for our class. Many of the items in Kite's (1990) questionnaire describe statistically and culturally less typical behaviors and are therefore ideal for our purpose; students are likely to show increased acceptance for these types of behavior after a class that teaches them about the variety of sexual behavior in other people.

In our effort to return to a broader consideration of sexual attitudes our questionnaire included questions about oral sex, masturbation, and group sex, as well as more modern behaviors, such as "sexting." In addition, we included control questions that ask about a number of sexual behaviors for which we would not want to encourage increased acceptance due to their illegal nature, such as exposing oneself in public or becoming aroused to nude children. If students demonstrate a shift in attitudes on all questions, then it would possible to interpret the change as the result of social desirability or an uncritical acceptance of all sexual behavior. However, if students only evidence a shift on the items that we would expect and wish them to, and not the control items, this interpretation is less reasonable, and therefore a claim that the course increased genuine acceptance would be more valid.

As already discussed, we were not interested in whether the students were more likely to engage in certain behaviors, or even if they felt these behaviors were something people should do, rather we wanted to measure their acceptance for these sexual behaviors in other women. That is we wanted to assess their rating of what normal or typical sexual behavior is. Therefore, and in keeping with Kite's suggestion for modified use of the questionnaire, students rated each behavior on a scale from one (completely abnormal) to five (completely normal). When discussing students ratings of each behavior we will therefore use the terms normal and abnormal. These items were analyzed separately and not indexed to allow full data exploration, however they did show acceptable levels of internal reliability at pretest ([??] = 0.90) and posttest ([??] = 0.88).

Results

Knowledge

Correlated t-tests showed a significant change from pretest to posttest in the level of students' knowledge, suggesting that a class in human sexuality does serve a knowledge increasing function at a university-level. Students did significantly better overall at posttest (M = 19.17, SD = 2.27) than they did at pretest (M = 17.31, SD = 2.19), t(38) = -4.82, p < .001, d = 0.89. This represents an improvement from 72% (C-) before taking the course to 80% (B-) after taking the course. Given the content and goals of the course, and the demographics of the institution, we were particularly concerned that the class increased any low knowledge areas about the female biology or sexual functioning/behavior. There was a significant increase in the student's knowledge of female biology from pretest (M = 4.47, SD = 1.01) to posttest (M = 6.94, SD = 0.98), t(37) = -2.16, p = .04, d = 0.75, representing an improvement from 64% (D) to 71% (C-). Finally, there was also a significant increase in the student's knowledge of sexual behavior from pretest (M = 3.74, SD = 0.72) to posttest (M = 4.23, SD = 0.58), t(38) = -4.45, p < .001, d = 0.73, representing an improvement from 75% (C) to 85% (B).

Attitudes

A series of correlated t-tests revealed a number of significant changes in students' responses concerning what they considered typical sexual behavior in women. After taking the class students rated activities such as masturbation, oral sex, using sex toys, fantasizing, and watching pornography as significantly more typical than they did before they took the class (see Table 1 for means, significance levels and effect sizes). For some of these items the students changed their view of the behavior from atypical to typical, for example anal sex which was considered atypical at pretest (M = 2.51, SD = 1.30) and on the typical end of the rating scale at posttest (M = 3.01, SD = 1.41), t(41) = -3.70, p = .001, d = 0.43. However, our students did not rate activities such as exposing oneself in public, having sex with animals, or becoming aroused by obscene phone calls as any more typical after the class (see Table 1 for means, significance levels and effect sizes).

A number of the items stand out as particularly interesting. When asked how normal it is to have intercourse with someone of the same sex, the pretest class average for this item was 2.61 (SD = 1.53), which is below the midpoint, suggesting students considered it atypical. At the end of the semester the class average for this item had risen to 3.23 (SD = 1.46), which is significantly more accepting of this behavior, t(40) = -3.46, p = .001, d = 0.51 and above the midpoint of the rating scale representing a rating in the direction of normal. However, for other items even if students rated an item as significantly more normal at posttest than they did at pretest this does not mean that they necessarily then came to view that behavior as normal. For example, students rated "being urinated on during sex" as significantly more normal (M = 1.53, SD = .85) after taking the class, than they did before taking the class (M = 1.21, SD = .71), t(42) = -2.32, p = .03, d = 0.35, although the ratings remained below the midpoint even at posttest, and so the behavior is still considered relatively abnormal. Likewise, "engaging in sex with more than one person at a time" was considered more normal at posttest (M = 2.55, SD = 1.33) than pretest (M = 2.14, SD = 1.16), t(41) = -2.12, p = .04, d = 0.32, but the rating remained on the abnormal side.

Although the students rate more typical sexual behaviors such as oral sex and masturbation as more normal following the course, they do not change their judgments of normality so dramatically as to include less typical and certainly less desirable sexual behaviors such as becoming aroused by children, sex with animals, or exposing oneself in public. In fact, the majority of the behaviors that did not show a significant change in ratings after the class are paraphilias which by definition are atypical forms of sexual expression, and which we included as forms of control. For all behaviors that are paraphilias, our students remained below the midpoint even after the class and showed no significant change (see Table 1 for means, significance levels and effect sizes). The other notable item that students did not evidence any change for was "not engaging in sex until marriage" which was rated as relatively normal at pretest (M = 3.48, SD 1.46) and showed no significant change at posttest (M = 3.50, SD = 1.54), t(41) = -0.41, p = .68, d = 0.01

Discussion

This study aimed to investigate whether an upper level seminar in human sexuality would increase students' content related knowledge and whether it would promote acceptance and a greater appreciation for the varieties of typical human sexual behavior in women. The data suggest that the class was successful in obtaining both goals.

It is the primary intention of any undergraduate course to teach students the relevant content and so increase their knowledge. The data suggest that this class was successful in increasing students' knowledge of specific areas within human sexuality as well as their overall knowledge of the topic. This is potentially quite important in our students' lives since some of the content areas that make up the overall knowledge set included items about sexually transmitted infections, contraception, and pregnancy. Further, the relatively low scores on the knowledge items at the start of the course suggest that despite sexuality education in the secondary schools, and ready access to information via the internet, an undergraduate course in human sexuality may still be relevant and necessary for today's student population.

A potentially unique secondary goal of classes such as human sexuality is to expose students to material and allow for discussion that might broaden their understanding. Such exposure and discussion may help to encourage acceptance and appreciation for the diversity of human sexuality, including potentially sensitive or controversial topics. The data suggest there was indeed a shift in the degree to which the students viewed several sexual behaviors such as masturbation, oral sex, using sex toys, fantasizing, and watching pornography, as typical. These data are consistent with that of other researchers including Weiss et al. (1992) who also reported significant changes in student acceptance of behaviors such as masturbation and oral sex. There was also a significant shift in student's attitudes about intercourse with members of the same sex. This result is striking firstly because of its relatively low rating at pretest, which suggests that at least among our students there is some degree of prejudice concerning homosexuality. Secondly, the significant change supports the idea that education, exposure to information, and an open exchange of ideas in an academic setting does indeed have the ability to change students' views on this matter.

There was no evidence of change in the student's views about more extreme and socially unacceptable behaviors such as being aroused by nude children. This suggests that students were not indiscriminately more accepting after taking the class, nor do they adopt an anything goes approach to sex, but rather they are more aware of and willing to acknowledge the range of sexual behaviors that fall within the realm of typical. Likewise, not all items were rated as typical at posttest, or significantly changed in their rating of normality suggesting that students were not simply yea-saying or reacting to a perceived social desirability. For example, posttest ratings remained below the midpoint for items such as being urinated on during sex and engaging in sex with more than one person at a time. Although these behaviors are certainly legal sexual behaviors which consenting adults might enjoy as part of the variety of sexual experience, few people would consider either typical. Our students shift towards more accepting attitudes but reluctance to consider them typical may reflect this.

There was also no change for the item that seems most obviously rooted in the students' moral bases--sex before marriage. Although it is certainly not abnormal to wait for marriage before having sex, neither is it typical. Therefore, it is striking that--at least this sample of today's undergraduate students--considers such abstinence as normal. This research was conducted at a Catholic based institution and so it might be that for some of our students this item reflects our students' religious values. That the class can open students' minds and encourage acceptance of the range of typical sexual behaviors without changing their attitudes about a behavior which may be rooted in their moral values, seems further testament to its worth. This suggests that perhaps the course does not move students' attitudes in one direction or the other but instead provides them with exposure and tools to examine their existing views. There is no evidence that this class is changing the students' fundamental values but rather succeeding in its aim to encourage them to appreciate the variations of typical human sexual behavior.

It is important to note that the attitude items questionnaire very specifically asked students whether certain behaviors were typical. It purposefully did not ask whether they intended to engage in these behaviors, nor did it ask whether they thought the behaviors were right or wrong. Consequently, there is no way to determine whether the shift in attitude towards sexual behaviors translated to any personal behavioral changes. However, the focus of the study was change in attitudes, not behavior. It was not a goal of the class for students own sexual expression to become more varied, but rather to be more appreciative and accepting of the human sexual experience.

Although, as illustrated by Kite (1990), it is hard to delineate the boundaries of normal sexual behavior, what constitutes typical sexual behavior is relatively more objective and is something that a human sexuality course might teach students, for example percentages of people who engage in masturbation. Therefore, a student rating such behaviors as normal following the class might be akin to demonstrating gained knowledge regarding sexual behavior and its' diversity. This allows for the possibility that the changes in normality ratings simply reflect this gained knowledge not in fact any increased acceptance. We cannot entirely discount this possibility without further data and analysis. However, the change in rating for "having intercourse with a member of the same sex" suggests this is not the case. While not abnormal, this is not statistically typical and so the change in rating for this item cannot simply be reflecting knowledge of numbers or statistics but rather a shift in attitude about this particular sexual behavior. This suggests that for at least some of the items our students understand normal to mean more than statistically typical, and that a shift in rating does demonstrate an appreciation for what is normal sexual behavior in other people--as was our aim. Furthermore, even if in some cases the differences in ratings do reflect gained knowledge, this may be a crucial first step in a change in attitudes.

Similarly, the possibility exists that the changes seen in the students' ratings do not reflect actual attitude change but instead reflect an increased comfort for a student to report their views on sex related content. This is likewise difficult to explore without additional data, however, the anonymity of the measures at pre and posttest makes it less likely that a student would be concerned about reporting her true attitudes on the individual items. Even if these shifts are in part reflective of increased comfort of students with expressing their views on potentially controversial topics this alone might be a worthy outcome of the class.

The focus on this research was specifically on whether there were changes in what students considered typical sexual behavior in women; we did not assess the range of what students considered typical sexual behavior in men. In addition, this study included only female participants. As noted earlier, there is some evidence that women and men respond differently to classes like human sexuality (Weis et al., 1992). Therefore, it might be informative to tease apart whether participants differ in their judgment of how typical specific behaviors are in men vs. women, and whether this interacts with the participant's own gender.

Limitations

There are a number of limitations inherent to a pre-posttest design that can undermine the internal validity of the study. Despite the overall pattern of significant change, with medium to large effect sizes, without a control group, we cannot be sure that these changes are the result of the class rather than some other factor. Although such single-sample pre-posttest design is common in classroom assessment research, future research using a non-equivalent control group design would strengthen these findings. Likewise, there was some attrition in our sample, with only 60% of all students providing both pre and posttest data. However, the benefit of a paired samples t-test and a pre-posttest design is that significant results are possible even with such a small sample available for final analysis, as was the case in our data.

This study utilized a relatively small convenience sample with possible self-selection issues, and as always both sample size and selection impact upon generalizability. The students who took this class chose to do so, and were primarily social science majors. This raises the concern that students who elect to take a course in human sexuality may be more open to the exploration of sex related content and therefore may more easily produce a shift in attitudes than students who would not choose to enroll in such a course. Nonetheless, this does not undermine that these students did evidence a change in knowledge and attitudes, and that the pretest data suggests that even if these are the more tolerant students they could still benefit from the class.

The instruments used to assess both content knowledge and attitude changes were adapted or designed specifically for this study. Therefore, neither instrument was piloted nor validated on previous samples. However, the attitudes measure was modeled on Kite's (1990) instrument, and demonstrated high internal reliability in this sample. The course setting was also unique in that it was small and all-female with a professor who is familiar to many of the students. This setting could influence student willingness and comfort in exploring and discussing sensitive topics. Future research should investigate whether the course would display similar levels of efficacy in a larger setting or in a mixed gender classroom environment using previously validated measures.

Conclusion

A course in human sexuality provides a unique opportunity for educators to teach students about topics that are very relevant to their day-to-day lives and that may have important implications for their health and wellbeing. Often the topics covered in a human sexuality course may be socially sensitive and an undergraduate course allows students to explore them in a safe environment. This research found that the value of this class for both knowledge and attitudes is considerable, and significant. We have identified a number of important future directions to assess more fully the maximum impact of such a class, and to ensure that it is effective for all students. As universities and students become increasingly job focused in their curricula choices, institutions may sideline general education courses as somewhat less valuable. This research supports the relevance of a course in human sexuality, which continues to show broad ranging efficacy.

Stacey-Ann Baugh

Department of Psychology, Trinity Washington University

Debbie Van Camp

Department of Psychology, Trinity Washington University

Correspondence concerning this article should be addressed to Stacey-Ann Baugh, Department of Psychology, Trinity Washington University, 125 Michigan Ave NE, Washington DC, 20017. E-mail: baughs@trinitydc.edu. Phone: (202) 884-9263

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Table 1
Attitude Items with Pre and Posttest Descriptive Statistics and Paired
t-test Results

                                          Pretest       Posttest

Item                                      M      SD     M      SD

1. Watching pornographic movies with a    3.81   1.02   4.17   1.02
  partner
2. Having sex with more than one person   2.14   1.16   2.55   1.33
  at a time
3. Performing oral sex                    4.11   1.30   4.62   0.76
4. Receiving oral sex                     4.33   1.09   4.76   0.64
5. Fantasizing about sex with someone     3.49   1.49   3.83   1.13
  other than partner
6. Having intercourse with a member of    2.59   1.53   3.23   1.46
  same sex
7. Masturbating                           3.93   1.32   4.54   0.94
8. Becoming excited by exposing oneself   1.65   1.01   1.56   0.92
  in public
9. Being unable to achieve orgasm         2.77   1.38   2.81   1.35
10. Using sex toys (e.g. a vibrator)      3.51   1.45   3.98   1.16
  during sex
11. Engaging in sex with animals          1.02   0.13   1.17   0.63
12. Sexting (sending nude pictures via    3.16   1.46   3.56   1.42
  text messages)
13. Engaging in anal sex                  2.51   1.30   3.01   1.41
14. Being aroused by nude children        1.18   .078   1.15   0.52
15. Not engaging in sexual intercourse    3.48   1.46   3.50   1.54
  until marriage
16. Masturbating after marriage           3.74   1.53   4.13   1.27
17. Being urinated on during sex          1.21   0.71   1.53   0.85
18. Being aroused by an obscene phone     2.14   1.42   1.89   1.07
  call
19. Inflicting pain during sex            1.91   1.15   2.04   1.05
20. Receiving pain during sex             2.26   2.93   2.04   1.10

                                          Paired samples

Item                                      t-test

1. Watching pornographic movies with a    t(42) = -2.50, p = .02,
  partner                                   d = 0.38
2. Having sex with more than one person   t(41) = -2.12, p = .04,
  at a time                                 d = 0.32
3. Performing oral sex                    t(42) = -2.46, p = .02,
                                            d = 0.49
4. Receiving oral sex                     t(42) = -2.39, p = .02,
                                            d = 0.54
5. Fantasizing about sex with someone     t(42) = -2.02, p = .05,
  other than partner                        d = 0.31
6. Having intercourse with a member of    t(40) = -3.46, p = .001,
  same sex                                  d = 0.51
7. Masturbating                           t(42) = -3.88, p < .001,
                                            d = 0.63
8. Becoming excited by exposing oneself   t(42) = 0.19, p = .85,
  in public                                 d = 0.11
9. Being unable to achieve orgasm         t(42) = -1.09, p = .28,
                                            d = 0.02
10. Using sex toys (e.g. a vibrator)      t(42) = -2.72, p = .01,
  during sex                                d = 0.43
11. Engaging in sex with animals          t(42) = -1.67, p = .10,
                                            d = 0.29
12. Sexting (sending nude pictures via    t(42) = -2.32, p = .03,
  text messages)                            d = 0.36
13. Engaging in anal sex                  t(41) = -3.70, p = .001,
                                            d = 0.43
14. Being aroused by nude children        t(42) = -1.14, p = .26,
                                            d = 0.05
15. Not engaging in sexual intercourse    t(41) = -0.41, p = .68,
  until marriage                            d = 0.01
16. Masturbating after marriage           t(42) = -2.07, p = .05,
                                            d = 0.30
17. Being urinated on during sex          t(42) = -2.32, p = .03,
                                            d = 0.35
18. Being aroused by an obscene phone     t(42) = 1.43, p = .16,
  call                                      d = 0.22
19. Inflicting pain during sex            t(42) = -1.67, p = .10,
                                            d = 0.12 .1
20. Receiving pain during sex             t(42) = -0.71, p = .48,
                                            d = 0.10

Note. All items were on a scale of 1-5 with a midpoint of 3 and higher
number indicating more normal. All analysis and means are based only
on the sample of 43 students who completed both pre and post-test.