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Sex, Mental Health, and the Culture Wars

What happens when sex is more about identity than pleasure, intimacy, or interaction? And what happens when culture warriors gang up on sexuality—and from several directions? And has this affected our mental health? After over 40 years and 40,000 sessions with individuals and couples as a Licensed Marriage and Family Therapist and Certified Sex Therapist, I am growing alarmed at the changes I see taking place in our society— most notably, the prospects for using sexuality to nourish ourselves physically or emotionally are declining. Simply stated, sex is seen less and less as an activity that contributes to mental health. Instead, it’s increasingly seen as an abstraction, only vaguely related to the currently more important activity of establishing and policing identity.

Changing Definitions

Even though our culture today seems dominated by sexual issues, it isn’t really sex that many people have on their mind. These days, cultural conversations about sexuality often focus on issues such as skepticism regarding true consent in heterosexual sex, a huge expansion of the definition of trauma, the invention and legitimation of “sex addiction,” and newly imposed limits on when it is acceptable to express interest in sex with someone for the first time.

Many Americans increasingly seem to want to protect themselves from sex, rather than embrace it. Note that enthusiastically pursuing your sexual identity or orientation is not the same thing as embracing sexuality itself. And knowing what you don’t want is not the same as knowing what you do want.

In fact, many of the newly minted sexual identities and orientations are about not having sex: asexual (lacking in sexual attraction to others), graysexual (inbetween asexual and sexual), aromantic (little to no romantic feelings toward others), or lithromantic (can feel romantic love but has no need for those feelings to be reciprocated). When people talk about sexual identity, they’re referring less to what they do, and more to the community to which they belong. In fact, as Temple University’s Jennifer Pollitt says, “There is a huge difference between orientation, behavior, and identity. The sexual or romantic behavior you engage in does not necessarily correlate with the identity that you’re using to describe your experiences or orientation.”1

If behavior “does not correlate with identity,” then what is identity based on? And on what basis do individuals decide to accept their own erotic behavior? Until recently, the convergence of behavior and identity was considered an important aspect of mental health. Now, in addition to turning language on its head, this conception of sex seems to endorse “splitting” (black-and-white, all-or-nothing thinking), which most psychologists—from the most Freudian to the most modern—agree is psychologically harmful.

Those attached to gender discourse may use the language of sex, but what they’re really talking about is self-image and community, not sexuality. Their conversations are not about a dyadic connection with another, which has been, historically, considered a hallmark of adult development and mental health.


Not surprisingly, the two generations that have gone through puberty most recently indeed have sex less than previous generations of late teens and young adults. UCLA’s annual California Health Interview Survey is the country’s largest state health survey. In 2021, it found that the number of Californians ages 18–30 reporting no sexual partners in the prior year reached 38 percent,2 almost double the number a mere ten years earlier. This trend is, I submit, part of a larger society-wide mental health challenge.

With the ubiquity of internet, social media, and smartphones, young people are less interested in distraction-free, in-person relating. They don’t develop the necessary skills to create or enjoy it, which include patience, listening, fluency in social cues, reading the impact of what they say on others, and tolerating/ignoring the possibility that something interesting is happening somewhere else.

The demand to feel emotionally safe and unchallenged as much as possible interferes with intimacy as well. Readers will recognize countless instances of young people being “offended” instead of disagreeing, bristling at “microaggressions” and “cultural appropriations” that aren’t about them, and not wanting to debate those who view things differently. In addition, young people are now launching into adulthood later, so they don’t have as much privacy or money, and don’t aspire to being in a couple nearly as much. Consequently, one of the main things about sex—“it’s what you do in a dyad”—has less appeal. The current ease of masturbating to pornography exacerbates this by facilitating erotic experiences that are about seeing and imagining, rather than feeling physically and emotionally.

At the same time, many young people are self-identifying with new versions of sexual identity and orientation at higher rates than ever before. According to a 2022 Gallup poll, the percentage of U.S. adults who identify as something other than heterosexual has doubled over the last 10 years, from 3.5 percent in 2012 to 7.1 percent.3 The change is mostly seen among those age 30 and under.

Identity and Community

American society now instructs young people to express their ordinary alienation, angst, anxiety, identity concerns, and resentments in the language of gender (along with race). This automatically provides many of today’s youth with a community in which they can participate and to which they can belong. Naturally, almost everyone wants to feel that they belong to something—that’s part of mental health. Yet it’s easy to see that claiming membership in these various communities is not completely harmless.

The now-common insistence that everyone reveal their pronouns (i.e., their gender identity) in completely non-sexual environments (such as university lectures, medical settings, commercial websites, email signature lines, and social media profiles) is accompanied by the new insistence that anyone who prefers not to do so is declaring that they are unfriendly toward LGBT people. Little consideration is given to the possibility that someone might not consider their gender to be the most salient part of their identity (which, for example, might be their race, religion, ethnicity, or profession). Or that they feel it is a private matter and no one else’s business.

These communities can even harm one’s health in the form of permanent and irreversible interventions, such as puberty blockers and surgeries intended to change sex. Advocates for gender-affirming care have worked hard to portray it as lifesaving and suicide prevention by fearmongering with inflated statistics about suicidal ideation. But when researchers compared transgender youth with teens suffering from mental health problems, there was little difference in suicide rates between the groups. Transgender youth are not much more suicidal than teens with garden variety mental illness, which means that failing to affirm a child’s transgender identity does not drive suicidal behavior. A recent study analyzed data from the world’s largest pediatric gender clinic, the UK’s Tavistock, and found the rate of completed youth suicides to be 0.03 percent, which is hardly a suicide epidemic.4 In reality, very few youths who identify as transgender ever commit suicide. And it really is true that concerned parents are being fed false suicide statistics that misleads them into believing their child is likely to kill themselves if they don’t consent to puberty blockers, hormones, and surgeries for them.

Claims that scientific studies show clear mental health benefits of gender-affirming medical treatments for transgender youth are not supported by evidence. Some of the studies commonly touted as demonstrating positive mental health outcomes show no or possibly even negative association between administering hormones and mental health. Studies purporting to demonstrate mental health benefits are often misleading due to their short follow up durations, often spanning just a few months to two years. There is no long-term data on this experimental protocol, and it is typically within the 4–8 year range that individuals start expressing regret.

But frightened, unhealthy thinking about sexuality is not limited to any political or cultural viewpoint. As I detailed in my book America’s War On Sex,5 the conservative religious Right generally opposes whatever makes sex simpler, safer, more enjoyable, and easier to separate from stable monogamous relationships. Rather than focusing on healthy pleasure (including how satisfying sex supports stable marriage), they tend to focus more on the unhealthy aspects of sex, such as emotional danger, STIs, coercion and violence, and unwanted pregnancies.

The Right has always disliked the optionality and autonomy of sexual exploration, opposing unmarried women having easy access to birth control pills; fighting the availability of sex toys; and restricting TV advertising of products such as condoms and tampons. Today’s manifestation of this instinct now extends to banning books from public and school libraries; restricting gender medicine; banning private swing clubs; and requiring registration to watch internet porn (currently enacted in Utah, Virginia, and Louisiana, with a dozen more states pending).

Masturbation and Mental Health

Whether we like to acknowledge it or not, masturbation is the primary sex life of almost everyone. And how you manage and accept or reject this fact can have a large influence on your mental health. Masturbation typically involves fantasy, and so talk of masturbation inevitably turns to pornography. Unfortunately, commentators and activists of all ideologies seem to agree that viewing pornography somehow colonizes a viewer’s brain so that he (always a he) becomes a dangerous, amoral predator who wants to have sex with every woman except his own mate.

Whether our fantasies involve pornography or not, they reveal a common theme about humans— that privately, we’re all perverts.

In their 2011 book A Billion Wicked Thoughts,6 data scientists Ogi Ogas and Sai Goddam revealed the most common sexual terms among 400 million internet searches. Being coerced is by far the most common sexual fantasy of women. Large (i.e., taboo) age differences between partners is a very popular fantasy of both men and women. This tells us that people’s public pronouncements about others’ masturbation are mostly performative, designed to imply that “I’m moral, I’m not over-sexed, and I definitely don’t have risky sexual impulses inside me.”

The fear of sexual fantasy reaches its climax with the anti-masturbation and anti-pornography NoFap movement. It currently claims over 300,000 members, and its website logs almost two million monthly visitors. With an anti-science tradition stretching back to noncredentialed activist Gary Wilson and to Christian fundamentalism, the group claims a wide range of harms from masturbating and watching porn, and corresponding benefits in abstaining from them—without any valid empirical evidence.

Of course, some people do masturbate or use pornography in self-defeating ways, but they often have mental health struggles with, for example, OCD, depression, bipolar disorder, Asperger’s or autism, or borderline personality disorder.

While masturbation itself is not a prerequisite for mental health, vilifying it and obsessively struggling to maintain abstinence can undermine having a healthy mental life. Those compensatory behaviors tend to demonize one’s own sexual impulses, which are then often experienced as rage and shame—turned in on oneself (which typically leads to depression), or focused outward (as explosiveness or even violence). As Andrew Sullivan wrote, “the suppression of these core emotions [sexuality] and the denial of their resolution in love always leads to personal distortion and compulsion and loss of perspective.”7

Psychology, Sex, and Mental Health

American psychotherapy has never been comfortable or well-educated about sexuality—for example, you can get a license to practice without hearing the words “vibrator” or “oral sex” in your training. And now the profession has extended its distance from ordinary or positive sexuality by instead focusing more on trauma and identity while disparaging pornography. Meanwhile, it has no answer to common issues such as desire discrepancy, infidelity after the other partner has lost desire, purity culture, adolescent sexuality, or the impact of technology on sexuality.

Psychologists used to include sexual desire and satisfaction in their profile of mental health. Today, the focus regarding sex is about trauma, consent, sex addiction, porn addiction, love addiction, “emotional affairs,” and sexual identity and orientation.

As a profession, psychologists are refusing to challenge even the most extreme activists, instead abandoning kids and families to gender-affirming specialists. While psychology has extensively studied questions such as “Why can’t some alcoholics take even one drink a year?” and “What’s the difference between sadness and depression?” and “What predicts whether a couple will divorce?” it dares not touch tough questions such as “Why is ‘asexual’ suddenly a complex orientation rather than a simple preference?” or “If children can’t consent to sex with an adult, why are they competent to select their gender?” or “How do we account for concentrated clusters of young teens claiming they’re transgender or non-binary in certain schools, when there aren’t similar clusters across town?”

As a result, psychology has only limited tools in dealing with children or adults with questions about gender or orientation. Almost overnight, gender-affirming specialists have acquired great status and professional power.

But by validating even the extremes of gender choice, gender spectrum, and gender activism industry in schools, the media, psychology, medicine, and elsewhere, our society now encourages young people to express their ordinary alienation, angst, anxiety, identity concerns, and resentments in the language of gender. Wouldn’t it be better if young people would simply say “It’s my life!” instead of “I just discovered I’m gender queer and demand hormones and surgery.”

Sexual Intelligence

Despite all these issues we can be intelligent about sex. To that end, there are three dimensions to enjoyable sex: self-acceptance, communication, and emotional skills. Together, these make up what I call Sexual Intelligence. Despite the contrasting public policy and psychosocial goals of both the political Left and the Right, each side in the culture wars should promote Sexual Intelligence as a vehicle for both societal and individual mental health.

Sexual Intelligence enables individuals to make choices that fit their own values, create stable erotic partnerships, resist mass media messages of perfectionism, encourage thoughtful decision-making, and resist impulsivity while allowing for self-expression. These are all good for mental health. And they are contrary to aggressive activism, name-calling, discrimination, and feeling threatened by others’ choices, from any direction or worldview.

Sexual Intelligence also depends on recognizing that information itself is not the enemy. Talking about sexuality and asking questions does not equal discrimination or “violence.” Likewise, acknowledging that humans are a varied group is a simple acceptance of the fact that adults need the skills of getting along with each other—i.e., communication and respect.

That approach to sexuality would greatly promote the mental health of everyone. It would also help cool down the culture wars. Healthy sex, after all, benefits all of society. END

About the Author

Marty Klein has been a Licensed Marriage & Family Therapist and Certified Sex Therapist for 42 years—over 40,000 sessions with individuals and couples. Marty is an outspoken critic of many popular and clinical ideas about sexuality and emotional health; for example, he is regarded as the foremost critic of the concept of sex addiction. A former instructor at Stanford Medical School, Marty’s humor, insights, and down-to-earth approach are regularly featured in the national media, such as the New York Times, the New Yorker, and NPR. He is the author of seven books on sexuality, including Sexual Intelligence and Beyond Orgasm.


This article was published on March 1, 2024.

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