Prior to the gay liberation movement of the 1970's, homosexuality was classified as a mental disorder. In the 1970's, however, when psychiatrists were revising the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), they removed homosexuality from the list of illnesses. The third edition of the manual (DSM-III), published in 1980, reflected this change. Homosexuality is not associated with disordered thinking or impaired abilities in anyway. Therefore, counseling or therapy for the purpose of changing sexual orientation is not recommended. Even when sought, such therapy is rarely successful. On the other hand, many gays, especially adolescents, find benefit from counseling in order to find information, support, and ways to cope with their sexuality.
For men, sexual orientation seems to be fixed at an early age; most gay men feel that they were always homosexual, just as most heterosexual men feel they were always heterosexual. In women, however, sexual orientation is less likely to be fixed early; some women change from a heterosexual to homosexual orientation (or vice versa) in adulthood. In such cases, sexual orientation is better seen as a choice than as an acting out of something preexisting in the psyche, and often such changes are made after a woman has left an unhealthy or abusive relationship or has experienced some other sort of emotional or psychological awakening that changes her outlook on life. In these cases, counseling for the sake of changing sexual orientation per se is not recommended, but it may be appropriate for the woman to seek help dealing with the other changes or events in her life. Most women in this circumstance find that a same-sex, even lesbian, therapist is most helpful, because she will be likely to empathize with her client.
Many women who change sexual orientation in midlife already have children, and many who are lesbian from adolescence choose to have children by artificial insemination or by having intercourse with a male friend. Often, such women have found a lack of support for their parenting and sometimes experience legal problems retaining custody rights of their children. Gay men, too, have had difficulty retaining parental rights or becoming foster or adoptive parents.
Psychological research shows, however, that homosexuals are as good at parenting as heterosexuals and that they are as effective at providing role models. Homosexuals are more likely than heterosexuals to model androgyny—the expression of both traditionally masculine and traditionally feminine attributes—for their children. Some research has shown that an androgynous approach is healthier and more successful in American society than sticking to traditionally defined roles. For example, sometimes women need to be assertive on the job or in relationships, whereas traditionally, men were assertive and women were passive. Similarly, men are less likely to experience stress-related mental and physical health problems if they learn to express their emotions, something only women were traditionally supposed to do.
Neither modeling androgyny nor modeling homosexuality is likely to cause a child to become homosexual, and children raised by homosexual parents are no more likely to become homosexual than children raised by heterosexual parents. Similarly, modeling of androgyny or homosexuality by teachers does not influence the development of homosexuality in children and adolescents. Having an openly homosexual teacher may be a stimulus for a gay child to discover and explore his or her sexuality, but it does not create that sexuality.
Other variations in adult sexual expression, sometimes associated with or confused with homosexuality, are transvestism and transsexuality. Transvestism occurs when a person enjoys or is sexually excited by dressing as a member of the opposite sex. Some gay men enjoy cross-dressing, and others enjoy acting feminine. The majority of homosexuals, however, do not do either; most transvestites are heterosexual. Transsexuality is different from both homosexuality and transvestism; it is categorized by a feeling that one is trapped in a body of the wrong sex. Transsexuality, unlike homosexuality or transvestism, is considered a mental disorder; it is officially a form of gender dysphoria—gender confusion. Transsexuals may feel as though they are engaging in homosexual activity if they have sexual relations with a member of the opposite sex. Some transsexuals decide to cross-dress and live as a member of the opposite sex. They may have hormone treatments or surgery to change legally into a member of the opposite sex. Transsexuality, unlike homosexuality or transvestism, is very rare.
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