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Toward a Conceptual Understanding of Asexuality

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Abstract

Asexuality has been the subject of recent academic (A. F. Bogaert, 2004) and public (e.g., New Scientist; CNN) discourse. This has raised questions about the conceptualization and definition of asexuality. Here the author reviews some of these issues, discusses asexuality from a sexual orientation point of view (i.e., as a lack of sexual attraction), and reviews the similarities and differences between this definition and related phenomena (e.g., hypoactive sexual desire disorder). Finally, the author concludes that the term asexuality should not necessarily be used to describe a pathological or health-compromised state. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Toward a Conceptual Understanding of Asexuality
Anthony F. Bogaert
Brock University
Asexuality has been the subject of recent academic (A. F. Bogaert, 2004) and public
(e.g., New Scientist; CNN) discourse. This has raised questions about the conceptual-
ization and definition of asexuality. Here the author reviews some of these issues,
discusses asexuality from a sexual orientation point of view (i.e., as a lack of sexual
attraction), and reviews the similarities and differences between this definition and
related phenomena (e.g., hypoactive sexual desire disorder). Finally, the author con-
cludes that the term asexuality should not necessarily be used to describe a pathological
or health-compromised state.
Keywords: asexuality, sexual orientation, HSDD, sexual attraction
In the wake of the publication of an academic
article (Bogaert, 2004) and a popular scientific
review in New Scientist (Paga´n Westfall, 2004),
scientific and public interest has been raised
about a hitherto overlooked phenomenon: asex-
uality. Despite this recent interest, the novelty
of the study of this phenomenon has meant that
the clarification of some basic conceptual and
definitional issues is lacking. My original study
(Bogaert, 2004) was largely an empirical exam-
ination of the issue. In the present article, I
address conceptual and definitional issues, with
a particular emphasis on how asexuality differs
from and is the same as other descriptors of
related phenomena, whether asexuality should
be viewed as a unique sexual orientation, and
whether it should be considered a pathological
condition.
Defining Asexuality
In biology and related disciplines, asexuality
usually describes organisms that do not use sex
(i.e., male and female variations) to reproduce.
In disciplines devoted to the study of humans
and behavior (e.g., psychology), the word asex-
uality has been used sparingly. A relatively re-
cent usage of the term, however, has been in the
context of sexual orientation. A model of sexual
orientation that includes asexuality was devel-
oped by Storms (1980; see also Berkey, Perel-
man-Hall, & Kurdek, 1990). Heterosexuals are
those individuals who score high on attraction
for members of the opposite sex (i.e., high on
heteroeroticism); homosexuals are those indi-
viduals who are high on attraction for members
of the same sex (i.e., high on homoeroticism);
bisexuals are those individuals who are high on
attraction for both sexes (i.e., high on both
heteroeroticism and homoeroticism); and
asexuals are those individuals who are low on
attraction for both sexes (i.e., low on both het-
eroeroticism and homoeroticism).
Note that Storms’s definition of asexuality
concerns a lack of sexual attraction to either sex
and not necessarily a lack of sexual behavior
with either sex, or even a self-identification as
an “asexual.” It would also not necessarily
mean that these individuals have no desire for
sexual stimulation (e.g., do not masturbate), al-
though, as discussed below, most of these indi-
viduals would, of course, likely have a very low
interest in any kind of sexual stimulation. It
would also not necessarily mean that these in-
dividuals do not have any capacity for physical
arousal (e.g., erection, vaginal lubrication), al-
though many who lack sexual attraction to oth-
ers may have limited physical arousal experi-
ences. Finally, it would not necessarily mean
that these individuals do not have a romantic/
This research was supported by Social Sciences and
Humanities Research Council of Canada Grant 410-2003-
0943. I thank Carolyn Hafer and Luanne Jamieson for their
help at various stages of this research.
Correspondence concerning this article should be ad-
dressed to Anthony F. Bogaert, Departments of Community
Health Sciences and Psychology, Brock University, St. Ca-
tharines, Ontario, Canada L2S 3A1. E-mail: tbogaert
@brocku.ca
Review of General Psychology Copyright 2006 by the American Psychological Association
2006, Vol. 10, No. 3, 241–250 1089-2680/06/$12.00 DOI: 10.1037/1089-2680.10.3.241
241
affectionate attraction for others, although, as
also discussed below, a large percentage of
these individuals likely do not form any kind of
romantic partnership with anyone. It is of note
that this emphasis on sexual attraction (e.g.,
whether one has eroticism and/or sexual fantasy
directed toward others) in defining asexuality is
consistent with other recent definitions and con-
ceptualizations of sexual orientation. Recent
formulations of sexual orientation emphasize
sexual attraction rather than overt sexual be-
havior, sexual identity, and romantic attrac-
tion in their definitions/conceptualizations (e.g.,
Bailey, Dunne, & Martin, 2000; Bogaert, 2003;
Diamond, 2003b; Money, 1988; Zucker &
Bradley, 1995). In this view, (subjective) sexual
attraction is the psychological core of sexual
orientation (Bogaert, 2003).
It was on this basis that I (Bogaert, 2004)
recently undertook the first empirical investiga-
tion of asexuality. I used a national probability
sample of British residents (N 18,000; Well-
ings, Field, Johnson, & Wadsworth, 1994). As
is typical of the sexual orientation questions on
such surveys, participants were asked to whom
they were sexually attracted: men, women, or
both. Unlike in most sexual surveys, however,
participants were given an option of not answer-
ing this question and instead indicating that
“they have never felt sexual attraction to anyone
at all.” This was the definition of asexuality
used (Bogaert, 2004), consistent with the mod-
els of sexual orientation mentioned above. One
important finding from my 2004 study con-
cerned the prevalence of asexuality. Approxi-
mately 1% (n 195) of the sample reported
never having had sexual attraction to anyone.
This figure was very similar to the prevalence of
same-sex attraction; that is, it was very close to
the number of gay men and lesbians in this
sample. (Other studies using representative
samples, however, have found higher levels of
homosexual attraction.) Other important find-
ings bear on some of the distinctions/definitions
of asexuality and sexual orientation noted
above. For example, although most asexuals
were not in a long-term relationship (e.g., not
married or cohabiting), a sizable minority
(33%) were and another 11% had had at least
one long-term relationship in the past. Such
partnerships in asexual people may occur for a
variety of practical reasons (e.g., economic,
child rearing), along with the fact that some,
perhaps many, asexual people may still have a
romantic/affectional attraction to others and
thus desire to form a romantic bond with them.
A second important finding was that, although
asexual people reported a relatively low level of
sexual activity with a partner (e.g., 0.2/week
vs. 1.2/week for sexual people), some clearly
still engaged in some level of sexual activity
with a partner, perhaps if only to please their
partner(s). Thus, distinctions between sexual at-
traction and other aspects of relationships (e.g.,
romantic attraction and sexual behavior) may be
important to make within the context of defini-
tional/conceptual issues surrounding asexuality,
just as they are for the typical categories of
sexual orientation (i.e., heterosexuality, homo-
sexuality, and bisexuality). For example, Dia-
mond (2003b) has argued that people may have
romantic orientation(s) toward the same sex,
even though their sexual attraction may be ex-
clusively directed toward the opposite sex (or
vice versa). Similarly, Klein (e.g., Klein, Sepe-
koff, & Wolf, 1985) has argued that people may
have emotional and social preferences, along
with lifestyle and behavioral components,
which are same-sex oriented, even though their
sexual attraction/fantasies may be oriented to-
ward the opposite sex.
Another important definitional/conceptual is-
sue that emerged from my (Bogaert, 2004)
study related to how people with other atypical
sexual proclivities might respond to the state-
ment, “I have never felt sexually attracted to
anyone at all.” Might this include people with
sexual attraction but who have unusual sexual
interests (e.g., paraphilias)? As I suggested (Bo-
gaert, 2004), this is unlikely because this state-
ment implies that all level of human involve-
ment/interest is lacking. Thus, it would exclude
not only heterosexuals, homosexuals, and bi-
sexuals, but also pedophiles and those with at-
traction to people not easily categorized as male
or female (e.g., intersex, transsexual). Even
most people with paraphilias (e.g., fetishists)
usually have some level of human partner in-
volvement/interest, even if they have a strong
attraction to some object (e.g., women’s shoes).
It is also unlikely that a significant number of
the asexuals in this sample have extreme, non-
human paraphilias (e.g., bestiality) for two rea-
sons. First, such extreme paraphilias (without
any human sexual attraction) are extremely rare;
second, the asexual people in this sample were
242 BOGAERT
largely women, who tend to be very underrep-
resented in the incidence of paraphilias (e.g.,
Freund, 1994). Thus, although the strict defini-
tion of asexuality presented above (Storms,
1980) may not exclude some extreme para-
philias, my (Bogaert, 2004) empirical investiga-
tion of this phenomenon likely excluded them.
One solution to this potential problem in future
investigations is to define and measure asexual-
ity as a more general phenomenon; that is, as a
lack of any sexual attraction. Thus, anyone who
does not have sexual attraction toward people,
objects, and so forth is defined as asexual. This
is the definition of asexuality promoted in the
present article.
Asexuality and Sexual Dysfunctions
How is asexuality, defined as a lack of sexual
attraction, similar to various forms of sexual
dysfunctions, particularly hypoactive sexual de-
sire disorder (HSDD)? Note that I am empha-
sizing HSDD (over other related dysfunctions,
e.g., arousal disorders) because it is likely the
most similar to asexuality. However, the argu-
ments about degree of overlap and distinctions
between HSDD and asexuality generally apply
to these other related dysfunctions.
HSDD is a relatively recent phenomenon, at
least in terms of a diagnostic category. Inhibited
sexual desire appeared as a diagnostic category
in the Diagnostic and Statistical Manual of the
Mental Disorders (3rd ed.; DSM–III; American
Psychiatric Association, 1980). In the DSM’s
fourth edition (DSM–IV; American Psychiatric
Association, 1994), the name was changed to
hypoactive sexual desire disorder. Similarly,
lack or loss of sexual desire appeared in the
International Statistical Classification of Dis-
eases and Related Health Problems in 1989
(ICD-10; World Health Organization, 1992).
HSDD is currently defined in the text revision
of the DSM–IV (DSM–IV–TR; American Psy-
chiatric Association, 2000) as “persistently or
recurrently deficient (or absent) sexual fantasies
and desire for sexual activity” (American Psy-
chiatric Association, 2000, p. 539). A clinician
must make the judgment of what entails a “de-
ficiency” or “absence.” The DSM–IV–TR di-
vides HSDD into certain subcategories, such as
“generalized” versus “situational” and “life-
long” versus “acquired.” A variation of HSDD
is “discrepancy of sexual desire disorder,” in
which a significant difference in sexual desire
occurs between two members of a couple. Sex-
ual aversion disorder is a related diagnosis to
HSDD, in which an aversion for genital contact
occurs (e.g., extreme anxiety when a sexual
encounter presents itself). Sexual arousal disor-
ders (e.g., female sexual arousal disorder; male
erectile disorder) refer to problems of physio-
logical arousal and may be related to desire
issues (e.g., HSDD). For HSDD and related
variations/disorders, a diagnosis is only applied
if it “causes marked distress or interpersonal
difficulty” (American Psychiatric Association,
2000, p. 539). A diagnosis must also exclude
evidence of certain well-known medical condi-
tions, depression, or the use of certain drugs,
which are known to lower sexual desire. If such
conditions fully explain the low/absent desire, a
separate diagnosis is applied (e.g., HSDD due to
major depressive disorder).
To revisit the question posed earlier: How are
asexuality and HSDD (and related disorders)
alike? Asexuality, defined as a lack of sexual
attraction, likely encompasses forms/variations
of HSDD and related disorders. In particular,
people who have had a lifelong absence of
sexual desire and are markedly distressed about
this situation or have marked interpersonal dif-
ficulty (i.e., lifelong HSDD) would not likely
have had any sexual attraction to anyone or
anything. Thus, the overlap between lifelong
HSDD (and related conditions) and asexuality
is likely significant. It is interesting to speculate,
then, whether the rate of asexuality that I found
in my previous work (1%; Bogaert, 2004) is
similar to the rate of those with a lifelong ab-
sence of sexual desire and related issues (e.g.,
lifelong HSDD). I know of no representative
sample similar to the rate of those with lifelong
HSDD; future research is needed to address this
issue. It is also interesting to speculate about
similar underlying causes affecting asexuality
and lifelong HSDD (and related conditions).
Thus, do many of the correlates of asexuality,
which may play a causal role in its development
(see Bogaert, 2004), also apply to lifelong
HSDD, and vice versa? For example, does a
lack of conditioning (e.g., lack of repeated as-
sociation between genital stimulation and po-
tential partners in adolescence, and/or few re-
wards within one’s prior sexual contexts) un-
derlie both? Does a prenatal alteration of the
anterior hypothalamus, thought to underlie tra-
243TOWARD A CONCEPTUAL UNDERSTANDING OF ASEXUALITY
ditional sexual orientation (e.g., Ellis & Ames,
1987; LeVay, 1991), also underlie both lifelong
HSDD and asexuality?
There are also important distinctions between
HSDD (and related disorders) and asexuality, at
least from a sexual orientation point of view.
One important difference is that some asexual
people may still have some level of sexual de-
sire, arousal, and/or activity, and they may even
derive pleasure from it; however, they just do
not direct or connect that desire/arousal/activity
toward or with anyone or anything. For exam-
ple, it is reported that some individuals who
identify as asexual have such “nondirected” or
“nonconnected” patterns of sexuality (Paga´n
Westfall, 2004).
Another important distinction between
HSDD and asexuality is that most people with
HSDD do not have a lifelong absence of desire.
For example, 33% of women and 15% of men
reported low desire in the past year in a repre-
sentative sample of the United States (Lau-
mann, Gagnon, Michael, & Michaels, 1994;
Laumann, Paik, & Rosen, 1999). Most of these
people would not likely have had a lifelong
absence of desire and would have felt some
sexual attraction at one point their life. Thus,
most people with the most common forms of
HSDD would not likely be asexual. It must also
be remembered that HSDD and related disor-
ders are diagnosed only if specific, additional
conditions are met (i.e., marked distress or
marked interpersonal difficulty). As such, there
may be a significant number of people with a
lifelong absence of sexual desire who would
never be diagnosed with HSDD because they
are contented and/or function adequately inter-
personally. These people too would likely re-
port no sexual attraction and hence be consid-
ered asexual. Thus, asexuality would likely
encompass both lifelong HSDD and non-
diagnosable forms of lifelong low/absent desire
because the definition of asexuality does not
necessarily assume that the individual is dis-
tressed or does not function adequately
interpersonally.
Asexuality and Sexual Orientation
Should asexuality be considered a different
or new category of sexual orientation? In other
words, is it useful to consider a lifelong lack of
attraction as a unique sexual orientation, distinct
from, say, the three main categories of hetero-
sexual/straight, homosexual/gay, and bisexual?
Before answering this question, some prelimi-
nary remarks about my assumptions and defini-
tions of sexual orientation are in order. I define
sexual orientation in a narrow way: as one’s
subjective sexual attraction to the sex of others.
My definition is narrow in part because it refers
only to the sex or gender of one’s preferred
partner(s). This is, of course, the traditional
view, but one’s sexual orientation could be
viewed more broadly, referring not just to the
sex/gender of one’s preferred partner(s) but, for
example, to other aspects of one’s sexual inter-
ests/attraction, such as the age or weight or
species of one’s preferred partners, or to other
dimensions beyond animate things (e.g., ex-
treme fetishists), or even to situations (e.g.,
power, submission). My definition of sexual
orientation is also narrow because it concen-
trates only on sexual attraction and not, as
mentioned, on other elements of sexuality and
romantic bonding toward others (e.g., sexual
behavior, romantic/affectionate attachment).
Finally, my definition is narrow because it re-
fers to only the subjective element of attrac-
tion—that is, a perceived eroticism/fantasy di-
rected toward others; it does not necessarily
refer to physical attraction/arousal or other as-
pects of sexuality that often accompany such
subjective attraction. Note that not all psychol-
ogists studying sexual orientation would neces-
sarily give precedence to subjective attraction
over physiological arousal/attraction (e.g., gen-
ital response directed toward females) in defin-
ing sexual orientation, but I believe this defini-
tion has merit for a number of reasons. First,
using a subjective definition of attraction seems
to best capture the psychology of sexual orien-
tation (e.g., the study of the mind, including
perceptions). Second, it may be more linked to
actual sexual behavior than physiological arous-
al/attraction. For example, a person who does
not perceive having sexual attraction toward
women despite exhibiting physical arousal pat-
terns toward them (e.g., in the laboratory) is
unlikely to engage in sexual behavior with these
partners. Notable in this regard is that women’s
subjective sexual attraction patterns often do
not match their genital arousal patterns, which
show arousal to female targets that is nearly
equal to arousal to male targets (Chivers,
Reiger, Latty, & Bailey, 2004). Despite this, the
244 BOGAERT
large majority of these women would report
their subjective sexual attraction patterns (and
would identify) as heterosexual.
Bearing these criteria in mind, I pose the
question again: Is it useful to categorize people
with a lifelong lack of attraction as having a
unique (asexual) sexual orientation? I raise this
question because there is likely some skepti-
cism in the academic and clinical communities
about whether asexuality should be categorized
as a separate and unique sexual orientation.
Thus, although there may be acceptance of the
fact that a small minority of people report a
lifelong lack of attraction and that the word
asexual might be a reasonable word to describe
them, there may be hesitancy about the useful-
ness of categorizing these people within a rela-
tively new category, distinct from those used
within the traditional discourse on sexual orien-
tation (i.e., heterosexual/straight, homosexual/
gay, or bisexual).
Two Objections to Asexuality as a Unique
Orientation
The hesitancy to view asexuality as a unique
orientation is likely based on one or both of two
objections, the first of which was raised previ-
ously (Bogaert, 2004). This first objection con-
cerns the validity of self-report. Some people
may report a lack of sexual attraction, but they
may in fact have demonstrable sexual attraction
to others of a particular sex/gender. For exam-
ple, if examined in a psychophysical laboratory
(e.g., using phallometry), some asexual people
may exhibit patterns of physical attraction/
arousal similar to those of sexual people (e.g.,
physical attraction/arousal patterns similar to
those of bisexual, gay or straight individuals).
Such people’s asexuality, then, may be best
described as a “perceived” or “reported” lack of
attraction, rather than an actual lack of physio-
logical attraction to a partner of either gender.
These people may report or perceive themselves
as being asexual for various reasons, such as not
being aware of their own attraction/arousal or
falsifying their attraction/arousal. In the case of
falsification, a strong argument could be made
that these asexual people do indeed have a typ-
ical sexual orientation but are merely motivated
to keep such attraction a secret. In the case of
those who are not aware of their own attraction
and yet respond physiologically in a similar
manner to sexual people, an argument can be
made that these individuals also have a tradi-
tional underlying sexual orientation, despite
their lack of awareness of this attraction. In
arguing this view, one accepts that physiologi-
cal attraction/arousal supersedes (or at least is as
important as) subjective sexual attraction in de-
termining one’s sexual orientation. However, as
mentioned, I define sexual orientation using
one’s subjective attraction as the main criterion.
Thus, even if there is psychological attraction,
as long as there is no subjective eroticism to-
ward anyone or anything (and hence the mind is
not registering such attraction), then a unique
sexual orientation category/designation is re-
quired for these individuals in my view.
The second objection to asexuality forming a
unique sexual orientation concerns the potential
overlap between very low sexual desire and a
lack of sexual attraction. According to this
view, people who have a very low desire (e.g.,
HSDD) do have an underlying sexual orienta-
tion, despite reporting no attraction. Thus, the
argument goes, if desire could be increased,
then the underlying inclination would be exhib-
ited. For example, some interventions, such as
administering high levels of testosterone, have
shown promise in increasing sexual desire—not
just autoeroticism but desire for other peo-
ple—in some individuals with HSDD (e.g., van
Anders, Chernick, Chernick, Hampson, &
Fisher, 2005). Thus, such interventions may
have the potential to reveal the “true” underly-
ing sexual orientation of these individuals. In
this view, then, many cases of asexuality, even
those with lifelong HSDD, would not have a
unique sexual orientation because an underlying
existing orientation may be revealed if certain
circumstances were to change.
If one accepts the reasoning that low sexual
desire is often merely masking an underlying
and traditional sexual orientation (but see criti-
cisms of this view in the next section), are there
any forms of asexuality remaining that might
still be usefully designated as having a unique
sexual orientation? There are three such poten-
tial forms. One is the case of an individual who
has no sexual desire and who does not have the
ability to increase their desire with any known
intervention. Thus, they would have no attrac-
tion or desire because the interventions to in-
crease desire would be ineffective. The second
case is an individual with little or no sexual
245TOWARD A CONCEPTUAL UNDERSTANDING OF ASEXUALITY
desire who could increase their sexual desire
through an intervention (e.g., testosterone) but
still has no sexual attraction toward anyone or
anything despite that potential increase in de-
sire. The third case is similar to the second:
Those who have sexual desire and possibly ex-
press it (e.g., masturbate) but do not direct this
sexual interest/desire toward anyone or any-
thing. Thus, in the latter two cases, despite a
potential sex drive/interest, these people do not
have any inclination toward others or any object
and, hence, would not have one of the tradi-
tional sexual orientations, nor would they pre-
sumably have any inclination for nonhuman
sexual objects and thus would not have a para-
philic orientation. The degree to which these
three groups make up a significant number of
asexuals is unknown, but as mentioned, the
third group—those with desire but no attrac-
tion—is reported to be one recognizable form
by people who identify as asexual. For example,
some asexual people report masturbating, de-
spite reporting no sexual attraction to anyone or
anything (Paga´n Westfall, 2004).
Arguments Against Asexual People
Having a Traditional, Underlying
Orientation
The view that many cases of asexuality have
a traditional underlying sexual orientation and
thus should not be viewed as having a unique
sexual orientation can be criticized in a number
of ways. First, evidence of effective treatments
of HSDD is limited (e.g., Ågmo, Turi, Elling-
sen, & Kaspersen, 2004; Heimen, 2002), sug-
gesting that increasing low sexual desire (and,
hence, revealing an underlying sexual orienta-
tion) may be difficult to perform. It is also of
note in this regard that studies of HSDD using
adequate controls and double-blind procedures
are rare (cf. van Anders et al., 2005). Second,
treatment is probably less likely to be effective
in people with lifelong HSDD, who are, of
course, most likely to be asexual. Thus, for
many people with a lifelong absence of desire, it
might not be possible to reveal an underlying
sexual orientation, if indeed there was one there
in the first place.
Third, the view that many cases of asexuality
should not be viewed as having a unique sexual
orientation because there is an underlying sex-
ual orientation toward others (or some object)
seems to assume a strong “essentialist” position
with regard to sexual orientation. In other
words, this view assumes there is an underlying,
presumably biologically determined (e.g., pre-
natal organization of anterior hypothalamus of
the brain) sexual orientation toward others that
all people have before adolescence and that will
reveal itself in adulthood under adequate social
and hormonal circumstances. Recently, there
has been a fair degree of support marshalled in
favor of biological factors in the development of
sexual orientation (e.g., Mustanski, Chivers, &
Bailey, 2002; Rahman & Wilson, 2003), but
even strong advocates of this position argue that
sexual orientation development is complex and
that multiple factors and interactions among
variables contribute to its development. More-
over, there may be a biological predisposition to
a lack of sexual attraction toward others, such
that for some people there may be an underlying
predisposition for an asexual orientation. For
example, I found (Bogaert, 2004) that asexual-
ity had certain biological correlates that suggest
a prenatal origin (e.g., potential alteration of the
hypothalamus). Thus, assuming that many cases
of asexuality have an inherently developed sex-
ual attraction system and an atypical or altered
sexual desire system (e.g., low testosterone;
high inhibition) is problematic. We simply do
not know enough about either low desire issues
or sexual orientation development to draw these
conclusions.
A fourth and related problem with this view
is that it equates sexual orientation development
with the phenomenology of sexual orientation
itself. In other words, it uses our assumptions
about sexual orientation development to de-
scribe what might be the expression of that
development years later. For example, using
this logic, we should describe a 4 year-old girl’s
sexual orientation as heterosexual/straight be-
cause she may have a predisposition to be sex-
ually attracted to men and may express that
attraction in the future if certain circumstances
occur. However, this logic is problematic. Sex-
ual orientation is not a possible predisposition
that may, if certain circumstances occur (e.g.,
experience with a partner, introduction of an
abnormally high level of testosterone; e.g., van
Anders et al., 2005), cause a future attraction.
Thus, even if an essentialist position is correct,
a biological predisposition is not the same as an
246 BOGAERT
actual sexual orientation. Consequently, I think
the argument can be made that a person who
currently has no attraction toward anyone (and
never had such attraction) is best described as
having an asexual orientation.
Additional Argument in Favor of
Asexuality as Unique Sexual Orientation
Another argument in favor of the usefulness
of categorizing asexuality as a unique sexual
orientation emerges less from arguments of the
definition(s) of sexual orientation and more
from a practical point of view and the need to be
sensitive to societal trends. There is currently
underway a small social movement, perhaps
akin to the gay rights movement of the 1960s
and 1970s, which has brought together a diverse
group of people who identify as asexual. Many
of these individuals consider themselves to be
unique and as having a separate sexual identity/
orientation. Note, as well, that there are a num-
ber of groups (e.g., Asexuality Visibility and
Education Network; AVEN) with websites and
chat lines that provide information and support
to individuals who identify as asexual. Simi-
larly, when the interest of the popular press
surrounding the issue of asexuality reached its
height in late 2004, CNN conducted an Internet
poll asking people to self-identify their sexual
orientation. A sizable proportion (6%) of the
nearly 110,000 respondents reported that they
identify as asexual (“Study,” 2004). The point
of presenting this result is not that this percent-
age accurately reflects the true proportion of
asexuals in the population—it likely does not—
but rather that a sizable minority are choosing to
identify with a term that is not part of the
traditional academic and clinical discourse on
sexuality and sexual identity. Such identifica-
tion with regard to sex, gender, and intimacy
issues is a powerful part of self-expression and
may satisfy basic human needs in the modern
world (Baumeister, 1986). Thus, the academic
and clinical communities need to be sensitive to
these issues. Thus, in keeping with the guide-
lines of the American Psychological Associa-
tion (APA; 2002), it is reasonable and practical
to use designations that individuals prefer (e.g.,
asexual, gay, lesbian, bisexual) when referring
to sexual orientation.
Asexuality and Pathology
A final issue to be discussed is whether asex-
uality should be considered pathology. To an-
swer this question, criteria for designating a
pathological state need to be established. Pa-
thology and/or abnormality with regard to one’s
inclinations and psychological characteristics
usually go beyond statistical rarity. This is, in
part, because statistical rarity by itself, espe-
cially in certain domains, can be considered
positive and life-enhancing (e.g., exceptional
musical talent). Modern medical and psycho-
logical approaches often limit sexual pathology/
dysfunction (and the need for treatment) to
when these inclinations entail “. . .marked dis-
tress or interpersonal difficulty” (American Psy-
chiatric Association, 2000, p. 539). These are
the criteria—distress or interpersonal diffi-
culty—I use to determine whether asexuality
should be considered pathological.
Distress, Interpersonal Difficulty, and
Asexuality
Currently, there are no data on the mental
health of asexual people, so conclusions about
distress or other psychological disturbance is-
sues in this group await future research. How-
ever, related research suggests that as many as
40% of the people not having sex in the past
year considered themselves to be very or ex-
tremely happy (Laumann et al., 1994). Many of
these people would not likely qualify as asexu-
als (with a lifelong lack of attraction), but this
does suggest that a lack of sexuality is not
necessarily a reliable predictor of happiness or
mental health. In addition, even if asexual peo-
ple do have, on average, elevated rates of dis-
tress or other mental health issues, there may be
a significant number, perhaps a majority, of
these individuals who do not. Research on other
sexual minorities is instructive in this regard.
Gay men and lesbians have been found to have
elevated mental health issues and often have
distress about their sexual inclinations (e.g.,
Meyer, 2003), yet many are also within the
normal range of contentment and mental health
(e.g., Busseri, Willowby, Chalmers, & Bogaert,
in press; Diamond, 2003a), and, of course, these
people (and homosexuality in general) are not
viewed as pathological from a modern medical
or psychological perspective. Thus, even if an
247TOWARD A CONCEPTUAL UNDERSTANDING OF ASEXUALITY
elevated level of distress or other mental health
issues occurs in asexual people, this should not
be used to pathologize all asexual people or
asexuality in general.
With regard to the second criterion of inter-
personal difficulty, it might be argued that asex-
ual people lack an important social dimension
of health because they do not typically engage
(nor want to engage) in sexual behavior with
others. Yet interpersonal functioning/relations
can be defined broadly and are not necessarily
equated with only one sphere of activity: sexual
interactions. Thus, in the DSM (e.g., DSM–IV–
TR), sexual dysfunctions (e.g., HSDD) are only
defined as problems when, along with causing
distress, they have negative effects on interper-
sonal relations beyond the specific sexual do-
main of issue. As an example, people who are
celibate actively choose to go against their sex-
ual desires (and sexual orientation) and never
have sex with others, and yet they are not
pathologized by the DSM. Thus, to pathologize
asexual people, who typically do not engage in
sex with others because it reflects their inclina-
tions/natures, would also be inconsistent with
this guideline. With regard to other (nonsexual)
aspects of interpersonal relations, we do not
know how asexual people function. Some may
have, of course, a broad impairment, but even if
a substantial number of asexual people do have
interpersonal difficulties, this should not be
used to pathologize all asexual people or asex-
uality generally.
Additional Considerations
A number of additional considerations with
regard to pathology and asexuality are worthy
of mention. First, is it relevant to this issue that
biological or physical health conditions may
underlie the development of asexuality? For
example, physical health issues, along with pos-
sible markers of atypical prenatal development,
were predictive of asexuality in my previous
work (Bogaert, 2004). Such a linkage is inter-
esting from an etiological perspective, but it
should not necessarily be used to pathologize
asexuality for at least two reasons. First, phys-
ical health and the markers of prenatal develop-
ment only accounted for a small percentage of
variation in the prediction of asexuality (Bo-
gaert, 2004). Thus, it may be likely that a large
percentage of asexual people do not have seri-
ous and demonstrable medical conditions. How-
ever, even if there are a large percentage of
asexual people who do suffer from serious
health problems, again, it does not follow that
all asexual people and asexuality per se should
be pathologized. Second, the fact that an un-
usual prenatal event caused atypical sexual de-
velopment (e.g., asexuality) should not be used
to determine whether someone currently has a
mental health problem. For example, atypical
biological development (e.g., prenatal maternal
stress, developmental instability; Lalumie`re,
Blanchard, & Zucker, 2002; Mustanski et al.,
2002) may underlie same-sex attraction, yet we
do not pathologize homosexuality. Again, it is
current distress and/or interpersonal difficulty
accompanying such atypical sexual develop-
ment that should determine whether a given
individual has pathology worthy of treatment.
A second additional consideration to note is
that, until recently, a lack of sexuality was not
perceived negatively (Sigusch, 1998); indeed, it
was the opposite, with sexual activity, particu-
larly if excessive or occurring within a nonre-
productive context (e.g., masturbation), being
perceived as a health and societal problem. In
addition, even today, to pathologize a lack of
interest in sex would be nonsensical from the
point of view of certain groups (e.g., some
religions and cultures). Thus, the weight of
much of the historical record and current cul-
tural context argues against the widespread
pathologizing of asexuality.
A final additional consideration concerns the
ramifications of stigmatization. To label some-
thing as pathology is often to stigmatize it. Such
stigmatization may, in fact, be a source of men-
tal health issues in asexual people, as it has been
argued to be for other sexual minorities (e.g.,
Meyer, 2003). If, on the other hand, we avoid a
general tendency to pathologize and recognize
that some people may be quite content to live as
asexual beings, it may in fact serve to remove
the stigma and possible distress associated with
such inclinations.
Summary
In this article, I discussed conceptual and
definitional issues of the phenomenon of asex-
uality. I noted similarities and differences be-
tween a sexual orientation view of asexuality
and related clinical conditions (e.g., HSDD). I
248 BOGAERT
also presented arguments for and against cate-
gorizing asexuality as a unique sexual orienta-
tion. Finally, although there is importance in
maintaining a clinical focus for some related
conditions, I argued that asexuality should not
necessarily be synonymous with a pathological
state.
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250 BOGAERT
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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Various theories assume that sexual orientation is related to sex role orientation or to erotic orientation. Hypotheses derived from these 2 assumptions were tested. Heterosexual, bisexual, and homosexual undergraduates (185 Ss) were administered measures of their masculine and feminine attributes (determined by the Personal Attributes Questionnaire) and their erotic fantasies (measured by the Erotic Response and Orientation Scale). Results generally fail to support the hypotheses derived from sex role theories of sexual orientation; within each sex, homosexuals, heterosexuals, and bisexuals did not differ on measures of masculinity and femininity. Strong support was obtained for the hypothesis that sexual orientation relates primarily to erotic fantasy orientation. These latter results support a 2-dimensional model of sexual orientation in which homosexuality and heterosexuality are treated as separate, independent factors. (33 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)