A brief history of sexology and lessons learned

The field of sexology, which entails the scientific and interdisciplinary examination of human sexuality, originated in Germany during the early 20th century.¹ To provide some historical context, the term Sexualwissenschaft (sexology) was coined by Iwan Bloch. In 1908, Bloch, with his colleague Magnus Hirschfeld, launched the inaugural sexological journal. The year 1919 witnessed the establishment of the first Institute for Sexology in Berlin, later known as the Hirschfeld Institute and thereafter associated with Humboldt University.² The institute’s motto was “Per Scientiam ad Justitiam” (Through Science to Justice). Additionally, in 1921 the inaugural international sexological congress was convened.^1-3

The genesis of sexology occurred during a period marked by notable societal shifts driven by the women’s rights movement and the concluding phases of the industrial revolution. Sexology embraced an interdisciplinary approach, challenging the constrained perspective of medical science, which predominantly examined sexuality through a pathologic lens. Trailblazers in early sexology, such as physicians Albert Moll, Max Marcuse, and Havelock Ellis, directed their efforts toward comprehending sexual variations and disorders. However, what distinguished early sexology from conventional medicine was its commitment to understanding the normality and healthiness of diverse forms of sexual expression.¹ These pioneers not only focused on scientific inquiry but also functioned as advocates for sexual reform, championing causes such as sex education, health care accessibility, and sexual rights.

It is noteworthy that a considerable number of early sexologists were Jewish. The Nazi regime in Germany targeted the field of sexology, denouncing it as “Jewish science,” which ultimately resulted in the dismantling of the Hirschfeld Institute by the Nazis in 1933. Many sexologists were compelled to flee Europe. The resurgence of sexology as a discipline occurred in the United States, largely propelled by the pioneering research of Alfred Kinsey.² In 1947, Dr Kinsey and his research team incorporated the Institute for Sex Research, with faculty of truly interdisciplinary scholars. The institute had 2 primary goals: to continue the team’s research on human sexual behavior and to administer research resources, including research materials, a library, case histories, and other related materials. Of note, 25 years after Dr Kinsey’s death, the Institute for Sex Research was renamed the Kinsey Institute for Sex Research in 1981 in his honor and today is known as the Kinsey Institute at Indiana University.

Building on the momentum from Dr Kinsey’s work, the first interdisciplinary scientific organization devoted to the study of sex was formed in the United States in 1958: the Society for the Scientific Study of Sex (SSSS). Notably, Albert Ellis, a prominent American psychologist, assumed the inaugural presidency. The name of the organization certainly reflected American’s ambivalence about the term sexology and viewing “sexual science” as a means of gaining legitimacy within academia and in public opinion. This society served as a professional home to many pioneering interdisciplinary sex researchers, with a large focus from social science researchers, while fostering interest among young scholars and students and serving as a vehicle for information exchange. As time went on, SSSS became more international in representation but remained mostly a US and Canadian member organization. SSSS founded the Journal of Sex Research in 1965, which continues today and remains one of our field’s premier sexological journals. In addition, the SSSS published the Annual Review of Sex Research (1990-2007). In 1978, SSSS changed its name to the Society for the Scientific Study of Sexuality, recognizing the importance of understanding and researching sex within the broader concept of sexuality as defined by the World Health Organization (WHO) in 1975.

The sexual revolution of the 1960s and 1970s provided further momentum to sex research, featuring influential figures such as Kinsey, Masters and Johnson, Benjamin, Money, Gagnon and Simon, and Bell and Weinberg,^4-11 who challenged conventional notions of “sexually healthy” practices.¹ This period witnessed a continued emphasis on an interdisciplinary approach in examining sexual expression, moving away from psychoanalytic treatment methods for addressing sexual dysfunction and disorders.

In 1975, amid the global expansion and revitalization of the field of sexology, the WHO released a technical document introducing a groundbreaking definition of sexual health. This definition underscored the importance of incorporating somatic, emotional, intellectual, and social elements into the framework of sexual well-being.¹² Additionally, it acknowledged the significance of sexual rights. This period witnessed a surge in international interest in sexology and sexual health, with Europe reestablishing its research centers on sexuality. The inaugural International Medical Sexology meetings took place in 1974 (Paris) and 1976 (Montreal). Subsequently, the World Association for Sexology (WAS) was founded during the third International Medical Sexology meeting in Rome in 1978. These gatherings were later renamed World Sexology Congresses and were sponsored by the WAS.

Simultaneously, global sexological entities started to thrive.^1,2 In 1974, the International Academy of Sex Research emerged, boasting a membership predominantly composed of individuals from North America and Europe. The academy inaugurated the Archives of Sexual Behavior in 1971 as its official journal, and it remains as one of our most prestigious sexological journals with an interdisciplinary and international focus. The Harry Benjamin International Gender Dysphoria Association, now known as the World Professional Association for Transgender Health, was established in 1979. These organizations, in alignment with the initial vision of early sexology pioneers, generally maintained their interdisciplinary focus.

Other more medically focused organizations were formed—reflecting a tension between seeing sexology as a legitimate science and leaning on medical science as the main frame of reference. For instance, the International Society for Impotence Research was formed in 1982, which mostly comprised surgeons. The society broadened its focus to become the International Society for Sexual and Impotence Research in 2000 and then the International Society for Sexual Medicine in 2006. In 2001, the International Society for the Study of Women's Sexual Health was formed to focus on women’s sexual health, which the Society for Sexual and Impotence Research perceived as being neglected. These more medically oriented organizations have broadened their membership over time and have attempted to become more interdisciplinary in understanding the complexity of sexual dysfunctions and disorders.¹³

The 1980s witnessed the emergence of the HIV pandemic, coinciding with advancements in technology and a heightened awareness of sexual and gender diversity as well as power dynamics. These factors underscored the necessity for a more profound comprehension of sexual practices. Furthermore, the field of sexology experienced a notable resurgence with the groundbreaking approval of Viagra in 1998, revolutionizing the treatment of erectile dysfunction. This prompted an increased call for public health initiatives addressing various sexual health concerns, encompassing HIV/STI prevention, sexual therapies, sexual violence awareness, and the implementation of comprehensive sexuality education.

In 2002, the WHO collaborated with the WAS, resulting in a significant development in the field by revising its definitions related to sex, sexuality, and sexual health. Notably, sexual health was recognized as being inseparable from the protection of sexual rights. A formal WHO working definition of sexual rights was established.¹⁴ This collaboration paved the way for the inception of a WHO program dedicated to advancing sexual health globally—an initiative that persists to this day.

In 2005, WAS underwent a transformative change, adopting the name World Association for Sexual Health (while maintaining the original acronym, WAS) to better reflect its expanded mission beyond the promotion of sexology, with the recognition that the field of “sexology” was not fully understood or accepted as a discipline globally. This broader mission encompassed areas such as sexuality education, clinical practice, sexual rights, and advocacy endeavors. This shift signaled a transition from a focus solely on sexology to a more holistic approach to sexual health. With this broader mission, WAS attempted to influence global health and human development policy by issuing a Declaration of Sexual Health for the Millennium in 2008, which underscored the crucial role of sexual health promotion in overall human development. This declaration aligned sexual health promotion with the UN Millennium Goals.¹⁵

Continuing these efforts, WAS launched World Sexual Health Day on September 4, 2010, with the aim of fostering global awareness of sexual health. Over the years, various themes have been explored, including the encouragement of open discussions on sexuality, the promotion of sexual health for a just society, and the acknowledgment of the significance of sexual pleasure.

As recognition grew that sexual health was integral to promoting overall health and well-being, WAS identified new threats and backlash to progress in sexual and reproductive health during this period. Consequently, WAS decided to strengthen the argument for sexual rights by issuing a revision of its 1999 Sexual Rights Declaration in 2014.¹⁶ The main advantage of this revision was its clear linkage to internationally recognized human rights standards.¹⁷ Emphasizing the pivotal role of sexual rights, the declaration stressed that all individuals are entitled to conditions that enable the exploration of their sexuality throughout their lives, within the framework of consensual and nonviolent interactions and relationships. A key aspect of promoting sexual health through the lens of sexual rights is the imperative for the decriminalization of consensual sexual behavior, irrespective of one’s sexual orientation, gender identity, or marital status. This approach is firmly rooted in the recognized principles of human rights of autonomy and bodily integrity, affirming an individual’s right to choose sexual partners and pursue and enjoy sexual pleasure while respecting the rights and freedoms of others.

Subsequently, in collaboration with the WHO, WAS played a significant role in the 2018 revision of the International Classification of Diseases, Eleventh Revision (ICD-11).¹⁸ Working alongside international member organizations, WAS successfully advocated for substantial revisions and updates in the classification of sexual dysfunctions, disorders, and gender incongruence. A noteworthy accomplishment was the depathologization of several previously labeled “disorders,” relocating numerous conditions from the mental health chapter to a new section in the ICD-11 named “conditions related to sexual health.” This transformative change was pivotal in emphasizing the interplay of biopsychosocial determinants of sexual and gender health conditions, destigmatizing these issues. Moreover, it conferred legitimacy and acknowledgment to sexual health by establishing a dedicated chapter within the ICD-11.

In 2021, WAS took another leap forward in advancing the sexual health agenda with the issuance of its Sexual Pleasure Declaration.¹⁹ This declaration places a strong emphasis on recognizing the essential role of sexual pleasure in promoting sexual health, comprehensive sexual education, service provision, and policy development. It called on public health authorities to acknowledge the significance of prioritizing sexual pleasure in efforts to address and prevent sexual problems. The declaration underscored pleasure as a crucial aspect of human sexuality, aligning with the definition set by WHO in 2002 concerning sexual health and sexual rights. To support this declaration, a technical guide was crafted, drawing on evidence from research, case studies, and practical insights, to demonstrate how sexual pleasure can be integrated as a central component of sexual health and rights initiatives.²⁰ At present, WAS is engaged in the development of a new Declaration on Sexual Justice, harkening back to the motto of the Hirschfeld Institute.

Overall, the WAS declarations mark significant milestones in the discourse surrounding sexual health and rights. They underscore the crucial recognition of sexual rights as a fundamental pillar for overall sexual well-being. The declarations champion the integration of sexual pleasure as a vital component in the promotion of sexual health and the formation of policies. Collectively, these statements reinforce the idea that sexual well-being encompasses not only physical health but also emotional and psychological dimensions, emphasizing the holistic nature of sexual health. Furthermore, they highlight the imperative role of advocacy by professional organizations in advancing sexual health as an essential determinant of overall health, rooted in interdisciplinary sexual science (sexology). Notably, the declarations stress the necessity of widespread dissemination of sexual knowledge and the availability of sexual health services for everyone.

While we have described a brief history of the resurgence and establishment of sexology through the establishment of institutes and professional organizations in the United States, it would be remiss to overlook the epistemological debates that emerged and have continued to serve as a backdrop to our ongoing understanding of human sexuality in general and in relation to sexual concerns and disorders. As Giami²¹ argues, the origins of sexology as a form of knowledge often served as a counterpoint to religion, legal studies, and medicine/biology. It combined Western models of knowledge with historical and non-Western ideas about love, sex, and eroticism. These epistemic shifts in the theories underlying sexology happened across 5 major waves.²¹ The first wave focused on pathology, deviance, and aberrations, as well as sexual problems, public health issues, morality, and population control. The second wave moved toward a focus on orgasm over procreation, with a rise in sex researchers such as Kinsey and Masters and Johnson. The third wave of sexology appeared in the form of sexual health, bringing in ideas around public health, sex education, programs, and interventions and a focus on risk prevention associated with sexual activity. Starting in the early 1990s, the fourth wave brought a focus on sexual health and a rise in pharmaceutical treatments for sexual problems. The fifth wave came toward the end of the 1990s with an emphasis on sexual rights and social emancipation, combatting discrimination based on sexuality and gender. With this history in mind, we can see these changes reflected in the thinking of the major sexologists across time.

Conclusion

So, what we have seen over the last 100 years is an incredible growth in our field. It is important to appreciate how far we have come. Advancement of the field of sexual health has been fueled by sociopolitical events and advances in science and technology. What began with the pioneering work of sexologists in the early part of the 20th century, a WHO technical document in 1975, the development of sexological organizations, the creation of sexual health declarations, and the formation of a new chapter in the WHO ICD-11 has led to an unprecedented recognition of sexual health as a critical component of overall health and well-being.

By focusing on sexology as a means to promoting sexual health as being essential to overall health and well-being, sexual scientists, educators, and clinicians are helping to create a better world. As a result, we have strong and vital sexological organizations, which continue to move our field forward. We have a plethora of sexological journals where we can publish our work. Sexual science research is increasingly being published in more general, mainstream scientific journals. Funding from national, international, governmental, and nongovernmental agencies and the pharmaceutical industry is at its height. Many sexual scientists have been welcomed into mainstream academic institutions. Our science informs public policy and laws.

But not all is rosy. Like periods in the past, there has been backlash against advances in sexual health. At present, we see threats to sexual and reproductive freedom, gender equality, and self-determination by political and conservative extremists.^22,23 Politicians around the world are employing populist strategies to gain power under the guise of restoring moral order—similar to the Nazi playbook. Science is seen by them as fake news. Sexual scientists are viewed as activists. This could not be more evidenced than by the decision of conservative legislators in the state of Indiana to successfully pass legislation to defund the Kinsey Institute in 2023. This legislative move threatened the link between Indiana University and the Kinsey Institute but was thwarted by Indiana University, which affirmed not only the Kinsey Institute’s continued affiliation with the university but also the importance of academic freedom and intellectual inquiry at Indiana University. But this was a clear example of the threats to our field today given current sociopolitical forces. Consequently, now is the time for all of us to redouble our efforts in supporting our professional organizations and/or joining advocacy efforts to preserve what we have gained and move the agenda forward.

Author contributions

E.C.: conceptualization-lead, project administration-lead, resources-lead, supervision-lead, validation-lead, writing–original draft-lead, writing–review and editing-equal. J.V.F.: conceptualization-supporting, project administration-supporting, writing–original draft-supporting, writing–review and editing-equal.

Funding

Jessie V. Ford acknowledges support from NIAAA (K01AA028532-01A1).

Conflicts of interest

None declared.