Electronic Journal of Human Sexuality, Volume 11, May 20, 2008

www.ejhs.org

It Starts in the Womb: Helping Parents Understand Infant Sexuality

Remi Newman

Sexuality educator, Santa Rosa, CA

Presented at the SSSS WR meeting in San Diego, CA April, 2008

Although it is recognized that infants and young children are sexual beings, many parents are unaware of this and are unprepared to provide the healthy guidance needed to raise sexually healthy children. This article examines "Having "the talk" before they can talk," a sexuality education workshop for new and expectant parents created and facilitated by the author. "Having "the talk" has been conducted four times with a total of 17 participants. Workshop activities and findings are discussed in the context of a literature review of research on infant and child sexuality.

From the moment they are born, infants are learning about their bodies, learning how to love and who to trust. In other words, they are learning about sexuality (Moglia & Knowles, 1997). And their parents, whether they realize it or not, are their primary teachers (Haffner, 1999).

Being a new parent can be overwhelming enough, never mind taking on the responsibility of becoming their child's primary sexuality educator. Although most parents want to be the primary sexuality educators for their children, many parents feel they didn't receive much sexuality education from their own parents and don't know how and when to begin (Richardson & Schuster, 2002). Many don't feel comfortable enough broaching the topic and never fulfill their duty as sexuality educators (Levine, 2002). For many parents, the openness and information necessary to be the sexuality educator they wish to be for their children will require practice and education (Roffman, 2001).

Rather than seeing themselves as sexuality educators for their kids, many parents instead see themselves as gatekeepers of sexuality information, not wanting them to know too much too soon (Roffman, 2001). In no other area of life do parents see a value in withholding education from their children. Parents may worry that the information itself is inherently damaging or that it will encourage sexual activity (Money, 1999; Roffman, 2001). Although studies have shown that teens who learn about sex and sexuality from their parents are more likely to postpone first sexual intercourse (American Social Health Association, n.d.; Lin, Chu & Lin, 2006). The only thing a parent may be withholding from their child is the chance to experience healthy affection, learn correct information, and the opportunity to learn their parent's values on sexuality.

“Having 'the talk' before they can talk," is a sexuality education parenting workshop designed to give parents knowledge about infant sexuality and increase their comfort with the topic, so they can be an active participant in their child's healthy sexual development from the very beginning. Workshop topics include biological gender and gender roles, responding to their infant's natural exploration of their bodies and communicating with them about their bodies. Through several interactive workshop activities, parents explore and share their personal values around sexuality and increase their knowledge of infant and child sexuality.

The goals of the workshop are:

to increase parents' knowledge about human sexual development from birth until the toddler years, so they better understand the developmental stages their child will experience.

to increase parents' comfort level with their child's sexuality.

to clarify parents' personal values on sexuality and encourage them to think about how they want to impart these values to their children.

to increase parents' ability to communicate (verbally and non-verbally) in order to facilitate an open, honest and informative dialogue with their children on sexuality

Participants

"Having 'the talk' before they can talk" has been conducted four times within the past 12 months, with a total of 17 participants. All were married and all but two participants were first-time parents. Twelve were female and five were male. Eleven had girls and six had boys. All had at least an undergraduate college education. Fourteen were white, two were Mexican and one was Mexican-American. All resided in Northern California (Sonoma County). Participants' ages ranged from 26 to 42. The ages of the participant’s children ranged from 6 weeks to 3 years old.

Workshop Activities and Findings

At the start of the workshop, participants complete a pre-test (Appendix A) to assess their knowledge. During introductions, they are asked to express what they hope to get out of the workshop and any specific questions they have. An icebreaker, Find Someone Who... (Appendix B) follows. For the first activity participants get into groups of two or three. They discuss what sexuality education (if any) they received from their parents/primary caregivers, what (if anything) they would like to do the same for their children, and what they would like to do differently. This activity helps participants begin to develop a positive vision of how they see themselves as sexuality educators for their children. Participants are reminded that their parents likely knew less than they do about sexuality education and that they probably did the best they could with the information they had. Also, just the fact that they are attending the workshop shows that they want to do better and that by the end of it they will likely know more about infant and child sexuality than most people.

All participants reported wanting to do a better job than their parents did. Although four out of 17 reported that they did receive some quality sexuality education, others reported receiving very little to none at all. All participants reported receiving some sort of unspoken message about sex. For example, one participant noted receiving no education at all, but getting a strong message that she was to wait until she was married to have sex. For the four (three females and one male) who reported receiving some education, in each case it was from their mother and in two cases she was a single mother.

When does sexuality begin?

In the next activity, titled Sexuality: When does it begin? (Appendix C), participants are asked to determine when various aspects of human sexual development can first happen. For example at what age can penile erection, vaginal lubrication and clitoral erection, toilet training, and possibility of orgasm first occur?

In almost all cases, participants who had baby boys reported that penile erection could first occur from birth-3 years, as they had already witnessed it. Yet, almost all participants (regardless of the gender of their child(ren)) guessed that vaginal lubrication and clitoral erection could not occur until 4-8 or even 9-12 years of age. For possibility of orgasm, five out of 17 participants answered from birth-3 years. For the other participants, answers ranged from age 4-8 up to 12-18 years of age.

When does it begin? also provides an opportunity to discuss infant's exploration of their own body (including their genitals), curiosity about other's bodies and how they are learning about love and trust through touching and holding. Most participants guessed that these aspects would first occur from birth-3 and from 4-8 years old. Almost all participants express surprise when told that all of the aspects of sexual development listed can first occur from birth-3 years and some even before, in utero. According to Parrot (1994), this is consistent with the literature.

When does it begin? gives parents a sense of what is normal behavior for their growing children. For some participants, finding out that what they have been observing is normal and healthy can be a relief. One of the couples who attended had a three year old who had exhibited masturbatory behavior from infancy. Both parents expressed that they wished they had known this information sooner, so as to save them the stress of worrying about their child and also not knowing how to respond.

Once the activity if finished, participants review a comprehensive definition of sexuality (Appendix D) that includes sexual anatomy, physiology, gender, sexual orientation, fantasies, life experiences and spirituality. This information helps parents understand that sexuality education is about more than anatomy and reproduction. It is about providing a foundation for the future. And it doesn't only happen once with "the talk." It is a lifelong process (Haffner, 1999).

Personal Values

The next activity, What are your personal values? (Appendix E), allows parents the opportunity to clarify their personal values on their child's sexuality and to promote discussion. Parents are first asked how they respond to their infant touching their own genitals in the bath or during diaper changes. None of the participants reported slapping the child's hand or pushing it away forcefully.

Although one participant reported that during bath time her 23 month old boy had recently grabbed the shower head as the water was coming out of it and pointed it directly at his penis which then became erect. She responded by grabbing the shower head away from him. He did it a second time and she grabbed it away again. She reported that she hadn't given much thought as to why she did that, but that it was just a reaction. By the end of the discussion this participant reported that next time she would not grab the shower head away, but instead let him play with it for a while.

Most participants report practical reasons rather than emotional ones for stopping genital play. For example, during diaper changes if there is feces present, they don't want their child's hands to get soiled. Also for those who have infants who have begun toddling, several participants reported that their child wanted time without their diaper, but that they didn't want to have to worry about their child urinating on the floor or on the bed. Suggestions such as allowing diaper free time during the day in the privacy of their backyard (if they have one) are offered.

One parent also reported that their reason for stopping genital play during diaper changes was simply being in a rush much of the time. For most participants stopping genital play is not a priority but neither is making sure the child has sufficient time and access to their genitals. By the end of the activity, several participants expressed that they will make providing diaper free time a priority.

What are your personal values? next two questions refer to gender roles. Participants are asked to answer questions on what colors baby boys and girls should be dressed in and what types of toys they should be encouraged to play with. Almost all participants with girls report that at times their girls wear blue, yet only one of the participants with boys reported that he had worn clothing with pink or purple. One participant noted that because her two year old girl didn't have much hair, she was often mistaken for a boy. Once she felt her daughter was old enough to be aware that she was in fact a girl and people thought she was a boy, she began to dress her daughter in very feminine clothing, so people would no longer mistake her for a boy. A participant with a 22 month old boy reported that her son had recently attended a girl's birthday party where all of the party favors were "girls toys." They included pink sunglasses and a bracelet. Her son loved them and was enjoying wearing them so much that she saw no good reason to stop him from doing it. She reported that she didn't want to do anything at this young age to "crush his spirit."

Four of the male participants (all fathers of girls) reported that although they were fine with their daughter wearing boys' clothes or playing with typical boy toys, they would not be fine if they had a son who was wearing girls' clothes or playing with typical girl toys. They attributed this to the fact that they would not want their son to suffer being teased for being too feminine. This provides an opportunity to discuss femiphobia (fear of the feminine as defined by Morin, 1998) and its relation to homophobia. One participant expressed that he would worry for his son if he turned out to be gay because he would have such a hard life. He stated he was glad he had a girl so he didn't have to worry about this possibility. This particular participant was Mexican. It was explained to him that his daughter may suffer as a Latina due to prejudice in the United States and that he and his wife were doing their best to give her a strong sense of pride in her ethnicity and her community that would prepare her to deal with prejudice, and that it could be the same if they had a gay son. They could do their best to prepare him to deal with adversity and feel good about who he was. Afterwards, this participant reported feeling much better about the possibility of having a gay son.

These questions help parents become aware of the choices they make regarding their child's gender role, so as their child grows and begins to express their desires regarding dress and toy preference, the parents are better able to allow them to be who they are (even if their choices differ from the typical gender roles) and, as one participant put it, not crush their spirits.

The final question on What are your personal values? deals with using correct genital terminology when speaking to one's children. One participant who had a two year old daughter reported that she was using a made up term because she thought the "real" names were too hard to learn to say. A mother of a two year old boy said she was using the made up terms she had been taught as a child, but her husband (who didn't attend) wanted her to use correct terminology. One mother of a 16 month old girl said she referred to her own genitals as her "hoo hoo" and to her daughter's as her "parts" because she didn’t felt comfortable saying "vagina" or "vulva." The majority of the participants reported that they were not speaking to their children at all about their genitals. Four participants (a couple with a three year old girl and two parents of boys) reported using correct genital terminology when speaking to their children.

This question leads to a discussion of the reasons to use correct genital terminology such as teaching one's child that all parts of her/his body are valuable, making it easier for a child to explain to a doctor or caregiver (other than parents) if they are experiencing pain in their genitals, and dealing with an alleged sexual abuse situation. For many of the parents once these reasons were explained and discussed, they reported that they would make a commitment to use correct terminology.

Finally, participants review What is infant sexuality? (Appendix F), an information sheet, complete the post-test (Appendix A) and evaluation (Appendix G). Three weeks later they are mailed a follow-up questionnaire (Appendix H) to test behavior change since the workshop.

Literature review

What is infant sexuality?

Martinson (1973) defines infant sexuality as the "possession of the biological and psychic response system that can and does respond to stimulation by self and others and that induces infants to seek and even to initiate intimate, affectional encounters with others" (p. 23).

Biological sexual development begins in utero, as the genitals begin to develop after the 6th week of gestation. Martinson (1994) writes that "Children are active and sensual, even before they are born.... one of the earliest sensory systems of the human body to function is the skin, which begins to function during the embryonic stage of development... when the embryo is less than an inch long from crown to rump, and less than 6 weeks old, light stroking of the upper lip region or wings of the nose has been shown to cause a response, a bending of the neck and trunk. Stroking the palm of a fetus also results in a response"

As early as 16 weeks, erectile response in male fetuses has been viewed with ultrasound (Haffner, 1999; Martinson, 1994; Parrot, 1994). It is assumed it would be the same for female fetuses and that lubrication and clitoral erection would begin this early as well (Borneman, 1994; Martinson, 1994), although the technology for demonstrating it doesn't yet exist (Money, 1999). In newborn males, spontaneous erections continue to occur, awake and asleep (Money, 1999) and female's vaginas lubricate and their clitorises swell (Richardson & Schuster, 2003). So although the sexual response cycle is present at birth (Haroian, 2000), many parents believe that infancy and childhood is a time of sexual innocence (meaning without sexuality) and that "sex is supposed to burst out full bloom at puberty or, hopefully, later " (Martinson, 1973, p. 23).

Parent's Role

According to Yates (1978), "sex clinics can treat dysfunctions, but only parents can prevent them" (p. 131). In order to be effective sexuality educators for their children, parents should share feelings, attitudes, beliefs as well as information (Haffner, 1999). Therefore, parents must be well informed on sexuality and must be comfortable with the topic. If the conversation begins early enough, talk about sexuality can become a part of everyday family life and establish an early rapport about sex and sexuality between parent and child that will carry over into the often challenging adolescent years (Pomeroy, 1974). According to Gordon (1973) parents and children have a special relationship that makes the information and attitudes that come from parents more meaningful than those received from others.

Children who are afraid to approach their parents with concerns about whether they are "normal" or not, may feel isolated and confused which may lead to depression and anxiety, and children who don't learn from their parents, are no doubt receiving information (often incorrect) elsewhere- from peers, the media and other sources (American Social Health Association, n.d.). Yet, Gordon (1973) also acknowledges that many parents are not prepared to take on the sexuality educator role due to their lack of knowledge and their reluctance to engage in meaningful communication on sexuality with their children. Some parents recognize their limitations and are willing to seek professional guidance to enhance their role as sexuality educator (Lin, Chu, & Lin, 2006).

It is also important that parents are aware of the messages they send their children about sexuality, whether they are conscious of it or not, and even if they never speak about it (Martinson, 1994). According to the American Social Health Association (ASHA) (n.d.), infants learn about sexuality from their parents, whether or not the parents are aware of this, as the infants "are sensitive to a parent's silent signals." Pomeroy (1974) defines this as "attitudinal sex education"-- "the kind every parent gives, every day, whether he knows it or not" (p. 13). As noted by Roffman (2001) "our earliest sexuality education is entirely nonverbal." This nonverbal education includes the perceptions and reactions of others to an infants' gender and bodily functions. It is in the way an infant is held, touched, diapered and bathed. An adults behavior and body language provides subconscious cues for the infant on sexuality attitudes. "An embarrassed look, a slapped hand, a face filled with disgust, a suddenly hushed tone, teach a powerful lesson, as does a reaction that is relaxed and accepting" (Roffman, p. 104).

The more comfortable a parent shows the child they are, the more comfortable they will feel in their bodies as they grow and the easier it will be for parent and child to have conversations later on regarding sexuality. Parents who use "teachable moments" demonstrate to their children that they are "askable" parents (Advocates for Youth, 2002; Haffner, 1999). According to ASHA (n.d.), the sooner a parent begins the dialogue the easier it will be. A child or adolescent will be more likely to come to their parents with questions if they have grown up with a sense that they can handle the topic (Moglia & Knowles, 1997).

"The secret to parenting an infant or any child about healthy sexuality is to separate her/his sexuality from your own. Whenever your child does something that is 'perceived' to be sexual, remember it is the observer that is labeling it. Example: a child touches her clitoris or his glans, the normal adult reaction is to assume the motivation is different than sucking a thumb. It is not. They are simply pleasurable stimuli. A child is not born with any of the sexual taboos, sexual myths, sexual misinformation that we have. But s/he will absorb very one we demonstrate or illustrate" (Moglia, personal communication, June 8, 2007).

The lack of understanding of infant and child sexuality and the reluctance to view children as sexual beings often leave parents missing the boat on being the primary sexuality educators of their children. According to Yates, "...parents, in their misguided search for the proper approach, continue to saddle children with vestiges of the Victorian ethic." (Yates, 30). While parents are waiting to have "the talk" with their kids, they have lost years of opportunities to nurture a healthy sexuality in their children.

Love and Trust

The first 18 months of life are a critical time for learning about love and trust (Haffner, 1999). A loving and gentle touch helps infants grow and develop as healthy individuals with a healthy sense of their own sexuality (Martinson, 1973; Richardson & Schuster, 2002) "When you cuddle and tickle him, you teach your baby that he can take in pleasure through his body and through close relationships with other people" (Richardson & Schuster, 2002, p. 81). Infants who receive insufficient touch exhibit a failure to thrive (Borneman, 1994; Martinson, 1994; Money, 1999; Parrot, 1994; Yates, 1978). Mother/infant grooming stimulates growth hormone in the infant as demonstrated by studies of premature babies (Money, 1999). Studies of premature infants have shown that those who received sufficient touch grew healthier faster than those who were touch deprived (Money, 1999).

Roffman (2001) notes that parents are providing the foundation for their child's later sexual life."The pleasure and comfort they come to associate with our loving touch and our physical warmth and presence will become their first and most important lessons in human intimacy" (Roffman, p. 187).

Correct Genital Terminology

Part of sexually healthy development and developing a positive body image is feeling comfortable with and appreciating all body parts (Haffner, 1999). It is never too early to teach correct names for body parts (Richardson & Schuster, 2002). Moglia (personal communication, 2000) recommends that parents begin as soon as possible using correct terms for the genitalia when speaking to their infants, because if they can't say the words "penis" or "vulva" to an infant who has no idea what they're saying, it's not going to get any easier when they get older and do know. Starting early helps parents begin to feel comfortable using correct terminology. By not saying anything parents may be conveying uncomfortable feelings with genitalia and even a sense of shame about the genitalia. If the parent makes a face when diaper changing or expresses disgust at the feces the child may internalize these reactions and begin to feel badly or shameful about their genitalia (Parrot, 1994). Although many parents don't display a negative attitude during diaper changes, few go as far as to show appreciation for the genitalia of their infants. How many parents go on about the cute little feeties, adorable belly, beautiful eyes, etc., but would never say what a wonderful penis or clitoris. Yates (1978) suggests that an approving smile during diaper changes can make a difference in how children grow to feel about their bodies.

"A million dollar smile accompanied by a pat with the powder to an erect penis says that the penis has value" (Yates, 1978, p. 164). Yates (1978) writes that adults with sexual problems are often uncomfortable with their bodies. She believes this can be traced back to early childhood. "The need for treatment could have been prevented by a direct, enthusiastic approach to sex in childhood." While many adults point critically to each part of their body, a child can easily have the opposite experience with the right encouragement from parents. "The child's body becomes beautiful, mirrored in his parents' eyes" (Yates, 1978, p. 165).

Girls are at a higher risk for having confusion and feelings of shame about their genitals because they are more hidden (Yates, 1978). Studies have shown that boys are more likely to have been taught the word penis than girls were to have been taught any name at all for their genitalia and in fact, girls were more likely to have been taught the name for boys' genitals than for their own (Richardson & Schuster, 2002). Parents who do name their female child's genitals often use the word "vagina" to refer to the entire genitalia. According to many sexuality educators (e.g. Haffner, 1999; Moglia & Knowles, 1997; Richardson & Schuster, 2002), the correct term is "vulva", referring to the outer female genitalia including inner and outer lips, vaginal opening, urethral opening, and clitoris. Although feminist sexuality activists from the Federation of Feminist Women's Health Centers (FFWHCs) have created a new definition for the female genital anatomy. According to the FFWHCs, the vulva is only the covering of the female genitalia and therefore includes only the pubic mound and the outer lips. The vagina serves a primarily reproductive function. It is the clitoris in fact that is the main female genital organ. It is made up of 18 parts including erectile tissue, glands, muscles, ligaments, nerves and blood vessels and is homologous to the penis (Chalker, 2000).

However defined, the clitoris (the only organ in the human body whose sole purpose is pleasure) is often left out by parents (Yates, 1978). As the visible glans of the clitoris is much smaller than the penis, Yates (1978) suggested that to explain its equal importance a parent could say that the nicest presents come in small packages or compare it to a beautifully wrapped present.

Learning correct names for sexual and reproductive body parts teaches respect for one's body and for other's bodies (it's also important that boys learn about girls and vice versa) (Haffner, 1999). Teaching children to respect their bodies and other's bodies is, in fact, one of the best tools we have for protecting them from sexual abuse (Haffner, 1999; Moglia & Knowles, 1997). Further, in the case of an alleged sexual abuse incident, it is extremely helpful if the child can use the correct terminology (Haffner, 1999).

According to Sarah Cicero, a psychotherapist with over 10 years of experience working with sexually abused children, the social services interviewer and therapist working with the child are not allowed to use the correct terminology if the child has not used it, as it could be construed that the therapist has influenced the child's experience and/or testimony. This can lead to confusion and make it more difficult to ascertain the child's experience. According to Cicero, "if more parents used the anatomically correct terms for their children's bodies we would have a healthier discussion about sexuality, both as it relates to possible sexual abuse and the more normal sexual exploration that occurs with children" (personal communication, April 4, 2008).

Another important reason to teach correct terminology is so a child can communicate effectively to a doctor, babysitter, daycare provider, or other caregiver if they are experiencing any pain or irritation in their genitals (Haffner, 1999).

Genital Self-stimulation and Orgasm

Infants are learning about their bodies through touch (Borneman, 1994; Parrot, 1994). They are learning that there is pleasure in physical closeness, in being held and cuddled. They smile and laugh when they are tickled. It is normal for babies to explore their bodies (Gossart, 2002; Martinson, 1994). Pleasurable genital self-stimulation (also referred to as genital play, infantile masturbation, or gratification behavior) usually begins between 7-10 months of age, but it is very variable (Haffner, 1999). It has in fact, been observed in utero. As noted by Chalker (2000), Giorgi and Siccardi (1996) observed a female fetus performing genital self- stimulation and responding in a way that mimicked orgasm.

Although infant self-stimulation has been identified as a common normal behavior and part of healthy development, many parents and even medical professionals remain ignorant about it, as demonstrated by an article in Pediatrics. Yang, Fullwood, Goldstein, & Mink (2005) identified 12 cases in which infants and young children were referred to a pediatric movement disorders clinic with a suspected movement disorder which was later determined to be simply masturbation. The onset of the behavior ranged from 3 months to 3 years. All patients were female. They exhibited flexing, twisting, muscle contractions, facial flushing, grunting and moaning. What often makes it difficult for parents to recognize self-stimulation in infants and young children is that they may not be directly manipulating their genitals with their hands, but may instead be flexing their thighs or rubbing against their crib, bed, or other object. Self-stimulation during the first year usually involves friction caused by rhythmic rocking or thigh pressure (Martinson, 1994). The families in the 2005 study had already been treated by multiple doctors before presenting at the movement disorders clinic and "in almost all cases, extensive work-up had been performed, including magnetic resonance imaging (MRI), electroencephalography (EEG), intravenous pyelography, small bowel biopsy, and gastrointestinal barium swallow. In some cases, treatment with antiepileptic agents was initiated before establishing a diagnosis of masturbatory behavior" (Yang, Fullwood, Goldstein, & Mink, 2005, p. 1427).

When an infant is touching their genitals they are not "masturbating" in the adult sense. They have not yet attached sexual thoughts to the act (Gossart, 2002). A baby touches their genitals for the same reason they suck their toes or their thumb (Moglia, personal communication, 2000). They are simply doing what feels natural and good and provides them with comfort (Borneman, 1994; Haffner, 1999; Martinson, 1994; Roffman, 2001). If a parents shames a child for this touch, often the child won't stop the behavior (and the feeling of wanting to do it won't go away), but will begin to believe that their body is somehow dirty and shameful and they may feel guilty about the behavior. This early shaming can have a harmful effect on the development of one's sexuality (Moglia & Knowles, 1997; Parrot, 1994). According to Borneman (1994), "Every human organ that is one day supposed to function efficiently must be exercised as early as possible. That goes for our genitals as well as for our brain and our nervous system" (p. 82).

Borneman (1994), through his data collection on over 4,000 children over a 20-year period, found that "children who had shown themselves to be especially agile as infant masturbators developed all other motor abilities, especially manipulation, earlier and more efficiently than nonmasturbators" (p. 70). Children who are raised in orphanages are less likely to masturbate and according to Borneman (1994), autistic children masturbate rarely or not at all. Martinson (1994) refers to Spitz' study (1949) of infants in an orphanage who did not receive adequate physical touch from caregivers and did not display any genital play even by age four. Spitz' earlier research (1946) of infants reared by their mothers who provided a warm and loving physical relationship showed that these infants exhibited genital play during their first year (Martinson, 1994).

Research has shown that responses that look like orgasms have been observed in infants during the first year of life (Borneman, 1994; Janssen, 2007; Martinson, 1994; Richardson & Schuster, 2003). Kinsey (1948) reported orgasm in a 4-month old female infant and later reported (1953) 23 girls, under the age of three, who appeared to reach orgasm through self-stimulation. Parrot (1994) writes that "it is estimated that at least half of all boys experience orgasm by the age of four, although they do not ejaculate in childhood because they lack the hormones necessary to do so" (p. 310). According to Janssen (2007), "some authors have ventured beyond 'early' discussing the existence of fetal orgasm (Brenot & Broussin, 1996; Giorgi & Siccardi, 1996)" (p. 123).

Diaper changes and baths are common times for infants and toddlers to take advantage of having access to their genitals. They are also good opportunities for parents to provide sex education by simply allowing children to discover and explore their bodies (Pomeroy, 1974). If there are siblings of different sexes, or if the parent of the opposite sex is bathing with the child, bath time can also be an opportunity to learn about the differences between boys and girls' bodies (Pomeroy, 1974).

Gender roles

Even in the womb, gender stereotyping begins. Studies have shown that pregnant mothers who know the sex of their baby describe male fetus' movements as strong and vigorous and female fetus' movements as lively or moderate (Haffner, 1999). Burke (1996) writes that "When the child emerges into the world, every physical movement and spoken word, every toy touched and game imagined, are colored by the power of gender role expectations" (p. 3).

Roffman (2001) refers to a study done in a maternity unit. The comments of visitors observing a particular newborn were recorded. Those who believed the baby was male "'observed' strong cries, muscular movements, and bigness; about 'girls' just the opposite ? sweet faces, delicate gestures, gentle form" (Roffman, p. 102). Infant boys and girls are socialized differently (Haffner, 1999; Moglia & Knowles, 1997; Parrot, 1994; Richardson, 2003; Roffman, 2001). Although there are many obvious ways in which gender difference is reinforced early on ? from birth announcements, clothing colors, room decoration and toy selection, there are many subtle ways as well. Infant girls are placed closer to the body when held, spoken to in softer tones and more often. They are also encouraged more to use verbal skills, whereas infant boys are more often encouraged at physical tasks such as reaching for an object (Roffman, 2001). Moglia & Knowles (1997) note that infant boys are more likely to be bounced when held while infant girls are more likely to be sung to and gently cuddled.

Through gender scripting , the p rocess by which children learn what behaviors are considered socially appropriate for their gender, young children begin adopting the behaviors that they are rewarded for and hiding behaviors that evoke punishment or ridicule (Moglia & Knowles, 1997). Scripting can have an effect on toy and activity selections and many psychologists believe that toy selections affect life skills (Haffner, 1999). While girls are learning to nurture with dolls and kitchen sets, boys are developing reasoning and spatial-relation skills with sports activities, building sets, trucks, etc. (Haffner, 1999). And although there is evidence that differences in male and female brain chemistry and hormone levels account for activity preference (Haffner, 1999), society contributes to these preferences by enforcing gender role expectations (Burke, 1996).

Haroian (2000) noted that cultures can be sexually permissive, supportive or restrictive/ repressive and that boys and girls in the United States do not necessarily grow up in the same culture. While boys exist in a heterosexually permissive culture, girls are raised in a sexually restrictive culture. It is generally accepted that "boys will be boys" and that they will experiment sexually or at the least show a great interest in sex, yet girls are expected to remain sexually inexperienced to protect their sexual innocence/virginity. The burden of upholding sexual morality rests solely with the girls (Haroian, 2000).

Social Implications

The current lack of effective sexuality education (of which family education is an important component) is a contributing factor to a variety of negative outcomes of adolescent sexuality in the United States, including high rates of STIs, unwanted pregnancy, sexual abuse, sexually dysfunctional relationships, and the inability to achieve intimacy and have a fulfilling sex life (Lin, Chu, & Lin, 2006). According to ASHA (n.d.) "research shows that uninformed children are at greater risk for early sexual activity, sexually transmitted diseases or infections (including AIDS), pregnancy, sexual exploitation, and abuse". Four million teenagers are infected with STIs each year and half of the forty thousand new HIV infections a year are in people under age 25 (Levine, 2002). According to Levine (2002), it is not sex itself that is to blame, it is the circumstances under which many young people have sex that leads to negative outcomes. "The best way to stem the tide of irresponsible sex, pregnancy, and venereal disease is to create a climate of acceptance and honesty about sex in the home" (Gordon, 1973, p. 2).

Money (1989) defines lovemap as "a developmental representation or template, synchronously functional in the mind and the brain, depicting the idealized lover, the idealized love affair, and the idealized program of sexuoerotic activity with that lover, projected in imagery and ideation, or in actual performance" (Money, 1989, p. 43). The development of a healthy lovemap is determined partially during the prenatal phase based on our genetics and hormone levels, although most of our lovemap develops once we are born, and is based on the people and situations in our lives (Moglia & Knowles, 1997). According to Money (1986) "the majority of patients with paraphilias described a strict anti-sexual upbringing in which sex was either never mentioned or was actively repressed or defiled" (as quoted in Levine, 2002, p. 12). Society's lack of education and openness about childhood sexuality leaves children who reach puberty with paraphilic lovemaps alone and potentially stigmatized and ostracized (Money, 1999).

Lack of research

There is a serious lack of scientific and sociological data on child sexuality due to the unwillingness to fund such research (Martinson, 1994; Money, 1999). "There is probably no human activity about which there is greater curiosity, greater social concern, and less knowledge than sexuality, particularly infant and child sexuality" (Martinson, 1973, p. 1). There is a reluctance to admit the existence of child sexuality (Martinson, 1973), much less examine it (Okami, Olmstead & Abramson, 1997).

According to Money (1999) "Restrictions on research apply especially to childhood sexuality... It would be the kiss of death to submit a grant application for the developmental investigation of childhood sexual rehearsal play or the developmental content of juvenile sexual ideation and imagery. The applicant's own institution as well as extramural private or public funding institutions would all respect the fiction that equates childhood sexuality with innocence, except for sexual molestation and abuse. The concept of developmental sexological health and well being in childhood is widely rejected" (p. 23).

Research methods that can be employed to examine childhood sexuality include asking adults or adolescents to recall childhood thoughts and experiences. Most people will not recall sexual encounters before the age of three (Martinson, 1973) and it is difficult to determine the accuracy of what they do remember. Another possibility is to interview parents about their children. Yet, many parents do not even recognize that their child has sexuality and it would be impossible to determine the accuracy of their observations (assuming they are not videotaped).

Workshop Evaluation and Follow-up

According to the pre-post test (Appendix A) results and the three week follow-up questionnaire (Appendix H), participants knowledge of infant and child sexuality has increased and they have made behavior changes based on the information received in the workshop. For example, according to the answers on the three week follow-up questionnaire, most are now using correct genital terminology. Following are some quotes from the three week follow-up questionnaire.

Since attending the workshop, has your comfort level with your child's sexuality changed? Please explain:

"My awareness now from the class has made it easier to be more open and therefore feel more comfortable. I hadn't thought about using the anatomical 'real' names with my child, so this is a new experience for me (and my husband).

"I already felt comfortable, but the class helped reinforce my feelings and added clinical terminology and relevance to my parenting style."

"I try to talk to her about her vagina and her vulva and I've been realizing that she loves touching it, and also walking around the house naked. It's a great experience to see her laughing, for me and also for her."

"All that information helped me realize the importance of my child knowing the right names of her genitalia and the good that will bring her in her self-esteem and future development."

Has your behavior related to your child's sexuality changed? Please explain:

"I have been more careful not to use the incorrect name for the genitalia. I let my child explore and touch her genitalia and explain to her that she has a beautiful body."

"Yes, I feel that her genitals are just a part of her body that she has to know."

Following are some examples from the pre-post test:

Name at least one thing you can do to foster a positive sexual self-image in your child:

Pre: "Reluctant to think about her sexual image. Worried about "sexualizing" her too soon in a world that is saturated with a lot of negative images that are devoid of intimacy."

Post: "Make talking about genitalia the same as the loving way we talk about all her body parts."

This example is from the participant who referred to her own genitals as "hoo hoo" and her 16 month old daughter's as her "parts." She went from feeling reluctant to think about her child's sexuality at all to having a tool she could use to foster a healthy sexuality in her daughter.

Name at least one reason to teach children the correct names for their genitals:

Pre: "I think it helps to communicate correctly if inappropriate things happen."

Post: "So they understand that they are a valuable beautiful part of their body that should be respected."

This example is from the participant who had the three year old who exhibited masturbatory behavior from a young age. She reported that she was worried when she first acknowledged what the behavior was (she reported being in denial at first) that there may have been sexual abuse (there was not), because she imagined her daughter had to have learned the masturbatory behavior from an adult. This led her to do some research on her own, so she came into the workshop with some knowledge of child sexual abuse, but was able to leave with a more positive spin on her child's sexuality that was not based on fear.

Conclusion

"Having 'the talk' before they can talk" lets parents know that the best way to get started is to do what they're probably already doing-- love, hold, cuddle, kiss, tickle and talk to their infants, look into their eyes, respond to their needs. When their needs are met, infants learn to trust their parents/ caregivers and the world around them (Gossart, 2002; Moglia & Knowles, 1997). It is important for parents to consider that they are their child's first experience of love, both physical and emotional (Richardson & Schuster, 2003). This primary relationship will lay the foundation for all future love relationships for their child (Haffner, 1999; Roffman, 2001).

References

Advocates for Youth. (2002, October). Growth and Development, ages zero to three--what parents need to know. Retrieved March 31, 2008, from www.advocatesforyouth.org/parents/0_3.htm

American Social Health Association. (n.d.). Talking to your kids. Retrieved March 16, 2008, from www.ashastd.org/parents/parents_overview.cfm

Borneman, E. (1994). Childhood Phases of Maturity: Sexual Developmental Psychology. (M.A. Lombardi-Nash, Trans.). Amherst, New York: Prometheus Books.

Burke, P. (1996). Gender Shock. New York: Anchor Books, Doubleday.

Carrera, M. A. (n.d.)Parents and their children's learning about sexuality. Retrieved on February 8, 2008, from www.advocatesforyouth.org/parents/experts/carrera.htm

Chalker, R. (2000). The Clitoral Truth: The secret world at your fingertips. New York: Seven Stories Press.

Gordon, S. (1973). The sexual adolescent: Communicating with teenagers about sex. North Scituate, MA & Belmont, CA: Duxbury Press.

Gossart, M. (2002). There’s no place like home… for sex education. Retrieved February 8, 2008 from www.advocatesforyouth.org/PUBLICATIONS/noplacelikehoe/age3.htm

Haffner, D. W.(1999). From Diapers to Dating: A parent's guide to raising sexually healthy children. New York: Newmarket Press.

Haroian, L. PhD., (2000,02,01). Child Sexual Development. Electronic Journal of Human Sexuality, Volume #3, [WWW document] URL http:// www.ejhs.org/volume3/Haroian/body.htm

Harris, R. H. illustrated by Emberley, M. (2006). It’s not the stork! A bookabout girls, boys, babies, bodies, families, and friends. Cambridge, MA: Candlewick Press.

Hedgepeth, E. & Helmich, J. (1996). Teaching about sexuality and HIV: Principles and methods for effective education. New York: New York University Press.

Irvine, J.M. (2002). Talk about sex: The battles over sex education in the United States. Berkeley, CA: University of California Press.

Janssen, D.F. (2007). Cultural notes on orgasm, ejaculation, and wet dreams. The Journal of Sex Research, 44(2), 122-134.

Kinsey, A. C., Pomeroy, W. B., & Martin, C. E.(1948/1998). Sexual behavior in the human male. Philadelphia: W.B. Saunders.

Kinsey, A.C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: W.B. Saunders.

Levine, J. (2002). Harmful to minors: The perils of protecting children from sex. New York: Thunder's Mouth Press.

Lin, Y., Chu, Y. & Lin, H.H.(2006). A study of the effectiveness on parental sexuality education. Education (Chula Vista), 127(1), 16-31.

Martinson, F. M. (1973). Infant and child sexuality: A sociological perspective. Saint Peter, MN: The Book Mark (Gustavas Aldolphus College).

Martinson, F. M. (1994). The sexual life of children. Westport, CT: Bergin & Garvey.

Mayle, P. (1977, 2000). "Where did I come from?" A guide for children and parents. New York: Lyle Stuart Kensington Publishing Corp.

Medora, N. P., & Wilson, S. (1992). Sexuality education for young children: The role of parents. Early Childhood Education Journal, 19(3), 24-27.

Moglia, R.F., & Knowles, J. (Eds.). (1997). Planned Parenthood All about sex: A family resource on sex and sexuality. New York: Three Rivers Press.

Money, J. (1999). The Lovemap Guidebook: A definitive statement. New York: Continuum.

Money, J., & Lamacz, M. (1989). Vandalized Lovemaps: Paraphilic outcome of seven cases in pediatric sexology. Buffalo, New York: Prometheus Books.

Morin, J. (1998). Anal pleasure & health: A guide for men and women. San Francisco, CA: Down There Press.

Okami, P., Olmstead, R. & Abramson, P.R. (1997). Sexual experiences in early childhood: 18-year longitudinal data from the UCLA family lifestyles project (UCLA). The Journal of Sex Research, 34(4), 339-348.

Parrot, A. (1994). Incest, infertility, infant sexuality. In Bullough, V. & Bullough, B. (Eds.), Human Sexuality Encyclopedia. New York: Garland Publishing. 289-310.

Pomeroy, W. B. (1974). Your child and sex: A guide for parents. New York: Delacorte Press.

Reich, W. (1974). The sexual revolution. (T. Pol, Trans.). New York: Farrar, Straus & Giroux. (original work published 1945).

Richardson, J., & Schuster, M. A. (2003). Everything you never wanted your kids to know about sex (but were afraid they'd ask): The secrets to surviving your child's sexual development from birth to the teens. New York: Three Rivers Press.

Roffman, D. M. (2001). Sex & Sensibility: The thinking parent's guide to talking sense about sex. Cambridge, MA: Da Capo Press.

Schoen, M., illustrated by Quay, M.J. (1990). Bellybuttons are navels. Buffalo, NY: Prometheus Books.

Yang, M. L., Fullwood, E., Goldstein, J., & Mink, J. W. (2005). Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature. Pediatrics, 116(6), 1427-1432.

Yates, A. (1978). Sex without shame: Encouraging the child's healthy sexual development. New York: William Morrow and Company, Inc.

Appendix A: Pre-Post Test for “Having ‘the talk’ before they can talk ”

Name at least one thing you can do to foster a positive sexual self-image in your child.

________________________________________________________________________________________________________________________________________________

Infants are primarily learning about their bodies through what sense?

________________________________________________________________________________________________________________________________________________

At what point do infants become sexual beings?

________________________________________________________________________________________________________________________________________________

Name one way that baby boys and baby girls are treated differently.

________________________________________________________________________________________________________________________________________________

What will lay the foundation for all future love relationships for your child?

________________________________________________________________________________________________________________________________________________

A baby boy can first have an erection:



from 3-6 months of age

from the moment he is born

at one month old

in utero

from 6-9 months of age



Name at least one reason to teach children the correct names for their genitals._______________________________________________________



What is the difference between sex and sexuality?_______________________________________________________



What is a vulva?_______________________________________________________

Newman 4/08

Appendix B:

“Having ‘the talk’ before they can talk” Mixer!

Walk around stopping to ask people if they are willing to sign a particular statement. If they say “no” try another statement. No one may sign more than two of your statements. The winner is the person who has the most signatures at the end of the allotted time.

Find Someone Who...

_____has cheerios (or other cereal) in their bag

_____has talked about sex & sexuality with their older child, niece or nephew

_____played “doctor” as a child

_____got a good night’s sleep

_____was in labor for under 8 hours

_____has ever cross-dressed

_____has dressed their baby boy in pink or purple

_____has dressed their baby girl in blue

_____feels (or felt) comfortable talking about sex & sexuality with one or both of their parents

_____has more than one tattoo

_____has a pacifier or sippy cup in their purse or bag

_____was in labor for over 24 hours

_____has not gone blind from masturbation

_____didn’t circumcise their baby boy

_____didn’t circumcise their baby girl

_____knows what a “vulva” is

Newman 4/08

Appendix C: SEXUALITY: When does it begin ?

The experiences in the left hand column are all a part of normal human sexual development. Mark on the grid when you think these milestones can first occur.

Human Sexuality is... Early childhood Birth-3 yrs. Late childhood 4-8 yrs. Early adolescence 9-11 yrs. Adolescence 12-18 yrs. Toilet Training Erection of penis Curiosity about differences between boys’ and girls’ bodies Vaginal lubrication & clitoral swelling Learns about love & trust through touching & holding Exploration of own body (hands, feet, genitals, etc.) Possibility of orgasm

Adapted from E. Hedgepeth & J. Helmich (1996), Teaching about Sexuality and HIV Newman 4/08

Appendix D: What is Sexuality???

Sexuality is a significant aspect of a person’s being consisting of many interrelated factors:

sexual anatomy, physiology, growth and development

gender, gender identity and gender role identity

sexual orientation

sexual behaviors & lifestyles, beliefs, attitudes & values

body image and self- esteem

sexual health

sexual fantasies and dreams

intimate relationships

life experiences as they relate to sexuality

spirituality as it relates to sexuality

“Our sexuality is not only a part of everything we do, it also influences everything we feel and everything we are.”

“Our sexuality makes us feel alive. It is one of the most vital elements of our personalities. It is a wonderful, empowering, and liberating part of being human.”

Quotes from Planned Parenthood All About Sex: A Family Resource on Sex and Sexuality, edited by Ronald Moglia, Ed.D. and Jon Knowles

Newman 4/08

Appendix E: What are your personal values?

Here is a short quiz to help you start thinking about your own values about sexuality and your infant(s). There are no right or wrong answers. The important thing is to think about your own beliefs and to determine the type of messages you want to give your children. You can check more than one answer.

When my child touches his penis/her vulva during a diaper change or at bath time, I...

move her/his hand and finish diapering or bathing quickly.

slap his/her hand and tell them, “That’s nasty.”

smile and say, “What a wonderful body you have!” and continue diapering or bathing.

let her/him play with her/his genitals for a while and then put the new diaper on or continue bathing.

other______________________________________________________________________________________________________

When it comes to dressing babies...

only girls can wear pink

only boys can wear blue

girls can wear clothes meant for boys

boys can wear clothes meant for girls

other______________________________________________________________________________________________________

When it comes to buying toys for babies...

only girls should have dolls

only boys should have trucks

boys and girls should have the same toys

other_________________________________________________

As I talk to my baby about his/her body during diaper changes or bath time...

I don’t mention their genitals

I use slang or made-up terms for their genitals

I use correct terms for their genitals

other_________________________________________________

adapted from Haffner, D. (1999). From Diapers To Dating Newman 4/08

Appendix F: What is infant sexuality?

“Sexuality develops naturally in all children.”

Everything you never wanted your kids to know about sex, Justin Richardson and Mark A. Schuster

From the moment they are born, infants are learning about...

Gender

Their bodies

Love & trust

What’s happening?

Gender—yes, boys and girls are different! But with babies, sometimes the differences are in the eyes of the beholder. Due to gender stereotyping, baby boys are often bounced more by their fathers and baby girls are often talked to more by their mothers. By 6 months old, babies can distinguish between male and female voices and between 12-18 months babies look longer at photographs of their own gender.

Bodies—infants are learning about their bodies through touch. Babies are learning that there is pleasure in physical closeness, in being held, in cuddling and touching. They smile and laugh when they are tickled. They are also experiencing spontaneous genital arousal (males are getting erections and females are lubricating and their clitorises swell). It is normal for babies to explore their bodies. Pleasurable genital self-stimulation often begins between 7-10 months of age (but can begin earlier or later). Some babies also have physical responses that look like orgasms.

Love & trust--- Infants feel loved and secure when they are held, touched, fed, washed, and diapered in a gentle, loving and caring way. When their needs are met, infants learn to trust their caregivers and the world around them.

What can you do to foster a positive healthy sexuality in your babies?

“The loving way you name and touch your child’s body can teach him that all of his/her parts are good, that physical closeness is both safe and wonderful, and that he/she is lovable. ” Everything you never wanted your kids to know about sex

“Talking to children positively about their bodies, puberty, and sexuality helps them develop a positive sexuality. Positive talk replaces embarrassment with pride. It replaces ignorance with knowledge and gives us comfort instead of discomfort. Positive talk also helps children learn to respect the sexuality of others.” Planned Parenthood All About Sex, edited by Ronald Moglia and Jon Knowles

Watch out for gender stereotypes. Allow your child to grow into the boy/girl they feel most comfortable being. Be aware of treating boy and girl babies differently.

Teach your children the correct terms for their genitals and the differences between boys’ and girls’ bodies.

When your infant is touching their genitals they are not “masturbating” in the adult sense. They are simply doing what feels natural and good. Do not shame them for it.

Love them, hold them, cuddle them, kiss them, tickle them, talk to them, look into their eyes, respond to their needs. A loving touch helps infants grow and develop.

Remember, you are your child’s first experience of love. This primary relationship will lay the foundation for all future love relationships for your child. Newman 4/08

Appendix G: Evaluation for “Having ‘the talk’ before they can talk ”

Name (optional) ____________________________ Date______________

On a scale of 1-5 rate each of the following statements:

Excellent to Poor 5 4 3 2 1

1. Objectives of the workshop were clear.

Excellent to Poor 5 4 3 2 1

2. Teaching methods were appropriate for the topic.

Excellent to Poor 5 4 3 2 1

3. Workshop content was clear & understandable

Excellent to Poor 5 4 3 2 1

4. Workshop materials were helpful.

Excellent to Poor 5 4 3 2 1

5. Instructor was well-prepared.

Excellent to Poor 5 4 3 2 1

6. Instructor established an open learning atmosphere.

Excellent to Poor 5 4 3 2 1

7. Presentation was effectively delivered and held my interest.

Excellent to Poor 5 4 3 2 1

8. How could this workshop be improved? For instance is there anything you think should be added or taken out?

9. Would you be interested in other workshops on children/teens and sexuality? If so, what specifically?

10. Additional comments?

Newman 4/08

Appendix H: Follow-up for “Having ‘the talk’ before they can talk ”

Name (optional) ____________________________ Date______________

1. Since attending the workshop, has your comfort level with your child’s sexuality changed?

Yes, I feel more comfortable

Yes, I feel less comfortable

No change, I am still uncomfortable

No change, I am still comfortable

Please explain:

________________________________________________________________________________________________________________________________________________________________________________________________________________________

Has your behavior related to your child’s sexuality changed? For example, has the way you refer to your child’s genitalia changed or the frequency with which your refer to your child’s genitalia? Has the way you respond if/when your child touches his/her genitalia changed? Please explain.

________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Any additional comments?

________________________________________________________________________________________________________________________________________________

Thank you for your feedback!

Newman 4/08