Sexual behaviors occur throughout childhood. Early in life, male infants can have erections and female infants are capable of vaginal lubrication. During the preschool period, masturbation occurs in both sexes. Between 2 and 3 years of age, children identify themselves as a boy or a girl, but the understanding that one is always a male or always a female may not develop until 4 to 5 years of age. Stating that one wants to be a member of the opposite sex and pretending to be a member of the opposite sex are not unusual behaviors in this age group. Preschool children need to begin to learn that genitals and sexual behaviors are private; it is common for preschool children to touch their genitals in public, show their genitals to others, or undress in public. It would be highly unusual for a preschool child to imitate intercourse or other adult sexual behaviors. If this behavior is occurring, the child should be evaluated for exposure to inappropriate sexual material and possible sexual abuse (see Chapter 22).
Most elementary school–age children show a strong and consistent gender identity, and their behaviors (gender roles) reflect this. If a child this age is engaging in cross sex gender role behaviors, parents may be concerned about teasing and the possibilityof their child having a homosexual sexual orientation. This concern is particularly likely if a boy is engaged in effeminate behaviors that are generally viewed as less socially acceptable than a
Gender identity Perception of oneself as male or female Gender role Behaviors and appearance that signal to others of being male or female Heterosexual Sexual attraction to members of the opposite sex with weak attraction to members of the same sex Homosexual Sexual attraction to members of the same sex with weak attraction to members of the opposite sex girl acting as a “tomboy.” By this age, dressing as a member of theopposite sex and, particularly, stating a desire to be the oppositesex are uncommon, but playing with toys designed for the opposite sex remains common. In assessing parental concerns aboutatypical gender role behaviors, the type of behavior exhibitedand its consistency should be considered. Reassurance that thebehavior is consistent with typical development is appropriatewhen these behaviors are part of a flexible repertoire of male andfemale gender role behaviors. Reassurance is appropriate if thebehaviors occur in response to a stress, such as the birth of an infant of the opposite sex or divorce of the parents. In contrastif these behaviors occur as a consistent and persistent pattern ofnearly exclusive interest in behaviors typical of the gender roleopposite that of the child’s anatomic sex, referral for evaluationfor gender identity disorder (GID) would be appropriate.
The biologic, social, and cognitive changes during adolescence place a focus on sexuality. Becoming comfortable with one’s sexuality is one of the principal developmental tasks of this period and is likely to include questioning and experimentation. Almost half of high school students report that they have had sexual intercourse. Ten to 25% have at least one homosexual experience, with this behavior being reported more commonly by boys than girls. Although many adolescents have sexual experiences with a same-sex partner, only a few have a homosexual sexual orientation by late adolescence. When adolescents develop a consistent sexual orientation is probably affected by many different factors (societal, family, individual). Some adolescents report that they are certain of their sexual orientation in the early teenage years, whereas for others this does not develop until later. By 18 years of age, only a small proportion of individuals report being uncertain of their sexual orientation.