Although masturbation is harmless, guilt created by the disapproval and punitive attitudes of others may cause considerable distress and impair sexual performance. Since 1973, the American Psychiatric Association has not considered homosexuality a disorder. Like heterosexuality, homosexuality results from complex biologic and environmental factors leading to an almost inevitable preference in the selection of a sexual partner. For most, it is not a matter of choice. The fear of AIDS has resulted in a decrease in casual sex.
Most cultures discourage extramarital sexuality but accept premarital coitus as normal.
In the USA, most people have intercourse before marriage, as part of the trend toward more sexual freedom in developed countries. Well-informed physicians can offer sensitive, disciplined advice on sexual matters and should not miss opportunities for helpful intervention, remembering that sexual practices differ by culture and that the strength of the sexual drive, individual needs, and the frequency of sexual contact vary greatly. The etiology of psychosexual disorders is complex and varies greatly. Inherited or subtle constitutional factors probably play a part. A forbidding, puritanical rejection of physical sexuality, including touching, by a parent engenders guilt and shame in a child and inhibits his capacity for enjoying sex and developing healthy relationships as an adult.