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Date vj iSLZQ.  
SEX KNOWLEDGE OF FRESHMEN AND SENIOR NURSING STUDENTS 
by * 
LOIS MARY WHEELER 
A professional paper submitted to the Graduate Faculty in partial 
fulfillment of the requirements for the degree 
of 
MASTER OF NURSING 
Approved: 
MONTANA STATE UNIVERSITY 
Bozeman, Montana 
August, 1970 
iii 
ACKNOWLEDGMENTS 
Sincere appreciation is extended to Mrs. Margaret Barkley, the 
Misses Virginia Felton and Rita Darragh, and to Dr. William Bliss for 
their generous assistance which made the completion of this paper 
possible. 
TABLE OF CONTENTS 
Page 
LIST OF TABLES   vi 
ABSTRACT  vii 
Chapter 
1. INTRODUCTION     1 
Statement of Problem   1 
Purpose           2 
Assumptions   2 
Methodology     2 
Limitations    3 
Definition of Terms     4 
Justification        5 
Summary     5 
2. REVIEW OF LITERATURE   7 
Introduction    7 
Cultural-Sociological Aspects of Sexuality  8 
Masturbation    14 
Homosexuality     17 
Contraception   18 
Influence of Religion   22 
Psychological Aspects    28 
Anatomy and Physiology   36 
Summary  40 
V 
Chapter Page 
3. ANALYSIS OF DATA  43 
Item and Question Analysis  49 
Comparison with Other Groups  54 
Summary   56 
4. SUMMARY s CONCLUSIONS s AND RECOMMENDATIONS  58 
Summary    58 
Conclusions   59 
Recommendations      62 
APPENDIX       63 
BIBLIOGRAPHY    84 
vi 
LIST OF TABLES 
Table Page 
1. Freshmen and Seniors X and Y Scores    44 
2. Rank Order Comparison of Freshmen and Senior Scores 
Test X  45 
3. Rank Order Comparison of Freshmen and Senior Scores 
Test Y   46 
4. All X and Y Scores   46 
5. X and Y Scores By Age  47 
6. X and Y Scores by Marital Status  47 
7. X and Y Scores by Population Groups  48 
8. X and Y Scores by Religion    49 
9. Comparison of Freshmen and Senior Nursing Students 
and 235 Female Counselees  54 
10. Comparison of Senior Nursing Students and 235 
Female Counselees    55 
11. Comparison of Freshmen Nursing Students and 235 
Female Counselees   56 
vii 
ABSTRACT 
Our Western society is preoccupied with sex. The nurse's 
role as health educator and resource person requires the use of sex 
knowledge to instruct others. An inquiry into the sex knowledge level 
of student nurses was deemed appropriate at this time to locate areas 
of strength arid weakness in order to establish guidelines for curricu¬ 
lum improvement. 
Two tests on sex were administered to sixty-eight freshmen 
nursing students in the fall of 1969 and to forty-two senior nursing 
students in the spring of 1970. One test was a sex knowledge inven¬ 
tory and the other examined knowledge of vocabulary and anatomy. 
Test results indicated a low level of knowledge in the fresh- 
uien class. Senior nursing students scored high in reproductive 
anatomy but their fund of sex information was meager. It was^con- 
cluded that students in a baccalaureate program are*not sufficiently 
well informed about human sexuality to function as health educators 
and resource personnel in this area. 
It was recommended that: (1) the nursing curriculum be 
revised to include course content in sex education, (2) anatomy, 
physiology, and obstetric text books be examined to insure recency 
of publication and authenticity of information, (3) a study be made 
to explore sex attitudes of nursing students, and (4) this study be 
replicated in another baccalaureate school of nursing. 
Chapter 1 
INTRODUCTION 
As long as man has Inhabited the earth he has had to come to 
terms with the drives and problems that occur because of his sexuality. 
The human being is free to use his sex not only for reproduction but 
also for his own enjoyment, both psychologically and physiologically. 
Due to our culture and mores the sexual relationship is often accom¬ 
panied by insecurity, fear and attitudes of guilt.^ The primary impor¬ 
tance of understanding human sexuality is to enable the individual to 
make responsible choices that will promote and sustain good physical 
and mental health. 
Statement of Problem 
As a school nurse I have been confronted with the contemporary 
problem of sex education. In my particular school system it was felt 
by a large number of teachers that the school nurses were the most 
qualified and most suitable persons to give instruction in sexuality 
because of their knowledge of anatomy and physiology, and because it 
was thought that they would be less embarrassed and more able to pre¬ 
sent sex education information to students. Upon evaluation our know¬ 
ledge and preparation was found to be inadequate for the task. A 
special class in sex education was arranged and offered by 
*Frank D. Cox, Youth, Marriage and the Seductive Society 
(Dubuque, Iowa: Wm. C. Brown Company, 1967), p. 8. 
2 
extension for school nurses and teachers by the University of Wyoming 
through their department of education. This experience caused me to 
speculate about the sex knowledge of nursing students. 
The problem was one of approach; (1) to determine the sex 
knowledge of freshmen and senior student nurses in a baccalaureate 
program, (2) to ascertain whether graduating seniors were adequately 
prepared to function as resource personnel or instructors of sex 
education, and (3) to gather accurate and pertinent data that could 
be used to establish guidelines for curriculum improvement. 
Purpose 
The purpose of this*investigation was; to (1) determine if 
students of a baccalaureate'nursing program were well informed about 
human sexuality and sufficiently knowledgeable in this area to instruct 
others, and (2) to locate areas of strength and weakness in order to 
improve curriculum. 
Assumptions 
The nurse’s role as a health resource person and teacher re¬ 
quires the use of knowledge to instruct others about human sexuality. 
Methodology 
The tools used in this survey were the Sex Knowledge Inventory 
Form X revised, and the Sex Knowledge Vocabulary and Anatomy Form Y> 
published by Family Life Publications, Incorporated, Durham, North 
3 
Carolina. Form X has a reliability coefficient of 0.88 and the 
validity is more suggestive than conclusive. Form Y has a reliability 
coefficient of 0.92. There was no information about the validity. 
Test X contains thirteen categories with varying numbers of questions 
in each. There is a total of eighty questions. Test Y contains three 
parts; the first two parts test a knowledge of anatomy and the third 
part tests vocabulary. There is a total of one-hundred questions in 
Test Y. 
Test X and Y were administered to eighty-six freshmen nursing 
students during fall quarter of 1969 and to forty-two senior nursing 
students during the spring quarter of 1970. Tests were purchased by 
the investigator. 
Limitations 
1. Not all freshmenutest scores could be used, as some stu¬ 
dents were unable to complete the tests in the time allowed. Sixty- 
eight X and Y tests were completed by freshmen. There were one- 
hundred-seventeen freshmen nursing students enrolled but only eighty- 
six volunteered for sampling. 
2. Of the seventy-six senior nursing students enrolled, 
forty-two volunteered for testing. 
3. There are no national norms for student nurses. 
4. Only knowledge is tested. 
4 
Definition of Terms 
For the purposes of this study the following population terms 
are arbitrarily defined, as there is no agreement among definitions in 
2 
sociology texts, geography texts, and encyclopedias. 
1. Rural in this paper connotes individuals residing on a 
ranch or farm. 
2. Small town means an aggregate population in one community 
of less than 10,000 inhabitants. 
3. Small city implies a population in one community setting 
of more than 10,000 but less than 25,000 persons. 
4. Suburban is a district outside of but adjoining a large 
city. 
5. Large city is defined as a community of more than 25,000 
people. 
6. Human sexuality. There are three elements involved in 
human sexuality. First, the genetic factors set the sexual pattern 
and define the general limits within which other factors may operate; 
second, the hormonal factor develops organs needed for the sex act and 
o 
Glenn T. Trewartha, Arthur H. Robinson, and Edwin H. Hammond, 
Elements of Geography, ed. John C. Weaver (5th ed.; New York? McGraw- 
Hill Book Company, 1967), p. 547. 
•’Unfortunately, there has been no general agreement among 
nations about what constitutes a city, so that the distinction between 
rural and urban is indefinite and variable." 
5 , 
increases their sensitivity for stimulation; and third, the psycho¬ 
logical factors essentially control the choice of sex object and the 
3 
intensity of sexual emotions in the human being. 
Justification 
In our Western world we are bombarded with sex daily. News¬ 
papers report crimes of sexuality, movies portray sex, advertisements 
appeal to sexuality and our literature’abounds with eroticism. 
Religious leaders discuss this topic in periodicals and from their 
pulpits. Because our society is so preoccupied with sex this investi¬ 
gation attempted to reveal the actual level of sex knowledge attained 
by students in a baccalaureate nursing program. 
SUMMARY 
Victorian reticence in regard to sexuality is rapidly dis¬ 
appearing from our contemporary social, religious and educational 
scene. Attitudinal changes are evident in the population. The trend 
is toward openness, awareness and a demand for sex education. The 
general public looks to the nursing profession for knowledge and 
instruction and it is one of the roles of the nurse to function in 
the area of sex education. 
•^William H. Perloff, Sexual Inversion, ed. Judd Marmor (New 
York; Basic Books, Incorporated, 1965), p. 67. 
6 
This study was relevant because of the preoccupation of our 
society wjlth.sex. Its purpose was to learn if students are well 
enough informed about human sexuality to instruct others, and to 
locate areas of strength and weakness in order to improve the nursing 
curriculum. The Family Life Publications testing sex knowledge were 
used as survey instruments. 
Chapter 2 
REVIEW OF LITERATURE 
INTRODUCTION 
Sexuality has always been of great concern to mankind and 
through the years much has been written on this subject. The medical 
profession, the clergy, anthropologists, sociologists and psycholo^ 
gists have been particularly interested in sexuality as it influences 
human behavior and interaction.- 
In 1961 Betty L. Cuthbert used the Sex Knowledge Inventory 
Form X to test sixty-seven nursing students at Johns Hopkins School 
of Nursing. In this survey the students had been in college nineteen 
months. As a result of the survey the curriculum was evaluated at 
Johns Hopkins and discussion periods on dating, courtship and marriage 
were added in the preclinical period. The test was then used as a 
teaching tool in obstetrics for discussion groups. A favorable 
4 
response was given by the students and instructors. 
One of the obligations of parents to their children is to 
give sex guidance throughout the years. The nurse may be called 
upon to increase the parents * information or work with them to 
formulate a plan. . . The nurse with others may work to improve 
the parents' attitude about sex. She may suggest books, pamphlets 
4 
Betty L. Cuthbert, "Sex Knowledge of A Class of Student 
Nurses," Nursing Research, X (Summer, 1961), 145-150. 
8 
and other material which is helpful for parents, giving them 
information and a proportionate increase in their self- 
confidence. 5 
In order for the nurse to be knowledgeable about sexuality, 
she should be familiar with some of the literature that has been pub¬ 
lished. Sociological, cultural, psychological, theological and 
physiological aspects of sexuality will be presented in the following 
sections of this paper as they contribute to and influence mans' 
behavior. 
CULTURAL-SOCIOLOGICAL ASPECTS OF SEXUALITY 
The social code pertaining to sexual behavior of children and 
unmarried adolescents in the United States is very restrictive. 
Pressure is constantly exerted to prevent any form of sexual behavior 
until marriage. A great deal more pressure is exerted on females than 
on males and premarital sex is condemned and sex knowledge is kept 
6 
hidden from children, lest it damage their moral character. Much of 
the sexual misery and inadequacy in Western culture today stems 
directly from the methods of child rearing urged on parents by Dr. 
Elizabeth Blackwell and other Victorians, and is still followed to a 
5 
Wayland J. Hayes and Rena Gazaway, Human Relations in Nursing 
(2d ed; W. B. Saunders Company, Philadelphia, 1959), p. 383. 
^Milton L. Barron, Contemporary Sociology (New York; Dodd, 
Mead and Company, 1964), p. 304. 
9 
considerable extent by many parents.^ 
Until World War I many authorities agreed that sexual feeling 
in young women was pathological and abnormal. Women were cautioned 
against the dire consequences of ’'self-abuse'1 which, it was asserted, 
would cause an undue amount of blood to flow to the genital organs, 
thus depriving other parts of the body of nourishment. This was pre¬ 
sumed to produce a diseased condition and to be the foundation for 
consumption, paralysis and heart disease, as well as weakening the 
g 
memory and making many lose their minds. 
Women's behavior is governed by a double standard of morality 
and.women are now caught in the process of social change. Cultural 
restraints hold them to traditional roles while new roles are offered 
by economic and social forces: moral principles comprise the social 
philosophy of a society and configurations are basic units of a social 
value system.^ 
Bogardus states that in most countries of the world the rural 
mind is essentially the underdeveloped mind; it has not been freely 
or fully stimulated; it has strong opinions, prejudices and religious 
^Edward M. Brecher, The Sex Researchers (Boston: Little, 
Brown and Company, 1969), p. 153. 
8 - 
Edward and Ruth Brecher, An Analysis of Human Sexual 
Response (New York: Signet Books, 1966), p. 129. 
9 
Barron, loc. cit. 
10 
faiths.10 
Social systems of rural people have fewer conflicting norms 
because they are influenced by fewer reference groups having varying 
11 
traditions and norms. Religion establishes group norms and ritual 
enforces the norms. The old ways are the right ways. United States 
rural society has been characterized by a less developed technology, 
a low level of literacy and education, social relationships limited 
to the local community, primary social relationships and a lack of 
12 
empathy or open-mindedness toward new roles. However, rural com¬ 
munities are now moving toward a more modern social system and the 
influence of contemporary sexual attitudes and practices is pene¬ 
trating these areas. The sexual emancipation of women and feminine 
freedom has caused the double standard of morality to start withering 
away. 
Han is the only animal who arrives at sexual maturity before 
he reaches social maturity. Society is protective of women in regard 
to reproductivity but punitive with respect to erotic aspects. In 
10Emory S. Bogardus, Sociology (New York: The MacMillan 
Company, 1950), p. 132. 
11Charles P. Loomis and J. A. Beegle, Rural Sociology: The 
Strategy of Change (Englewood Cliffs, N.J.: Prentice-Hall, Inc., 
1957), p. 84. 
12 
James H. Copp (ed.). Our Changing Rural Society: Perspec¬ 
tives and Trends (Ames: Iowa State University Press, 1964), p. 41. 
11 
societies where manifestations of strong sexual desire in women is 
penalized, it produces females whose sexual impulse seems inferior 
to the male. Women are just as quick to respond sexually as men, but 
it has been a time honored assumption that women are subject to less 
urgent sexual needs than men and this has led to a more strict control 
13 
of their conduct. 
In the Western world the interpretation of sex has been 
characterized by one of two outlooks: naturalism, which means a 
positive and accepting attitude toward the physical material world, 
including accepting sexual nature of man with gratitude and joy; or 
dualism, that regards the body merely as a tomb from which the immortal 
soul must be released with lust disciplined and extirpated. Hellenis¬ 
tic dualism contributed so heavily to Western civilization that it 
14 became the predominant pattern for behavior. 
Adultery has traditionally been condemned by religion, society 
and law. In cities where formal sanctions can be ignored, sexual 
inhibitions are being discarded and a deviant subculture is arising, 
which has come to be known as ’’The Swinging Scene.'• The ,,Swingers,, are 
13 Eberhard and Phyllis Kronhausen, The Sexually Responsive 
Woman (New York: Grove Press, 1964), pp. 16-19. 
14 William G. Cole, Sex in Christianity and Psychoanalysis 
(Oxford: Oxford University Press, 1966), p. 3. 
12 
generally middle class married couples who organize and attend parties 
with other married couples for the express purpose of sexual inter¬ 
course with each other’s partners. Of the 204 swinging couples sur¬ 
veyed, the chief characteristic was their inherent normality. 
Kinsey previously revealed that there was a high percentage of devia¬ 
tion from accepted moral standards of society. 
There are two generalizations that can be made concerning 
heterosexual coitus; it is the most prevalent form of sexual behavior 
for the majority of adults and it is rarely the only type of sexual 
activity indulged in. Cultural considerations of right and wrong 
exert a profound influence on sexual behavior. Copulation between 
males and females is biologically adaptive, as it promotes perpetua¬ 
tion of the species.^ 
Most of the preparatory activity that takes place between 
humans occurs on the symbolic level and may consist primarily of 
language responses; this is opposed to animals who are dependent upon 
direct body stimulation. Both man and animal indulge in some type of 
foreplay. There are two reasons for this: it enhances the probabil¬ 
ity that copulation will be attempted by increasing the level of 
15 
Brecher, op. cit., p. 254. 
16 
Clellan S. Ford and Frank A. Beach, Patterns of Sexual 
Behavior (New York; Harper and Row, 1970), p. 28. 
13 , ; 
excitement and it synchronizes the reactions of the male and female so 
17 
that copulation will be successfully completed. 
In all infrahuman species heterosexual intercourse is the 
most frequent form of sexual expression, although monkeys and apes 
18 
engage in other types of sexual habits in addition to copulation. 
In contrast with humans who assume a variety of positions, subprimates 
and terrestrial animals have sexual contact which always involves rear 
«. 19 entry. 
In nearly every human society and for all species of infra¬ 
human animals, sexual intercourse is generally preceded by sensory 
stimulation. In our own society some people indulge in a minimum of 
foreplay and others devote long periods of time to physical inti¬ 
macies prior to intercourse. Social level frequently determines the 
amount and kind of foreplay among people of the United States. Man¬ 
ual manipulation of the female breast occurs regularly in 96 percent 
of the histories of the married males of the upper level and manual 
manipulation of the female genitalia by the male is regularly found in 
20 
about 90 percent. Manual manipulation of the female breast occurs 
17Ibid., p. 52. 18Ibid., p. 29. 
19Ibid., p. 41. 
20 ^ 
Alfred C. Kinsey, Wardell B. Pomeroy, and Clyde E. Martin, 
Sexual Behavior in the Human Male (Philadelphia; W. B. Saunders 
Company, 1948), p. 367. 
14 
in only 79 percent of married males at low levels and manipulation 
of the female genitalia occurs in only 75 percent of the cases. Many 
persons in the upper levels consider a certain amount of oral eroti¬ 
cism as natural, desirable and a fundamental part of love making. 
Eighty-seven percent of the upper social levels use the deep kiss as 
a prime source of arousal, but the lower level male considers such 
oral contacts to be dirty, filthy and a source of disease. Mouth- 
breast contact occurs at all social levels but predominates at the 
upper levels. Mouth-genital contacts are quite common in the sexual 
21 
activity of many other mammals, especially anthropoids. In college 
educated men 72 percent of the males had at least experimented with 
such contacts. Males who have never gone beyond eighth grade had an 
22 
accumulative incidence of 40 percent of oral-genital contacts. 
"Western sphincter morality" is a learned response to powerful 
aversions to human waste products and odors. After women overcome 
conditioned embarrassment, shame, and guilt they find oral-clitoral 
23 
stimulation very pleasurable. 
Masturbation 
Masturbation commonly involves handling, rubbing or mouthing of 
21 22 Ford, op. cit., p. 62. Kinsey, op. cit., p. 371. 
23 Kronhausen, op. cit., p. 160. 
15 
the genitals and is considered a perversion by some members of our 
society, Michael Balint classifies perversions as: (1) homosexual 
aberrations, which can range from the beautiful to the hideous, 
(2) sadism and masochism, (3) exhibitionism and voyeurism, (4) fetish¬ 
ism, which is a turning away from a living object and replacement by 
something inanimate, (5) transvestitism and (6) bestialism. Balint 
says this occurs for want of something better, a low I.Q., no oppor¬ 
tunity or no hope of finding human partners. His last category is 
necrophilia and use of immature children. He considers these mani¬ 
festations of sexuality to be a psychosis rather than a perversion. 
He defines perversions as creating a high state of excitement without 
gratification.^ 
Ninety-two percent of American males masturbate to orgasm at 
least once during their lives and this is the chief source of sexual 
outlet for males until adolescence. Males of lower educational levels 
are more apt to replace masturbation with heterosexual coitus at 
25 
adolescence and are more likely to consider masturbation perverted. 
Self-stimulation is not limited to the masculine sex in our 
society. Victorian accounts advocated amputation or cautery of the 
24 
Michael Balint, "Classification of Perversions," Perversions, 
Psychodynamics and Therapy, ed. Sandor Lorand, M.D. (New York: Random 
House, 1956), pp. 17-19. 
25 
Kinsey, op. cit., p. 499. 
16 
clitoris, straitjackets to make the genitals inaccessible to the hands, 
chastity belts, sewing the vaginal lips together to put the clitoris 
out of reach and surgical removal of the ovaries for correcting female 
masturbation.^ 
Although adult masturbation is generally frowned upon by most 
societies, a different attitude is often taken toward auto-genital 
stimulation by children. Nursing texts advise that if genitals are 
kept clean and free from irritation, masturbation must be regarded as a 
normal phase of development. It is an unimportant aspect of childhood 
behavior and the child should not be condemned, threatened, punished or 
restrained, as it arouses fears and promoted secrecy and guilt 
feelings. 
Evidence suggests that adults in other societies rarely ever 
engage in auto-genital stimulation. The Crow Indians interpret mastur¬ 
bation by an adult as a confession of inability to obtain a lover, and 
28 it is something of which a man or woman should be ashamed. 
In some subhuman primates it is obvious that masturbation is 
performed with the express purpose of producing an orgasm. Male apes 
26 
Donald W. Hastings, M.D., "Can Specific Training Procedures 
Overcome Sexual Inadequacy?" An Analysis of Human Sexual Response, 
ed. Ruth and Edward Brecher (New York: Signet Books, 1966), p. 232. 
27 
Inez L. Armstrong and Jane J. Browder, The Nursing Care of 
Children (Philadelphia: F. A. Davis Company, 1964), p. 323. 
28 
Ford, op. cit., p. 163. 
17 
and monkeys stimulate themselves manually, orally, or by rubbing the 
penis against some object. Masturbatory behavior is less frequently 
observed in females of all species and never produces a clear cut 
29 
climactic result as in males. 
Homosexuality 
Our society disapproves of homosexuality and most communities 
have strict laws for punishing this type of behavior in the male. The 
legal code in this matter does not usually pertain to females. Four 
30 
percent of white males in this country are exclusively homosexual. 
Males identify each other by exchanging glances. If the man being 
glanced at catches and holds the glance and returns it, he is also a 
homosexual. The majority of male contacts are made by "cruising" in 
bars and are one night stands. 
The attitude of Americans toward female homosexuality is char¬ 
acterized by disregard. In some societies there is approval of homo¬ 
sexuality. Among.the Siwans of Africa all men and boys engage in anal 
intercourse. Keraki bachelors of New Guinea practice sodomy. Among the 
Australian'Aranda women stimulate each other's clitoris. The Nama 
31 
women in Africa use an artificial penis in mutual masturbation. 
Bachelor baboons who have restricted opportunities for contact 
29 30 
Ford, op. cit., p. 168. Kinsey, op. cit., p. 651. 
”^Ford, op. cit., pp. 139-141. 
18 
32 
with females sometimes have homosexual relationships. There are 
recorded instances of homosexual relations in female primates, but 
this behavior is not noted as frequently as in the male. 
Homosexual activity has been described for all species of 
mammals. Behavior of this type is so common in domestic animals that 
it goes unnoticed unless it is used as an indication of the estrus 
* 33 
cycle. 
Contraception 
Contraception has been practiced in one form or another since 
ancient times in an effort to control family size. One method of 
birth control technique that has been used for centuries is coitus 
interruptus and another is sexual abstinence. The population explo¬ 
sion and the fact that two-thirds of the human population live under 
conditions of poverty, hunger and disease reflect urgent need for 
reliable contraception. 
In 1961 the National Council of Churches decreed that couples 
are free to use the gifts of science for conscientious family limita¬ 
tion and to provide means that are mutually acceptable, noninjurious to 
health and appropriate to the degree of effectiveness required in a 
32 
Ford, op. cit., p. 143. 
33 
Judd Marmor (ed.), Sexual Inversioh (New York; Basic Books, 
Inc., 1965), p. 38. 
19 
specific situation. Motives rather than methods are the primary 
moral issue. 
At the Lambeth Conference in 1958 the Anglican Communion 
stated that the means of family planning are matters of clinical and 
aesthetic choice, if admissable to Christian conscience. 
The Roman Catholic Church declares that artificial methods of 
birth control are immoral because they frustrate one of the natural 
ends of the marital act, procreation of children. 
The condom can be traced to primitive societies. In pre¬ 
historic caves, sketches of men and women engaged in intercourse 
depict the male seemingly using some form of a sheath. Ancient 
Romans used the bladders of animals for this purpose and the Chinese 
used sheaths of oiled silk. Today the condom is a thin strong sheath 
made of rubber or a synthetic material and is widely used throughout 
the world. The sheath fits tightly over the male's penis and, when 
correctly used, is very reliable. 
Oral contraceptives contain hormone-like substances which 
enter the blood stream and prevent ovulation. Generally one pill is 
taken daily for twenty days on a precise schedule during the menstrual 
cycle. The pills are available through prescription only. The pill is 
34 
"Birth Control," Encyclopaedia Britannica (1969), III, 707. 
20 
a very dependable method of contraception and can be used success¬ 
fully by women of little education and low intelligence. 
The diaphragm and jelly was first used in Germany in the 
1880's. The diaphragm is made of soft rubber mounted on a flexible 
metal rim. It is placed in the vagina to cover the cervix, which pre¬ 
vents pregnancy by blocking passage of semen to the uterus. When 
properly fitted by a physician and used according>to instructions 
it is very effective. Highest protection is achieved when the 
diaphragm is used in combination with spermicidal jelly. 
The cervical cap, which may be made of plastic or metal, fits 
snugly over the cervix. It is smaller than the diaphragm but acts in 
the same way to stop passage of semen. It must be fitted by a 
physician. It has a high rate of effectiveness. 
The inter uterine device is made of an inert material molded 
into shapes such as spirals, loops, and circles and are about 20 to 
30 mm. in diameter. The inter uterine device is inserted into the 
uterine cavity by a physician and left in place until a pregnancy is 
desired. It is thought to prevent the fertilization of the ovum. The 
special advantage of the inter uterine device is that only one contra¬ 
ceptive act is required for lengthy protection. 
Spermicidal compounds in the forms of foams, jellies and 
creams are injected into the vagina before each act of intercourse 
by means of a slender plastic applicator. This type of contraception 
21 
35 is not as reliable as methods mentioned above. 
The rhythm method of contraception is. traceable to prehistoric 
societies based on some coincidental but causally unrelated pheno¬ 
menon, such as phases of the moon. Until the twentieth century any 
success with this technique must have been accidental because of the 
general Ignorance about the sensitive menstrual-ovulatory timetable 
upon which it depends. The method requires sexual abstinence during 
the fertile period, those days just before and after ovulation when 
impregnation is most likely to occur. Even with medical guidance the 
rhythm method is difficult for many women to employ because their 
cycles are irregular. Precise records of menstruation and temperature 
changes are utilized to help pinpoint expected ovulation dates. 
Statistically, this method has been found to fail substantially more 
often than the techniques previously discussed. 
Coitus interruptus dates back almost to the beginning of 
recorded history. Conception is avoided by withdrawal of the penis 
before ejaculation. Withdrawal may often fail if the action is not 
completed in time. Precise timing is complicated by the fact that 
small amounts of semen sometimes may be emitted before the male climax. 
Rigorous self-discipline is required and coitus interruptus is not 
always a successful method. 
35 Ibid., p. 708. 
22 
The emerging consensus on world needs for limiting the growth 
of human numbers was expressed in a broad social context by an inter¬ 
national group in 1960. In a statement presented to the United Nations' 
secretary general, they said, 
Unless a favorable balance of population and resources is 
achieved with a minimum of delay, there is a prospect of human 
misery, famine, uaadereducation and unrest which could generate 
growing panic exploding into wars fought to appropriate the 
dwindling means of survival. We believe that widespread, 
effective and voluntary use of medically sound birth control is 
essential.36 
INFLUENCE OF RELIGION 
As Bogardus states, there is a relationship between the rural 
community and religious teachings (see page 9). Since Montana is an 
essentially rural state it would be expected that students' attitudes 
toward sexuality would reflect opinions, prejudices and inhibitions 
of religious teachings. In some religious groupings a high value is 
placed on the suppression of the sex drive. The implication is that 
this drive can then be sublimated into religious expression. Love and 
religion have a close association and the standards for sex conduct 
37 
come from religious sources. 
Calvin attempted controlling sexual drives and this led him 
36Ibid., p. 709. 
37 John W. Drakeford, Psychology in Search of a Soul (Nashville: 
Broadman Press, 1964), p. 107. 
23 
into moralism and legalism which are considered the parents of pru¬ 
dery. Luther thought that sex was inevitable but he was not convinced 
, , , 38 
that it was good. 
Bishop Fulton Sheen sought to interpret sex as a positive 
force, natural and acceptable but the undertones of dualism in Roman 
Catholic thought and practice render this a difficult task to carry 
39 
through consistently. 
The idea that man has more libido than he can handle seems to 
be a remnant of the prejudice against sex for pleasure. Contemporary 
protestant theologians, Brunner and Niebuhr, regard shame as intrinsic 
to the human situation and explicitly deny that it springs from 
40 
cultural conditioning. 
No elaborate sex code can be developed from the teachings of 
Jesus, but from the total message of revelation a general sex ethic 
emerges. This approach reveals that sex is not an evil, but that it 
is good and necessary. Sex is one of God's many gifts to man and a 
part of man's total personality. Sexual intercourse may be an expres¬ 
sion of tender, spiritual love between husband and wife.^*- 
During the time of the writings of the Old Testament the 
38 
Cole, op. cit., p. 131. 39 Cole, op. cit., p. 159. 
40. 
Cole, op. cit., p. 194. 
^Slenlee H. Barnette, Introducing Christian Ethics 
(Nashville; Broadman Press, 1961), p. 117. 
24 
Jewish people, who were originally nomadic and who had recently 
turned to an agrarian way of life, considered the daughter of the 
family as an economic asset and a part of the father's property. As 
such she was to be respected. As a prospective wife and mother she 
brought a good marriage price. If she were damaged goods she lost 
her merchandise value. Therefore, the laws of the ancient Jews were 
stringent and punitive in regard to premarital sex.^ 
Prostitution is noted in the Old Testament and many warnings 
are given against harlotry: 
Her house is the way to hell, going down to the chambers of 
death. 3 
The New Testament condemns prostitution and sexual activity 
outside of marriage but Jesus himself forgave prostitutes. 
Adultery was viewed as a serious sin in the Old Testament 
because of the great concern for the family and bloodlines. The word 
is brief, "Thou shalt not commit adultery."^ The New Testament is 
more verbose and more rigorous: 
Ye have heard that it was said by them of old times, Thou 
shalt not commit adultery: 
But I say unto you, that whosoever looketh on a woman to lust 
after her hath committed adultery with her already in his heart. 
^^illiam Graham Cole, Sex and Love in the Bible (New York: 
Association Press, 1959), p. 237. 
43 ^ 44 
Proverbs 7:27. Exodus 20:14. 
25 
It has been said whosoever shall put away his wife let him 
give her a writing of divorcement. 
But I say unto you, that whosoever shall put away his wife 
saving for the cause of fornication causeth her to commit 
adultery: and whosoever shall marry her that is divorced 
committeth adultery. • 
Homosexuality has existed from earliest times and some 
societies have tolerated it, some have encouraged it and some con¬ 
demned and punished it severely. The Hebrews and the early church 
felt that homosexuality was a sin and crime and this viewpoint has 
continued through Christianity to modern times. The first mention of 
homosexuality in the Bible occurs when two angels stayed at Lot's 
house in the town of Sodom and the males of Sodom came to Lot's resi- 
46 dence demanding to "know" the angels. The word sodomy is derived 
from this incident. Judges 19 has a similar story, Deuteronomy 
23:17-18 and Leviticus 18:20 deal with homosexuality. The penalty 
was death. 
Transvestism is dealt with in the Bible as follows: 
The woman shall not wear that which pertaineth unto a man, 
neither shall a man put on a woman's garment: for all that do 
so are abomination unto the Lord thy God.^ 
Masturbation is referred to in a questionable manner and deals 
with the story of Onan and his widowed sister-in-law, Tamar. According 
to the law of the Levirate marriage, it was Onan's duty to impregnate 
45 46 47 Mathew 5:31-32. Genesis 19. Deuteronomy 22:5. 
26 
the childless Tamar. Onan was unwilling and "spilled his seed on the 
48 
ground." This act could be interpreted as coitus interruptus or as 
masturbation. The Catholic Church believes that the story may be 
applied to either or both acts and condemns them as unnatural and as 
mortal sins. Protestants have traditionally been in agreement with 
49 
Rome in opposing both acts. 
Rape is mentioned in Genesis 34, which gives the first Bibli¬ 
cal accounting of this act. Judges 21 also contains a reference. 
Incest is the most widespread sexual taboo and is found in 
nearly every culture. However, the two daughters of Lot had an 
incestuous relationship with their father. This was not disapproved 
of nor punished, as there were no other men available to perpetuate 
the family name and Lot was excused because he was intoxicated at 
the time."^ 
Bestiality was a common and troublesome problem, probably due 
to the agrarian culture of the ancient Jews. Exodus 22:19 says, 
"Whoever lies with a beast shall be put to death." Leviticus 20:15 
states, "If a man lies with a beast, he shall be put to death: and 
you shall kill the beast." Leviticus 18:23 continues, "Neither shall 
any woman give herself to a beast to lie with it: it is a perversion." 
48 49 
Genesis 38: 1-11. Cole, op. cit., p. 297. 
"^Genesis 19: 30-38. 
27 
Since the Bible treats the whole range of human sexuality, 
some students will be familiar with the aforementioned quotations. 
Those students adhering to fundamentalistic principles will, by their 
religious instruction, have a different viewpoint on sexuality than 
those students who have come from homes where religious interpretation 
is more liberal or even absent from the family circle. 
A Vatican Two Decree is a solemn conciliar utterance setting 
forth the Roman Catholic church's present understanding of its own 
nature. This document was accepted and promulgated by Pope Paul VI, 
51 
November 21, 1964. The Vatican Two Decree on Education states. 
Parents must be acknowledged as the first and foremost 
educators of their children. Their role as educators is so 
decisive that scarcely anything can compensate for their failure 
in it. For it devolves on parents to create a family atmosphere 
so animated with love and reverence for God and men that a well 
rounded personal and social development will be fostered among 
the children. 
The Council further states that, ’’As they advance in years, they 
52 
should be given a positive and prudent sexual education." 
The basic purpose of all sex knowledge is to help the indi¬ 
vidual to a fuller knowledge of himself as a person. 
^Hfalter M. Abbott, S.J., (eds.). The Documents of 
Vatican II (New York: An Angelus Book, 1966), p. ll. 
^^Rev. James T. McHugh, "Sex Education Basic Teaching 
Attitudes," Religion Teacher's Journal, II (July, 1969), pp. 16-17. 
28 
PSYCHOLOGICAL ASPECTS 
Regardless of how much sex may be banalized in our society, 
it still remains the power of procreation, the drive which per¬ 
petuates the race, the source at once of the human being’s most 
intense pleasure and his most pervasive anxiety. It can, in its 
daimonic form, hurl the individual into sloughs of despond, and, 
when allied with eros, it can lift him out of his despondency 
into orbits of ecstasy. 
Rollo May also stated that sexual freedom, because it involves 
the responsibility of choice, increases internal anxiety and guilt. 
Preoccupation with one's own performance and concern with orgasmistic 
proficiency create conflicts that contribute to the depersonalization 
and mechanization of sexual union. ’’Enlightenment" is an escape from 
53 
the anxiety involved in an imaginative and passionate relationship. 
In contrast Freud stated that inhibitions are related to 
functions and noted a relationship between inhibition and anxiety. 
He felt that the sexual function is specifically related to inhibi¬ 
tion and that disturbances of sexuality in men consist of a turning 
aside of the libido at the initiation of the act, absence of physical 
preparedness, suspension of the act before its natural culmination 
5A 
and the non-occurrence of the psychic effect. Since the ego is the 
53 
Rollo May, Love and Will (New York: W. .W. Norton and 
Company, Inc., 1969), pp. 38~43. 
54 
Henry Alden Bunker, M.D. (trans.). The Problem of Anxiety, 
by Sigmund Freud (New York: W. W. Norton and Company, Inc., 1936), 
p. 12. 
29 
locus of anxiety, repressed impulses automatically become converted 
into anxiety. Freud found that coitus interruptus, frustrated excite¬ 
ment, and enforced abstinence give rise to outbreaks of anxiety and a 
general predisposition to anxiety which may be induced whenever 
sexual excitation is inhibited, frustrated or diverted in the course 
of its gratification. Disturbances of the libido become converted 
into anxiety.**"* In other words anxiety neurosis is caused by repeated 
experiences of sexual arousal terminating in frustration rather than 
fulfillment. In a Victorian world Freud provided enlightenment and 
made it possible and permissible for people to think and talk about 
sex. 
Havelock Ellis recognized that normal gratification leads 
directly to the social sphere, as it involves another person. This 
encroaches upon the sphere of morality, "As no one is entitled to seek 
his own good in any line of action which involves evil to other 
S6 
persons." Ellis did not consider masturbation in children as per¬ 
verted and thought it was natural when the adult was deprived of 
normal heterosexual outlets.**^ He thought that tight lacing of 
55Ibid., p. 40. 
"^Havelock Ellis, Psychology of Sex (New York: A Mentor Book, 
1938), p. 13. 
57Ibid., p. 80. 
30 
58 
corsets contributed to masturbatory practices. It was a commonly 
held belief in that era that masturbation led to insanity. Ellis 
59 
regarded homosexuality as having congenital origins. He stated that 
transvestism was associated with homosexuality and named it "Eonism," 
He postulated that too close attachment to the mother encourages the 
60 
appearance of Eonism. In regard to frequency of intercourse Ellis 
realized that there were widely divergent needs and that the individual 
should follow his own course of action. However, he did state that 
the physical and spiritual benefits may tend to be lost by frequent 
61 
repetition. He made the observation that variations of posture in 
the sex act were not unnatural and vicious as was commonly supposed in 
his generation. Ellis liberalized thinking on this subject and 
dignified man's sexuality. 
Adler agreed that sexuality exists very early in life but he 
felt that children should be distracted from any manifestation of 
sexuality and that they were specially stimulated by pictures, books 
and movies. He stated that the inferiority complex was the core of 
62 
sexual abnormalities. Children with an inferiority complex grow up 
58Ibid., p. 94. 59Ibid., p. 174. 
60Ibid., p. 179. 61lbid., p. 213. 
62 
Alfred Adler, The Science of Living, ed. Heinz L. Ansbacher 
(Garden City, New York: Anchor Books, 1969), p. 126. 
31 
confusing their sexual desire with the desire for conquest and 
superiority. Overstressed sexuality is significant among the per¬ 
verted because they exaggerate their tendencies as insurance against 
having to face the problem of normal sex life. He further stated that* 
in addition to childhood environment Which is reflected in the life 
style, political and economic conditions have an influence on sexual- 
ity. ^ He felt that sexual excesses lead to disharmony of sexual 
activity. He disagreed with Freud that a suppressed libido is the 
cause of a neurosis. He posited that neurotic persons do not find 
64 their proper sex expression. 
According to Fromm, since sexual desire is associated in the 
minds of most people with love, they are easily misled in concluding 
that they love each other when they only desire each other physically. 
Sexual desire can easily blend with and be stimulated by any strong 
emotion, examples include the anxiety of loneliness, the wish to con¬ 
quer or be conquered, vanity, and the wish to hurt as well as to love. 
Love is supposed to be a spontaneous emotional reaction but it is a 
decision, a judgment and a promise. Love is not the result of ade¬ 
quate sexual satisfaction, but sexual happiness is the result of 
love. J Fromm believes that the most frequent sexual problems, 
63Ibid., p. 128. 64Ibid., p. 130. 
65 Eric Fromm, The Art of Loving (New York: Bantam Books, 
1956), p. 45. 
32 
frigidity and impotence, are caused by inhibitions which make it 
impossible to love. If a sexually inhibited person can emerge from 
fear or hate and become capable of loving, his or her sexual problems 
are solved. If not, no amount of knowledge about sexual techniques 
• gg 
will help. In a somewhat contradictory statement Fromm character¬ 
izes modern man as unable to postpone the satisfaction of wishes and 
as needing to consumate sexual desires immediately. He further 
mentions that this lack of inhibition leads to the paralysis and 
destruction of the self and that sexual appetite may not be as 
67 
natural as it is supposed. 
Eleanor Hamilton states that sexual communication is one of 
the most sensitive acts requiring positive knowledge and practiced 
skill. We are not born sexual artists. Sexual communication is 
stimulated and carried on in an atmosphere of approval and mutual 
involvement in each other's well being. Caressing words are powerful 
stimulants. Words should express appreciation of the sex organs. 
The verbal caress is the touch of love. Non-verbal sexual communica¬ 
tion includes what is said with the eyes; they may be passionate or 
frozen. The body also communicates. The art of touch says, "You 
66Ibid., p. 75. 
^Eric Fromm, The Sane Society (Greenwich: A Fawcett Premier 
Book, 1955), pp. 148-149. 
33 
are liked."^ 
Viktor Frankl suggests that love is not interpreted as a 
mere epiphenomenon of sexual drives and instincts but that love is as 
primary a phenomenon as sex. Normal sex is a mode of expression for 
love and sex is justified, even sanctified, as soon as, but only as 
long as, it is a vehicle of love. Love is not to be understood as a 
mere side effect of sex. Sex is a way of expressing the experience 
69 
of that ultimate togetherness that is called love. 
Maslow states that one can accept and enjoy one's needs and 
welcome them to consciousness if a past experience with them has been 
rewarding and if present and future gratification can be counted on. 
This is as true for thirst, sleep and dependency needs as for sex 
needs. He says that if needs constitute tensions, they are pleasur¬ 
able tensions and should be self-actualizing.^ The gratification 
of primary needs causes the emergence into consciousness of higher 
needs. 
68 
Eleanor Hamilton, "Sexual Communication," Counseling in 
Marital and Sexual Problems, ed. Richard H. Klemer (Baltimore: The 
Williams and Wilkins Companyi 1965), pp. 177-181. 
69 
Use Lasch (trans,), Man's Search For Meaning, by Viktor E. 
Frankl (New York: Washington Square Press, Inc., 1959), p. 177. 
70 
Abraham H. Maslow, Toward A Psychology Of Being (2d ed.; 
Princeton: D. Van Nostrand Company, Inc., 1962), pp. 30-31. 
34 
May proposes welcoming the body back into the union with the 
self. Sexual feelings are particularly significant because they are 
among the earliest feelings used by the child in self-identity. Un¬ 
fortunately sexual feelings have been widely tabooed in the past in 
our society and the child has been led to believe that such feelings 
are "naughty.” Since feelings are a part of the child^ identity, the 
taboo would clearly imply, "Your image of yourself is dirty." This is 
one important part of the origin of the tendency to despise the self 
in our society. The tendency to separate sexual activity from the 
rest of the self is illustrated by Puritan attitudes. To welcome the 
body back into union with the self suggests recovering an active 
awareness of one's body. It means experiencing one's body, the 
pleasure of eating or resting or the exhilaration of using toned-up 
muscles or the gratification of sexual impulses and passion, as as¬ 
pects of the acting self. It is not the attitude of "My body feels," 
but "I feel." One aspect of interpersonal relationships is the 
71 
experiencing of sexual desire and passion. 
Our society has a tremendous preoccupation with sex, which 
may be considered an obsession that drains off anxiety from another 
area and prevents us from being confronted with something distasteful. 
^^Rollo May, Man's Search For Himself (New York: A Signet 
Book, 1953), p. 94. ' 
35 
May says the clamor of sex all about us drowns out the ever-waiting 
presence of death. Sex is the easiest way to prove that we are not 
72 
dead yet. 
Albert Ellis is a proponent of liberality in sex. He states 
that normal individuals cannot remain abstinent for long periods of 
time without physical consequences: these include headaches, gastric 
upset, congestion of the pelvic region and high blood pressure. How¬ 
ever, he feels that the main dangers of abstinence are not physical 
but psychological. He attributes the inability to concentrate, 
insomnia and extreme nervousness to abstinence. 
On the subject of masturbation Ellis says that this form of 
sexuality is beneficial, harmless and tension-relieving when performed 
73 
without fears and anxieties. He reiterates that sex guilt is not 
justifiable because no one should ever be guilty about anything he 
does. He says that man makes mistakes but that he can change himself 
and do much better in the future; therefore, there should be no guilt 
74 
about the past. Ellis advocates kissing, caressing and petting to 
75 
climax as long as both people enjoy themselves. 
72 
Rollo May, Love and Will, op. cit., p. 106. 
73 
Albert Ellis, Sex and the Single Man (New York: Lyle 
Stuart, Inc., 1963), p. 27. 
74Ibid., p. 34. 75Ibid., p. 109. 
36 
ANATOMY AND PHYSIOLOGY 
Until 1966 accurate and definitive information was not avail¬ 
able to the general public about human sexual responses. Most of what 
had been published previously was conjecture and unsubstantiated by 
research. After eleven years of scientific study with human subjects, 
76 
Masters and Johnson published the findings of their work. 
According to these authors the male and female go through four 
phases in the sexual cycle; (1) the excitement phase, (2) the plateau 
phase, (3) the orgasmic phase and (4) the resolution phase. Since the 
obvious anatomical manifestations of erection of the penis and con¬ 
striction of the scrotal sac have been well known for as long as man 
has observed these phenomena, the physiological details of the phases 
will be omitted in this paper. Little has been known about the 
female response and some aspects will be included here. 
Excitement Phase 
Nipple erection is the first evidence of the breasts' response 
to sexual tension. This occurrence is the result of involuntary con¬ 
traction of muscular fibers within the nipple. The veins of the 
breast become engorged with blood and there is an obvious increase in 
76 
William H. Masters and Virginia E. Johnson, Human Sexual 
Response (Boston; Little, Brown and Company, 1966). 
37 
the actual size of the breasts in young women undet forty who have 
not suckled babies/^ In women over the age of fifty there may be 
erection of only one nipple and there is a marked reduction of the 
vasocongestive reactive potential of the breasts. There is very 
little clinically discernable increase in breast size in aging 
78 
women. 
Plateau Phase 
M Marked areolar engorgement develops late in the excitement 
phase, creating an illusion that the responding woman has partially 
lost nipple erection. The unsuckled breast will have increased in 
size from one-fifth to one-fourth. Women who have nursed more than 
one child rarely demonstrate significant increase in breast size under 
the influence of sexual stimulation, nor do aging women. 
A sex flush first appears over the epigastrium either late in 
the excitement period or early in the plateau phases of the sexual 
cycle. This measles-like rash spreads rapidly over the breasts to 
the abdomen and shoulders and may spread to the anterior and lateral 
79 
borders of the thighs and over the buttocks and the entire back. 
Carpopedal spasm is frequently present late in the plateau phase or 
77Ibid., p. 28. 78Ibid., pp. 224-225. 
79Ibid., p. 32. 
38 
during orgasm. 
Orgasmic Phase 
There is no specific breast reaction to orgasm. The heart 
rate is significantly elevated and may reach 180 beats per minute. 
The systolic blood pressure may rise from 30 to 80 mm. of mercury and 
the diastolic pressure elevations may range from 20 to 40 mm. of 
mercury during orgasm. Spastic contractions of the uterine muscula- 
80 
ture occur. 
Resolution Phase 
The nonsuckled breasts lose their deep vasocongestion slowly 
and the nipples lose their erection. The sex flush subsides in 
opposite order of its appearance. A film of perspiration may appear 
as a surface coating on the entire body from shoulders to thighs. The 
feet, hands, foreheads and upper lips of orgasmistic women perspire 
profusely. 
The female genitalia also undergo change during sexual excita¬ 
tion. In young women the labia majora thin out and flatten against 
the perineum. There is a slight elevation of the labia in an upward 
and outward direction away from the vaginal outlet. The labia minora 
increase at least two, and occasionally three, times in diameter. In 
80 81 
Ibid., p. 36. Ibid., p. 36. 
39 
the nulliparous women the minora undergo a color change which ranges 
from a pink to a bright red. In the multipara the color varies from 
bright red to a deep wine. 
Prior to the Masters-Johnson investigation it was presumed 
that the Bartholin glands were responsible for the lubrication of the 
■J • . 
vaginal canal prior to and during the sex act. This assumption was 
found to be in error, as the vaginal barrel produces copious amount of 
lubrication through a process described as "sweating." 7 The Bartholin 
glands produce only a minute amount of fluid. 
Clitoris 
The clitoris is a unique organ in the total of human anatomy. 
Its express purpose is to serve both as a receptor and transformer of 
sensual stimuli. It is totally limited in physiologic function to 
initiating or elevating levels of sexual tension. There is marked 
variation in the normal size of clitorides among women. Some women 
experience clitoral glans tumescence under sexual influence and some 
84 do not. Most clitorides developed shaft elongation in the excite¬ 
ment phase. In the entire population studied by Masters and Johnson, 
the whole clitoral body retracted from the normal pudendal overhang 
82Ibid., p. 69. 83Ibid., p. 45. 
8
^Ibid., p. 49. 
40 
position during the plateau phase. If high sexual tension levels are 
allowed to fall by withdrawal of stimulation the retracted shaft and 
glans will return to the normal position. No specific orgasmic-phase 
reaction of the clitoris was established. During the resolution phase 
the clitoris returns to the overhang position within five to ten 
85 
seconds after cessation of contractions. Glitoral size has no rela- 
86 
tionship to the effectiveness of the female^ sexual performance. 
Most marriage manuals emphasize the importance of direct 
clitoral manipulation. The Master-Johnson report states that direct 
manipulation of the clitoris is painful and that stimulation of the 
entire mons area produces physiological responses of the clitoris. 
The female requires continued stimulation during the actual orgasmic 
experience in opposition*to the average male's reaction to his 
ejaculatory experience. The female is frequently not content with one 
orgasmic experience. There may be great variation in duration and 
intensity of orgasmic experience, varying from individual to individual 
and within the same woman from time to- time. Clitoral and vaginal 
87 
orgasms are not separate biologic entities, as was stated by Freud. 
As the mores of our society come to accept objective sex 
research, widespread sexual problems will be attacked effectively 
either by medical or behavioral scientists. 
85Ibid., p. 53. 86Ibid., p. 57. 87Ibid., p. 67. 
41 
SUMMARY 
Sexuality has always been of concern to mankind. The medical 
profession, the clergy, anthropologists, sociologists and psycholo¬ 
gists have been particularly interested in this subject insofar as it 
influences human behavior and interaction. 
Primitive people have established taboos on various practices 
but there was no uniformity among peoples as to what was prohibited 
and what was allowed or encouraged. Mores are particular to each 
individual culture. Most of the sexual misery in our Western culture 
today stems from the methods of child rearing originating with the 
Victorians. Our social code is still restrictive to unmarried adoles¬ 
cents, but the sexual emancipation of women has caused the double 
standard of morality to start withering away. New roles have emerged 
for women as a result of educational, economic, and social forces. 
Contemporary American cultural attitudes are reflected in: 
the acceptance of masturbatory activity in children, disapproval and 
persecution of male homosexuality, and, availability of contraceptives 
The Bible has exerted a profound influence on the sexual cus¬ 
toms of Christians and Jews. When the Old Testament was written, 
virginal daughters were an economic asset and brought a good marriage 
price to their fathers. All phases of sexuality are in the Bible and 
interpretation ranges from fundamentalistic to liberal. 
42 
Psychiatrists and psychologists have long recognized that sex 
plays an important part in the psycho-social relationships of indivi¬ 
duals. Many and diverse theories have been postulated about the role 
of sex in mental health. Freud posited that repressed sexual impulses 
are converted into anxiety; Fromm wrote that sexual happiness is the 
result of love; Maslow related sexual gratification to rewarding past 
experiences and May stated that sexual freedom and preoccupation with 
performance increases anxiety and guilt. 
The scientific study of Masters and Johnson threw new light 
on human sexuality and several old theories were refuted. New 
information was disseminated. The fact that human beings were used 
as laboratory subjects points out the enormity of attitudinal altera¬ 
tion since the Victorians. Society would not have permitted such a 
study to have taken place prior to World War II. 
Chapter 3 
ANALYSIS OF DATA 
In December 1969 the Sex Knowledge Inventory Form X revised 
and the Sex Knowledge Vocabulary and Anatomy Form Y, published by 
Family Life Publications, Incorporated, Durham, North Carolina, were 
administered to eighty-six freshmen nursing students prior to their 
formal instruction in reproductive anatomy. Of the eighty-six tests 
given sixty-eight were completed and usable for this study. Near the 
end of spring quarter 1970 forty-two senior student nurses were given 
these same tests. The students who took these tests did so on a 
volunteer basis and the sample does not represent 100 percent of 
either the freshmen or senior nursing class. There were 117 freshmen 
nursing students enrolled in December 1969 and seventy-six senior 
nursing students enrolled in Hay 1970 when the tests were administered. 
There was a significant difference between.the knowledge of 
the freshmen and senior students. The freshmen mean on Text X was 
42.34 and the senior mean, 50.58. The mean difference on Test X was 
8.24. There were eighty questions on Test X. The result of the t test 
was 4.80, Test X. The freshmen mean on Test Y was 64.07 and the 
senior mean was 81.77 representing a mean difference of 17.70 raw 
score points. There were 100 questions on Test Y. The correlation 
coefficient for all freshmen and senior scores was 0.60. The t test 
equaled 4.80 for X scores and the t test was 7.37 for freshmen and 
44 
senior Y tests. See Table 1. 
Table 1 
Freshmen and Seniors 
X and Y Scores 
Category No. Test X 
Mean S.D. 
Test 
Mean 
Y 
S.D. 
Freshmen 68 42.34 9.62 64.07 12.45 
Seniors 42 50.58 7.38 81.77 12.08 
Correlation significant at the 0.05 level. Critical value of 
t = .05, two tailed test at D.F. 108 is 2.00. 
The range of scores for freshmen on Test X was 10 to 59 and 
the range of scores for seniors on Text X was 33 to 67. 2.9 percent 
of freshmen made 70 percent or above on Test X. 23.81 percent of the 
seniors made a 70 percent or above on this test, as shown in Table 2. 
45 
Table 2 
Rank Order Comparison of Freshmen and 
Senior Scores Test X 
Raw 
Score 
Freshmen 
No. Receiving Grade Of 
A B C D F 
Raw 
Score 
Seniors 
No. Receiving Grade Of 
A B C D F 
72-80 72-80 
64-71 64-71 1 
56-63 2 56-63 10 
48-55 21 48-55 21 
40-47 27 40-47 6 
32-39 9 32-39 4 
24-31 5 24-31 
16-23 3 16-23 
8-15 1 8-15 
Total 2 21 45 Total 1 10 21 10 
Freshmen scores ranged from 38 to 89 on Test Y and seniors 
ranged from 40 to 97 on Test Y. 32.3 percent of the freshmen made 
70 percent or above on Test Y and 90.48 percent of the seniors made 
70 percent or above on Y, as illustrated in Table 3. 
46 
Table 3 
Rank Order Comparison of Freshmen and 
Senior Scores Test Y 
Raw 
Score 
No. 
A 
Freshmen 
Receiving Grade Of 
B C D F 
Raw 
Score 
Seniors 
No. Receiving Grade Of 
A B C D F 
90-100 
80-89 
70-79 
60-69 
50-59 
40-49 
30-39 
10 
12 
20 
16 
9 
1 
90-100 
80-89 
70-79 
60-69 
50-59 
40-49 
30-39 
13 
14 
11 
2 
2 
Total 10 12 20 26 Total 13' 14 11 2 2 
The mean score for all freshmen and seniors tested was 45.53 
with a standard deviation of 9.68 on Test X. The mean score for all 
freshmen and seniors tested was 70.93 with a standard deviation of 
15.02 on Test Y. Please refer to Table 4. 
Table 4 
All X and Y Scores 
Category No. Test X 
Mean S.D. 
Test Y 
Mean S.D. *r 
All 110 45.53 9.68 70.93 15.02 0.60 
^Correlation significant at the .05 level. 
47 
There is a significant difference between the scores of stu¬ 
dents twenty years old and younger and those twenty one or older. 
Those twenty one or older scored higher. The t test on X scores was 
4.09 and the t test on Test Y was 6.97. See Table 5. 
Table 5 
X and Y Scores by Age 
Category No. Test 
Mean 
X 
S.D. 
Test Y 
Mean S.D. 
20 or less 
21 or more 
66 
44 
42.69 
49.86 
9.25 
8.68 
64.21 
81.16 
12.49 
12.59 
Correlation significant at the 0.05 level. The critical 
value of t « .05, two-tailed test at d.f. 108 is 2.00. 
There is a significant difference between the knowledge level 
of single and married students. Married students scored higher than 
single students. The result of the t test on X scores was 2.27 and 
2.24 on Y scores. Refer to Table 6. 
Table 6 
X and Y Scores^by Marital Status . 
Category No. Test 
Mean 
X 
S.D. 
Test Y 
Mean S.D. 
Single 98 44.82 9.76 69.84 14.73 
Married 12 51.42 6.55 79.92 14.39 
Correlation significant at the 0.05 level. The critical value 
of t = .05, two-tailed test at d.j f. 108 is : 2.00. 
48 
Rural, small town, suburban and large city students scored 
significantly higher on Test X than did small city students. There 
was no significant difference in the scores among students from rural, 
small town, suburban and large city populations on Text X. 
On Test Y students from large cities and suburban areas 
scored significantly higher than students from small towns and small 
cities. There was no significant difference between scores of rural 
and suburban or large city students, as shown by Table 7. 
Table 7 
X and Y Scores by Population 
Category No. 'Test 
Mean 
X 
S.D. 
Test Y 
Mean S.D. 
Rural 33 47.91^ 7.93 72.74, 15.78 
Small Town 39 45.53^ 8.69 68.211 14.71 
Small City 18 38.72W 10.58 65.332 14.38 
Suburban and 
Large City 20 47.603 10.49 78.201’2 10.95 
test at 
xext X, t 
d.f. 49 is 
Test 
2.00. 
3.53. Critical value of t = .05, two-tailed 
test at 
2Test X, t 
d.f. 55 is 
Test 
2.00. 
2.57. Critical value of t = .05, two-tailed 
test at 
\est X, t 
d.f. 36 is 
Test 
2.00. 
2.59. Critical value of t = .05, two-tailed 
test at 
^est Y, t 
d.f. 57 is 
Test 
2.00. 
2.68. Critical value of t = .05, two-tailed 
2Test Y, t Test 3.12. Critical value of t = .05, two-tailed 
test at d.f. 36 is 2.00. 
49 
There was no significant difference between the sex know¬ 
ledge of students who labeled themselves catholics or protestants. 
The scores of those students who stated that they had no religious 
affiliation were not computerized statistically due to the small size 
of the sample. The t test for X scores was 0.09 and for Y scores 
was 0.72. See Table 8. 
Table 8 
X and Y Scores by Religion 
Category No. Text X 
Mean S.D. 
Test Y 
Mean S.D. 
Catholic 31 45.78 9.59 69.28 14.32 
Protestant 77 45.58 10.42 71.58 15.44 
No Religion 2 
Correlation significant at the 0.05 level. The critical 
value of t = .05, two-tailed test at D.F. 108 is 2.00. 
ITEM AND QUESTION ANALYSIS 
Scores with correct frequencies under ten were studied to 
ascertain what type of question was missed most often by both fresh¬ 
men and seniors. Results are shown in Appendix A, Tables 12, 13, 
14, and 15. 
On Test X, Table 12, fewer than ten freshmen correctly an¬ 
swered questions 1, 15, 27, 49, 57, 77 and 79. On Test X, Table 13, 
fewer than ten seniors correctly answered questions 1, 7, 9, 15, 16, 
50 
27, 49, 57 and 79. These questions were as follows: 
Question 1. "What is the relation between being sexually 
attracted to a man or woman and being in love with that person?" 
Eight freshmen answered correctly and six seniors gave the correct 
answer. The majority of the students did not recognize that sexual 
attraction and love may be present at the same time. 
Question 7. "On the average, how do men and women differ in 
fundamental potential capacity for responsiveness to sexual stimula¬ 
tion?" Victorian training and attitudes perpetuate the erroneous 
belief that women are not as capable of responsiveness to stimulation 
as men. Eleven freshmen and nine senior students answered this 
question correctly. Some women have to unlearn inhibitions acquired 
from prudish and protective home training and overcome anxiety, fear 
and guilt before they are able to respond effectively to sexual 
stimulation. A high percentage of the students tested were unaware 
that females have the same potential for responsiveness as men. 
Question 9. "How do men and women who are aroused and ready 
for orgasm differ in their needs for orgasm?" Twenty-six freshmen 
answered this question correctly while only nine seniors knew that 
men and women do not differ greatly in their orgasmistic needs. The 
students missing this question were under the misconception that there 
is a difference in sexual needs between men and women. This too 
reflects the Victorian sexual myth heritage. 
51 
Question 15. "When she is sexually excited a woman's clitoris 
may be noticeably enlarged and quite firm. What is likely to happen 
to the enlarged clitoris as the woman progresses in sex desire to 
readiness for intercourse?" One senior and three freshmen answered 
correctly that the clitoris will be withdrawn beneath protective folds 
of flesh. This phenomenon was not recognized until the Hasters- 
Johnson study was made. These students have not learned by experience, 
discussion or reading that this occurs. 
Question 16. "By what kind of behavior in relation to the 
clitoris will a husband be more likely to bring his wife to readi¬ 
ness for intercourse and for orgasm?" Twenty freshmen and six seniors 
answered, by indirect stimulation through rubbing and caressing 
adjacent areas, which is the correct answer. The remainder of the 
students lacked authentic anatomical information. 
Question 27. "How often is failure to find sexual satisfac¬ 
tion in marriage caused by a fundamental difference between the man 
and wife in capacity to want and to enjoy sex relations?" This 
question is a recapitulation of Question seven and nine. Seven 
freshmen and nine seniors answered correctly that this is a rare 
occurrence. Erroneous answers were undoubtedly a holdover from the 
Victorian attitude that sex isn't quite nice and well bred ladies do 
not enjoy or desire it. 
Question 49. "If the population of the United States is to 
52 
remain at its present level, no couple may have more than:" how 
many children? Seven freshmen and four seniors answered, three, 
which is the correct answer according to the answer sheet. In view 
of the population explosion students should be aware of this fact. 
A need for discussion is indicated. 
Question 57. "How often are there male sperm cells, which 
could cause pregnancy, in the fluid which flows from the male sex 
organ before orgasm?" Seven freshmen and nine seniors correctly 
answered that this fluid contains sperm cells at times. Because of 
the occasional sperm content coitus interruptus is not always a 
reliable method of birth control. If a nurse is called upon to teach 
a class in family planning she should be cognizant of this fact. 
Question 77. "How curable are syphilis and gonorrhea?11 The 
answer sheet states that almost every case of either disease can be 
cured. Nine freshmen gave this answer as did fourteen seniors. The 
fact that two-thirds of the seniors checked another response may be 
indicative that senior nursing students are aware of the sequelae 
of tertiary syphilis and recalled that "the majority of patients with 
early latent syphilis will remain sero-reactive for more than one year 
88 
following treatment." 
88 
Charles E. Lyght, M.D., et al. (eds.), The Merck Manual of 
Diagnosis and Therapy (Rahway, New Jersey: Merck Sharp and Dohme 
Research Laboratories, 1966), p. 1465. 
53 
Question 79. "How soon after the beginning of menopause may 
a woman safely discontinue the practice of birth control?" Five 
freshmen and five seniors knew that when a woman has not menstruated 
for two years she may safely dispense with birth control methods. 
Knowledge is clearly lacking in this area. 
On Test Y, Table 14, freshmen students made fewer than ten 
correct answers on anatomical questions numbers two and eight, Part I. 
In the male anatomical diagram the epididymis and the seminal vesticles 
were either unidentified or misidentified by freshmen. Seven freshmen 
correctly identified the epididymis and eight correctly labeled the 
seminal vesicles. The senior students, Table 15, having had courses 
in anatomy, scored much higher on the anatomical section of the test. 
However, it was interesting to note that six freshmen nursing stu¬ 
dents were unable to identify the penis as were two seniors. Twenty- 
seven freshmen did not recognize the diagram of the vagina nor did 
four seniors. It is incomprehensible to this investigator that gradu¬ 
ating senior nurses could fail to identify these two reproductive 
structures from anatomical drawings. 
When verbally questioned two freshmen nursing students 
reported having taken a course in sex education at the high school 
level. No seniors reported having had a course in sex education either 
at the high school or collegiate level. 
54 
COMPARISON WITH OTHER GROUPS 
235 female marriage counselees were given Test X in 1968 and 
the statistics reported by Family Life Publications, Inc. The mean 
age of this group was 20.9 and their mean score was 48.6. The 110 
Montana State University student nurses had a mean age of 20.22 and 
a mean score of 45.53. The average nursing student score was 3.07 
below the mean for premarital counselees tested in 1968, as shown 
in Table 9. 
Table 9 
Comparison of Freshmen and Senior Nursing 
Students and 235 Female Counselees 
235 Female Counselees 110 Student Nurses 
Age 
Age Range 16-44 years Age Range 17-33 years 
Mean Age 20.9 years Mean Age 20.22 years 
Education 
Range 9-20 years Range 12-16 years 
Mean 13.5 Mean 13.5 
Scores 
Range 20-73 Range 10-67 
Mean 48.6 Mean 45.53 
S.D. 8.84 S.D. 9.68 
55 
The forty-two senior nursing students scored 1.98 points 
higher on mean scores than did the counselees, as presented in Table 
10. 
Table 10 
Comparison of Senior Nursing Students 
and 235 Female Counselees 
235 Female Counselees 42 Senior Nursing Students 
Age 
Age Range 16-44 years Age Range 21-33 years 
Mean Age 20.9 Mean Age 22.29 
Education 
Range 9-20 years Range 16 years 
Mean 13.5 years Mean 16 years 
Scores 
Range 20-73 Range 33-67 
Mean 48.6 Mean 50.58 
S.Do 8.84 S.D. 7.38 
The female counselees1 mean score was 6.26 higher than fresh 
men nursing students. It was determined statistically that there was 
a significant difference in the scores of those age twenty and younger 
and those age 21 or older. The freshmen nursing students had a mean 
age of 18.26 while the counselees had a mean age of 20.9. Please 
refer to Table 11. 
Comparison with the nursing students tested in 1961 at the 
Johns Hopkins School of Nursing was not made because the question 
56 
content of Test X has been changed somewhat since those nurses were 
tested. 
Table 11 
Comparison of Freshmen Nursing Students 
And 235 Female Counselees 
235 Female Counselees 68 Freshmen Students 
Age 
Age Range 16-44 years Age Range 17-21 years 
Mean Age 20.9 Mean Age 18.26 
Education 
Range 9-20 years Range 12 years 
Mean 13.5 years Mean 12 years 
Scores 
Range 20-73 Range 10-59 
Mean 48.6 Mean 42.34 
S.D. 8.84 S.D. 9.62 
There are no comparisons with Test Y for other groups as this 
information was not available from the Family Life Publications, Inc. 
SUMMARY 
Sixty-eight freshmen were given the Sex Knowledge Inventory, 
Form X revised, and the Sex Knowledge Vocabulary and Anatomy Tests in 
December 1969 before they had had formal classes in reproductive 
anatomy. In May 1970, forty-two senior nursing students were given 
these same tests just prior to their graduation from Montana State 
57 
University, Bozeman, Montana. 
The statistical calculations for this study were done by the 
computer on the Montana State University campus. In analyzing the 
data it was found that there was a significant difference between 
the knowledge of: (1) freshmen and senior nursing students on tests 
X and Y, (2) students twenty years old and younger and those twenty- 
one or older on tests X and Y» (3) single and married students, 
tests X and Y, (4) rural and small city students, tests X and Y, 
(5) large city and small city students, tests X and Y, and (6) stu¬ 
dents from large cities and students from small towns and small 
cities, test Y. There was no significant difference between the 
sex knowledge of catholic and protestant students on either test. 
There was a low level of knowledge in the following areas: 
(1) general information, (2) sex techniques, (3) possible causes of 
poor sexual adjustment, (4) birth control, (5) conception, pregnancy 
and childbirth, and (6) effects of menopause on sex life. Misinfor¬ 
mation and Victorian attitudes accounted for incorrect answers on 
several questions that were missed by a large percentage of the 
freshmen and seniors. 
The 235 female premarriage counselees who were tested in 1968 
scored 1.98 lower on their mean scores than did senior nursing stu¬ 
dents. The counselees averaged 6.26 points higher than freshmen 
nursing students. No statistics were available for test Y from 
Family Life Publications, Incorporated. 
Chapter 4 
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS 
Summary 
The problem was to; (1) determine the level of sex knowledge 
of freshmen and senior student nurses in a baccalaureate program, 
(2) ascertain whether graduating seniors were adequately prepared to 
function as resource personnel or instructors of sex education, and 
(3) gather accurate and pertinent data that could be used to establish 
guidelines for curriculum improvement. 
The instruments selected to gather the desired information 
were the Sex Knowledge Inventory, Form X revised, and the Sex Know¬ 
ledge Vocabulary and Anatomy, Form Y, published by Family Life Publi¬ 
cations, Incorporated, Durham, North Carolina. 
The population consisted of one-hundred-seventeen freshmen 
and seventy-six senior students, representing one-hundred percent of 
both classes. All were given the opportunity of participating in the 
testing. Sixty-eight freshmen and forty-two senior tests were 
completed. A total of 58.1 percent of the freshmen class and 55.3 
percent of the senior class were tested. This was a sufficient 
sample from which to draw valid conclusions. 
It was found that students twenty-one years or older scored 
significantly better on both tests than students who were twenty 
years old or younger. Married students scored significantly higher 
59 
than single students on both tests. Students from small cities 
scored significantly lower than other students. There was no signifi¬ 
cant difference on scores among students from small towns, large 
cities and rural areas on test X. On test Y students from large 
cities and their suburbs scored significantly higher than students 
from small towns and small cities. There was no significant differ¬ 
ence between scores of rural and large city students. Religious 
affiliation made no significant difference between the scores of 
catholic and protestant students. 
In the item analysis of test X scores, it was found that fewer 
than ten seniors correctly answered the following questions in the 
areas, listed: 1, 7 and 9, general information; 15 and 16, sex 
techniques; 27, possible causes of poor sexual adjustment; 49, birth 
control; 57, conception, pregnancy and childbirth; and 79, effects of 
menopause on sex life. 
All questions on test Y were correctly answered by ten or 
more of the seniors. 
Conclusions - 
The conclusions presented werejdrawn from the data obtained 
from the survey. The recommendations follow the conclusions and are 
based on their results. 
60 
CONCLUSION: 
1. 
2. 
CONCLUSION: 
1. 
Students in a baccalaureate program are not sufficiently 
well informed about human sexuality to function as 
resource personnel or teachers. 
Weaknesses of knowledge are in the following areas: 
a. General information 
b. Sex techniques 
c. Possible causes of poor sexual adjustment 
d. Birth control 
e. Conception, pregnancy and childbirth 
f. Effects of menopause on sex life 
Areas of strength are: 
a. Sex dreams 
b. Sterilization and circumcision 
c. Menstruation 
d. Superstitions, misconceptions ; and misinformation 
e. Masturbation 
f. Anatomy, with the exception of the clitoris 
S* Vocabulary 
There were variables that made a significant difference 
in the students' sex knowledge. 
Age was a significant factor. Students over the age of 
twenty-one had more sex knowledge. 
2. Marital status was a factor. Married students scored 
4. 
CONCLUSION: 
1. 
61 
significantly better than single students. 
The population of the community of origin was a factor 
in some instances. 
a. On test X students from small cities scored sig¬ 
nificantly lower than other students. 
b. On test Y students from large cities and their sub¬ 
urbs scored significantly higher than students from 
small towns and small cities. Students from small 
towns and small cities have the least knowledge of 
sexuality. They are influenced more by cultural 
and religious restraints which mold them into 
traditionally protected and ignorant feminine roles. 
They are more sheltered by their reference groups 
and their social relationships are more circum¬ 
scribed by restrictive community mores. 
Class level in college was a factor, 
a. Seniors had more knowledge than freshmen. 
There were variables that made no significant difference 
in test scores. 
Religious affiliation was not a factor. The Vatican Two 
Decree on Education has not made an appreciable difference 
between the sex knowledge of catholic and protestant 
young people. 
62 
2. Rural origin was not a factor. Isolation in the country 
does not preclude the acquisition of sex knowledge. 
Recommendations 
It is recommended that the nursing curriculum be revised to 
include course content in sex education. More emphasis should be 
placed upon: (1) birth control, (2) conception, pregnancy and child¬ 
birth, and (3) venereal disease control. Students should be provided 
with the opportunity to discuss psychological and attitudinal factors, 
techniques, causes of poor sexual adjustment and the effects of meno¬ 
pause on sex life. These classes should be held concurrently with the 
students' enrollment in anatomy and introductory psychology courses. 
It is recommended that anatomy, physiology and obstetrical 
text books be examined to establish the recency and authenticity of 
information on the clitoris. 
It is recommended that a study be made to explore sexual 
attitudes of nursing students. An investigation of this nature might 
illuminate some of the reasons why some students did not participate 
in a sex knowledge survey. 
It is further recommended that this study be replicated in 
another baccalaureate school of nursing to establish reliability. 
APPENDIX A 
64 
Table 12 
Item Analysis, Frequency of Correct Answers on Test X 
Sixty Eight M.S.U. Freshmen Nursing Students 
No. Freq. No. Freq. No. Freq. No. Freq 
1. 8 21. 35 41. 47 61. 20 
2. 49 22. 46 42. 33 62. 35 
3. 34 23. . 44 43. 42 63. 18 
4. 61 24. 28 44. 50 64. 17 
5. 64 25. 31 45. 18 65. 40 
6. 46 26. 39 46. 44 66. 37 
7. 11 27. 7 47. 14 67. 39 
8. 39 28. 48 48. 42 68. 63 
9. 26 29. 36 49. 7 69. 53 
10. 33 30. 26 50. 47 70. 61 
11. 40 31. 12 51. 45 71. 56 
12. 53 32. 20 52. 45 72. 41 
13. 53 33. 35 53. 66 73. 40 
14. 47 34. 35 54. 33 74. 55 
15. 3 35. 53 55. 56 75. 34 
16. 20 36. 29 56. 45 76, 47 
17. 29 37. 33 57. 7 77. 9 
18. 53 38. 32 58. 58 78. 45 
19 18 39. 27 59. 54 79. 5 
20 31 40. 39 60. 43 80. 42 
65 
Table 13 
Item Analysis, Frequency of Correct Answers on Test X 
Forty Two M.S.U. Senior Nursing Students 
No. Freq. No. Freq. No. Freq. No. Freq 
1. 6 21. 19 41. 32 61. 22 
2. 39 22. 30 42. 24 62. 41 
3. 22 23. 35 43. 24 63. 11 
4. 40 24. 21 44. 41 64. 19 
5. 42 25. 25 45. 19 65. 37 
6. 38 26. 30 46. 30 66. 28 
7. 9 27. 3 47. 12 67. 29 
8. 31 28. 36 48. 32 68. 42 
9. 9 29. 29 49 4 69. 38 
10. 28 30. 29 50. 35 70. 42 
11. 32 31. 10 51. 31 71. 42 
12. 37 32. 15 52. 25 72. 36 
13. 28 33. 22 53. 41 73. 34 
14. 36 34. 21 54. 37 74. 40 
15. 1 35. 32 55. 42 75. 27 
16. 6 36. 23 56. 37 76. 32 
17. 17 37. 17 57. 9 77. 14 
18. 41 38. 30 58. 40 78. 36 
19. 20 39. 13 59. 34 79. 5 
20. 17 40. 35 60. 38 80. 24 
66 
Table 14 
Item Analysis, Frequency of Correct Answers on Test Y 
Sixty Eight M.S.U. Freshmen Nursing Students 
Part 1 Part 2 ' part 3 
Question 
Number 
Frequency Question 
Number 
Frequency Question 
Number 
Frequency 
1. 15 1. 32 1. 65 
2. 7 2. 27 2. 66 
3. 48 3. 17 3. 64 
4. 46 4. 55 4. 66 
5. 62 5. 44 ,’5. 64 
6. 11 6.a 53 6. 63 
7. 34 b 24 7. 63 
8. 8 c 11 8. 65 
9. 35 7. 53 9. 68 
10. 30 8.a 32 10. 65 
11. 14 b 32 11. 63 
12. 37 c 24 ' 12. 54 
13. 22 9. 29 13. 45 
14. 56 10. 11 14. 67 
15. 31 11. 22 15. 56 
16. 46 12. 41 16. 53 
17. 60 •13. 61 17. 48 
18. 35 14. 53 18. 54 
19. 59 15. 58 19. 51 
20. 41 16.a 25 20. 68 
b 16 21. 63 
17.a 16 22. 56 
b 23 23. 32 
18. 32 24. 68 
19. 29 25. 63 
20. 22 26. 48 
21. 35 27. 55 
22. 56 28. 50 
23.a 49 29. 52 
b 31 30. 60 
24. 35 31. 46 
25. 24 32. 62 
26. 34 33. 45 
27. 41 34. 64 
28. 32 35. 57 
67 
Table 14 (continued) 
Part 1 
Question Frequency 
Number 
Part 
Question 
Number 
2 
Frequency 
Part 
Question 
Number 
3 
Frequency 
29. 40 36. 47 
30.a 47 37. 68 
b 39 38. 66 
31. 29 39. 47 
32 26 40. 34 
68 
Table 15 
Item Analysis, Frequency of Correct Answers on Test Y 
Forty Two M.S.U. Senior Nursing Students 
Part 1 Part 2 Part 3 
Question Frequency Question Frequency Question Frequency 
Number Number Number 
1. 25 1. 28 1. 42 
2. 21 2. 24 2. 42 
3. 36 3. 10 3. 42 
4. 34 4. 40 4. 42 
5. 40 5. 38 5. 42 
6. 32 6.a 39 6. 40 
7. 39 b 28 7. 42 
8. 10 c 18 8. 41 
9. 36 7. 37 9. 42 
10. 38 8.a 29 10. 41 
11. 23 b 28 11. 40 
12. 38 c 15 12. 40 
13. 38 9. 27 13. 36 
14. 40 10. 22 14. 41 
15. 35 11. 18 15. 40 
16. 41 12. 39 16. 42 
17. 41 13. 40 17. 40 
18. 38 14. 36 18. 40 
19. 41 15. 35 19. 42 
20. 38 16. a 22 20. 42 
b 16 21. 39 
17.a 29 * 22. 38 
b 34 23. 37 
18. 33 24. 42 
19. 25 25. 41 
20. 27 26. 36 
21. 36 27. 41 
22. 40 28. 40 
23.a 38 29. 40 
b 33 30. 39 
24. 20 31. 33 
25. 34 32. 38 
26. 35 33. 31 
27. 35 34. 41 
28. 37 35. 41 
69 
Table 15 (continued) 
Part 1 Part 2 Part 3 
Question Frequency Question Frequency Question Frequency 
Number Number Number 
29. 30 36. 42 
30.a 38 37. 42 
b 34 38. 41 
31. 24 39. 41 
32. 14 40. 37 
APPENDIX B 
71 
SEX 
KNOWLEDGE 
INVENTORY 
FORM X 
REVISED 
DEVELOPED BY 
GELOLO MCHUGH 
FAMILY LIFE PUBLICATIONS, INC 
DURHAM, NORTH CAROLINA 
72 
Place Answer Pad under the test booklet and line up Page 1 with Column 1 \ 
1. What is the relation between being sexually attracted to a man 
or woman and being in love with that person? 
A. Sex attraction is physical desire; love is an attitude. 
B. Sex attraction and being in love are the same thing. 
C. If there is no sex attraction, there can be no love. 
D. Sex attraction may mean that love also is present. 
E. If there is no love there will be no sex attraction. 
2. Sex relations are: A. For physical pleasure. 
B. A way to relieve tension. 
C. A way to express love. 
D. A biological urge. 
E. All of the above. 
8. Of the following, which one supplies the best evidence for pre¬ 
dicting: that a prospective husband or wife will be a good sex 
partner? 
A. The “sex appeal" of the man or woman. 
B. His or her interest in or conversation about sex. 
C. His or her physical demonstrations of affection. 
D. All of his or her behavior during courtship. 
E. His or her response to physical closeness. 
4. Happily married couples have sex relations: A. Whenever they can; every day if possible. 
B. When the wife wants sex relations. 
C. When the husband wants sex relations. 
D. When both need sex relations. 
E. When sex relations are pleasing to both. 
5. Happily married couples make each act of sex relations last: A. As long as possible. 
B. No longer than necessary. 
C. Until the woman is satisfied. 
D. Until the man is satisfied. 
E. As long as it is pleasing to both. 
6. How do men and women differ in readiness for orgasm? A. They usually are ready at the same time. 
B. Women usually are ready sooner than men. 
C. Men often are ready sooner than women. 
D. Well matched couples usually are ready at the same time. 
E. Men always are ready sooner than women. V, 
7. On the average, how do men and women differ in fundamental 
potential capacity for responsiveness to sexual stimulation? 
A. Men can respond faster, more intensely than women. 
B. Women can respond faster, more intensely than men. 
C. Men and women probably do not greatly differ in this capacity. 
D. Men can respond faster but not as intensely as women. 
E. Women can respond longer but not as fast as men. 
8. What is the most probable answer to the question of whether men 
and women are alike in the capacity to have and to recognize a 
physical urge for sex relations? 
A. Apparent differences may be due to differences in learned attitudes. 
B. Apparent differences are real and are due to physical differences. 
C. Women are naturally less able to have sex hunger. 
D. A few women are equal to men in this capacity. 
E. There are no sex differences in this capacity. 
9. How do men and women who are aroused and ready for orgasm 
differ in their needs for orgasm? 
A. Men have a more pressing physical need. 
B. Women have a more pressing physical need. 
C. Failure to secure orgasm causes more emotional distress in men. 
D. Failure to secure orgasm causes more emotional distress in women. 
E. Men and women do not greatly differ in their needs. 
10. In some women sexual excitement causes a noticeable enlargement 
and firmness of the clitoris. Other women become sexually excited 
with no noticeable change in the clitoris. How do these women 
differ in strength of sex desire and capacity for orgasm? 
A. Absence of clitoral response indicates low desire and low capacity. 
B. Women with no clitoral response require direct clitoral stimulation. 
C. Noticeable clitoral response is unrelated to desire or capacity. 
D. an enlarged and firm clitoris indicates capacity for vaginal orgasm. 
E. An enlarged clitoris must be directly stimulated for orgasm to occur. 
Note go on to tht next page. 
73 
Be sure to line up Page 2 with Column 2 of the answer pad 2 
11. Many women are unable to achieve orgasm without manual stimu¬ 
lation of the clitoris through the rubbing or caressing of nearby 
areas. Some women easily achieve orgasm through penile stimula- 
lation of the vagina. How fio these women differ in sex desire and 
in capacity for orgasm? 
A. A need for clitoral stimulation indicates less desire and capacity. 
B. Response to clitoral stimulation indicates more desire and capacity. 
C. A vaginal response indicates more desire and capacity. 
D. A vaginal response indicates less desire and capacity. 
E. Stimulation required for orgasm is unrelated to desire or capacity. 
12. What determines whether a husband and wife will be active sex 
partners up to and beyond sixty years of age ? 
A. Stronger than usual sex drives in both. 
B. A continuing need for sex relations by the husband. 
C. Better health than the average couple. 
D. Mutually satisfying sex relations through the preceding years. 
E. A moderate sex life with little or no masturbation by either one. 
13. What is the main reason for sex play before intercourse? A. To make the woman’s sex organs ready for intercourse. 
B. To reduce sexual excitement in the man. 
C. To make intercourse more satisfying for both. 
D. To help a woman satisfy sex needs a man does not have. 
E. To make the man’s sex organs ready for intercourse. 
14. What kind of sex play do marriage counselors commonly suggest 
as appropriate for sex relations? 
A. Sex play should be limited to kissing and hugging. 
B. Either may kiss or caress the other in any way pleasing to both. 
C. The man may kiss or caress the woman in any way pleasing to both. 
D. The woman should be very active in sex play. 
E. The couple should avoid oral-genital contacts and kissing. 
15. When she is sexually excited a woman’s clitoris may be noticeably 
enlarged and quite firm. What is likely to happen to the enlarged 
clitoris as the woman progresses in sex desire to readiness for 
intercourse? 
A. It will be longer and more exposed, for contact in intercourse. 
B. It will be larger, longer, and more firm. 
C. It will be smaller, shorter, and less firm. 
D. It will be withdrawn beneath protective folds of flesh. 
E. There will be no noticeable change in its size or location. 
16. By what kind of behavior in relation to the clitoris will a husband 
be more likely to bring his wife to readiness for intercourse and 
for orgasm? 
A. By touching and rubbing it in all sex play. 
B. By avoiding it and adjacent areas at all times. 
C. By indirect stimulation thru rubbing and caressing adjacent areas. 
D. By stronger direct stimulation of it as sex desire increases. N 
E. By direct stimulation of it until orgasm is achieved. 
17. What parts of a woman’s body are almost always found to be 
responding to sexual excitement by becoming noticeably larger or 
more firm ? 
A. Vagina, cervix, and clitoris. 
B. Inner labia, clitoria, and vagina. 
C. Breasts, vagina, and inner labia. 
D. Inner libia, breasts and perineum. 
E. Perineum, clitoris and cervix. 
18. Of the following, which is the best position for intercourse? A. A side position, which frees the hands for se* play. 
B. The man above with the woman facing him. 
C. The man above with the woman facing away from him. 
D. The woman above with the man facing her. 
E. Any position pleasing to both. 
19. When they are aroused and ready for orgasm how many orgasms 
will a man or a woman need, and be able to have? 
A. Both will need only one and can have only one. 
B. Men may need more but can have only one. 
C. Women often need and can have more than one. 
D. Men often need and can have more than one. 
E. Women may need more but can have only one. 
20. What is the important reason why a woman should do everything 
she can to help her husband understand her sex feelings and 
desires? 
A. So he can know her sex needs are different from his. 
B. So he will delay his orgasm until she is satisfied. 
C. So they will almost always achieve orgasm at the same time. 
D. So he will stimulate her adequately and give her satisfaction. 
E. So he will not feel guilty when she fails to achieve orgasm. 
Note go on to th$ next page. 
74 
B« sure to line up Page 8 with Column 8 of th« answer pad 3 
21. Whnt in likely to huppen to the internal and/or external female 
aex oriruna ax a rexult of viinirnu* physical activities such ae ten¬ 
nis, gymnastics, or horseback riding? 
A. Some internal injury wilt occur. 
B. The vagina will be enlarged. 
C. Nothing is likely to happen. 
D. The hymen will be made thicker and stronger. 
E. The hymen will be torn or destroyed. 
22. Women who have a hymen: A. Have had no intercourse. 
B. Often have pain when menstruating. 
C. Do not masturbate. 
D. Are unable to become pregnant. 
E. None of the above is necessarily true, 
23. How cun one tell whether a woman has ever had Intercourse? A. Sexually experienced men can tell by the way she walks. 
B. One can tell by her social behavior and sex attitudes. 
C. One can know by whether she has an unbroken hymen. 
D. A physician can always tell by a physical examination. 
E. There is no sure way. 
24. How painful will intercourse be for a woman with a hymen? A. May be quite painful. 
B. Will not be painful. 
C. There will be no pain if the woman wants intercourse. 
D. First intercourse always is painful. 
E. There will be pain if the man’s sex technique is poor. 
25. Whut Is the probable reason when muscles of a wife's vaginal en¬ 
trance go Into spasm, which may prevent Intercourse altogether 
or cause her pain in Intercourse? 
A. Insufficient or inadequate sex play before intercourse. 
B. No sex desire or inability to enjoy sex relations. 
C. A learned involuntary reaction to sex relations as painful, dangerous. 
D. Normal expectation that sex relations are threatening or painful. 
E. An intentional act from fear of pregnancy or of intercourse. 
26. How often le unsatisfactory Intercourse caused by a difference In 
size of the male and female sex organs? 
A. Almost always. 
B. Very often. 
C. Often. 
D. At times. 
E. Rarely. 
27. How often Is failure to find sexual satisfaction In marriage caused 
by a fundamental difference between the man and wife in capacity 
to want and to enjoy sex relations? 
A. Almost always. 
B. Very often. 
C. Often. 
D. At times. 
E. Rarely. 
28. What is the usual aftereffect of orgasm on a man or woman? A. No noticeable effect. 
B. A relaxed, satisfied feeling. 
C. A tired feeling. 
D. A feeling of weakness. 
E. Nervous tension. 
29. What is the most likely reason when a wife continues to find Inter, 
course painful after medical examinations reveal no cause for this 
pain? 
A. She and her husband are not physically well mated. 
B. Her husband's sex technique is inadequate or wrong for her. 
C. She feels guilty about or afraid of intercourse. 
D. She is having sex relations just to please her husband. 
E. She is trying to avoid sex relations by pretending pain. 
SO. Of the reason* listed, which one most often accounts for a wife’* 
failure to be active in sex play or to be responsive in intercourse? 
A. Her husband provides inadequate or insufficient sex play. 
B. Her husband wants and expects her to be passive. 
C. She has learned not to be responsive or fears pregnancy. 
D. She is physically unable to experience strong sex desire. 
E. She is sick or is too tired to enjoy sex relations. 
Now go onto tk$ noxt pope. 
75 
Be sure to line up Page 4 with Column 4 of the answer pad ^ 
81. What ia the probable cause when sex relations have become less 
frequent and a felt need for sexual closeness often is absent in 
the couple that had an enjoyable and satisfying sex life during 
the early part of their marriage ? 
A. Sex has become less important than material and social success. 
B. Their earlier sex behavior exceeded their real sex needs. 
C. Other ways to enjoy each other have replaced sex. 
D. Fatigue or marital conflicts are blocking sex desire. 
E. Unrecognized sexual problems are preventing the enjoyment of sex. 
32. What is the most likely cause when a husband develops symptoms 
of impotency in the form of inability to maintain erection, pre¬ 
mature ejaculation, or failure to achieve orgasm? 
A. A failure to meet and marry the right woman. 
B. Dissatisfaction with and disappointment in sex in marriage. 
C. Poor sexual health and a need for medical care. 
D. Non-sexual marital conflicts, worries, resentments or fatigue. 
E. Unrecognized sexual conflicts, worries, and resentments. 
S3. Which of the suggestions listed here may be the best approach to 
the problem when a wife fails in her efforts to overcome a lack 
of responsiveness in sex relations? 
A. Become pregnant. 
B. Seek profesaional help. 
C. Take a more active part in sex play. 
D. Improve her physical health. 
E. Ask her husband to help her be more responsive. 
84. WhidTone is the best indication of a successful sexual adjustment 
in marriage? 
A. The amount of sex relations wanted by both husband and wife. 
B. The degree of passion experienced by both throughout the sex act. 
C. The wish to be together after sex needs are satisfied. 
D. The frequency of reaching orgasm at the same time. 
E. The couple's wish to learn new and better ways to enjoy sex. 
35. A couple has sex relations enjoyable to both during the first weeks 
of marriage. What does this mean? 
A. This Indicates previous sexual experience. 
B. This could be a good sign or may mean nothing. 
C. This is a slightly favorable sign. 
D. This proves they can get along together. 
E. This proves they will be happily married. 
86. Why do some newly married men reach orgasm much too soon to 
be effective sex partners? 
A. Excessive masturbation in adolescence and adulthood. 
B. Homosexual experiences in childhood or early adolescence. 
C. Lack of sex experience or a wrong conception of the female sex role. 
D. Diseased or unhealthy sex organs or glands. 
E. A lack of confidence or a lack of sexual self control. . 
37. What is best for a man who repeatedly reaches orgasm before he 
wants to, and too soon for his wife to enjoy intercourse? 
A. Permit no sex play during relations. 
B. Reduce sex play before intercourse. 
C. Think of other things during sex play and intercourse. 
D. Seek professional help. 
E. Have sex relations more often. 
88. How do homosexual experiences in childhood affect sexual adjust¬ 
ment and performance in adulthood? 
A. Often cause the adult to prefer homosexual relations. 
B. Cause low sex desire and disinterested heterosexual performances. 
C. Often cause inability to have heterosexual relations. 
D. May have no effect or may do some psychological damage. 
E. Often cause frigidity and premature ejaculation. 
89. Is it likely or unlikely that an adult preference for homosexual 
relations can be changed to a preference for heterosexual relations 
by getting married? 
A. Very likely. 
B. Likely, 
a Unlikely. 
D. Very unlikely. 
E. Depends on person he or she marries. 
40. What is a “wet dream** 7 A. An abnormal loss of semen during sleep. 
B. A normal discharge of semen often while one is dreaming about sex. 
C. An abnormal discharge of semen during a dream about sex. 
D. A discharge of semen caused by sex thoughts before sleeping. 
E. A periodic discharge of male sex fluids similar to menstruation. 
Now go onto tho noxt peg*. 
76 
Be sure to line up Page 6 with Column 6 of the answer pad 
41. What is the usual reason for "wet dreams”? A. Abnormal or excessive sex desire. 
B. Lack of self control in sex feelings and desire. 
C. A need for sex outlet, or sex tension resulting from a sex dream. 
D. Sex tension caused by sex thoughts before sleeping. 
E. Strong desire for sex relations with someone who is not available. 
42. How often do women have dreams that release sex tensions? A. Never. 
B. Almost never. 
C. Occasionally. 
D. Frequently. 
E. As often as men have “wet dreams ” 
43. What do physicians say about the effects of modern methods of 
birth control? 
A. That they reduce a woman’s chances to have a wanted pregnancy. 
B. That their use endangers the health of women. 
C. That they may harm the male sex organs. 
D. That they very rarely harm the health or fertility of either sex. 
E. That they protect the health of couples who use them. 
44. When they are used in the correct way, how effective are medically 
approved methods of birth control ? 
A. Completely effective. 
B. Highly effective. 
C. Only moderately effective. 
D. A slightly better than no method. 
E. Completely ineffective. 
45. What is the effect of birth control on pleasure in intercourse? A. Increased pleasure for the wife, reduced pleasure for the husband. 
B. Increased pleasure for both husband and wife. 
C. Reduced pleasure for both husband and wife. 
D. Increased or reduced pleasure, depending on attitudes. 
E. No effect on pleasure for either husband or wife. 
46. When consistently and intelligently used as directed by a compe¬ 
tent authority, which of the following is an effective method of 
birth control? 
A. A rubber sheath or condom. 
B. An oral contraceptive (pills). 
C. A vaginal diaphragm with contraceptive cream. 
D. An intrauterine device (I.U.D.) 
E. Any one of the above. 
47. Which method of birth control requires no preparation just before 
sex relation by either husband or wife, but once in use provides 
continuous and highly effective control ? 
A. A rubber sheath or condom. 
B. Oral contraception (pills) 
C. An intrauterine device (I.U.D.). 
D. A vaginal diaghragm. 
E. The “safe period.” 
48. Of those listed here which is an unreliable method of birth 
control ? 
A. Withdrawal by the male before orgasm. 
B. Douching immediately after sex relations. 
C. The safe period. 
D. Sex relations without orgasm by the male. 
E. Any of the above. 
49. If the population of the United States is to remain at its present 
level, no couple may have more than: 
A. One child. 
B. Two children. 
C. Three children. 
D. Four children. 
E. Five children. 
60. What is the usual effect of surgical sterilization as a method of 
birth control on a man’s or a woman’s sex desire, or pleasure in 
sex relations? 
A. No change in desire or pleasure. 
B. Reduced desire in men but not in women. 
C. Reduced pleasure in men but not in women. 
D. Reduced pleasure in women but not in men. 
E. Reduced desire in women but not in men. 
Now go on to the next page. 
77 
B« sure to lino up Pago 6 with Column 6 of the answer pad 0 
51. What is the effect of circumcision on sex activities in adulthood? A. No effect. 
B. Increased enjoyment 
C. Decreased enjoyment 
D. Increased ability to prolong sex relations. 
E. Reduced desire to masturbate. 
52. What is menstruation? A. Clearing the body of impure blood. 
?. Bringing the ovum (egg) down into the womb. 
C. Clearing the unfertilized ovum (egg) from the womb. 
D. Clearing the womb to prepare again for possible pregnancy. 
E. Nature’s way of reducing sex desire in women. 
63. Is a menstruating woman sick? A. Yes. 
B. She is in poor emotional health. 
C. Her resistance to infection or disease is low. • 
D. She naturally feels weak and unwell from loss of blood. 
E. Menstruation is not an illness. 
54. Of the items listed here which one is the most important in con¬ 
sidering the possibility of intercourse during menstruation? 
A. The attitudes of the man and the woman. 
B. Whether a woman can enjoy sex at this time. 
C. Whether intercourse increases depression of menstruation. 
D. Whether it is physically possible to have intercourse at this time. 
E. Whether intercourse during menstruation is dangerous to health. 
55. What is the most likely result of intercourse during menstruation? A. Injury to the Roman's sex organs. 
B. Infection of the male sex organs. 
C. A normal pregnancy. 
D. An abnormal pregnancy. 
E. Nothing of importance ty physical health. 
56. What changes usually occur in menstruation after marriage? A. No changes occur unless the woman becomes pregnant. 
B. Menstruation is more Regular and less difficult. 
C. Menstruation is less regular and more difficult. 
D. Menstrual pains and headaches disappear. 
E. Depression and moodiness are no longer present. 
57. How often are there male sperm cells, which could cause preg¬ 
nancy, in the fluid which flows from the male sex organ before 
orgasm? 
A. This fluid always contains sperm cells. 
B. This fluid often contains sperm cells. 
C. This fluid contains sperm cells at times. 
D. This fluid never contains sperm cells. 
E. No one knows whether this fluid contains sperm cells. 
58. How many times must a woman have intercourse for pregnancy 
to be possible? 
A. Once. 
B. Several times. 
C. Many times. 
D. Once, if she is passionate. 
E. Several times, if she is not passionate. 
69. What kind of intercourse is necessary for a woman to become 
pregnant? 
A. She must reach orgasm before the man. 
B. The man and woman must reach orgasm at the same time. 
C. She must reach orgasm after the man. 
D. Pregnancy is possible whenever sperm cells enter the vagina. 
E. The man must reach orgasm for pregnancy to be poesible. 
60. At what time in her cycle of menstruation is a woman most likely 
to become pregnant? 
A. About two weeks before menstruation begins. 
B. During the three days before menstruation begins. 
C. During menstruation. 
D. In the first day after menstruation ends. 
E. During the first week after menstruation ends. 
Now go on lo tho nazt page. 
78 
Be sure to line up Page 7 with Column 7 of the answer pad 7 
61. How soon after birth of her baby ia it possible for a woman to 
become pregnant again? 
A. Before menstruation begins again. 
B. Not until after she has menstruated. 
C. Not until she stops breast feeding her baby. 
D. Not until she feels sex desire. 
E. Not until she again is able to achieve orgasm. 
62. How does being unresponsive in intercourse affect the possibility 
that a woman will become pregnant? 
A. Makes pregnancy impossible. 
B. Greatly reduces possibility of pregnancy. 
C. Has no effect. 
D. Increases possibility of pregnancy. 
E. Reduces possibility unless her husband is very passionate. 
63. By using a pregnancy test how soon after pregnancy could have 
occurred can a doctor know that the woman is, or is not, pregnant? 
A. Ten to twelve days. 
B. Two to three weeks. 
C. Four to six weeks. 
D. Three months or more. 
E. Pregnancy tests are not reliable. 
64. Without the use of a laboratory test for pregnancy how soon after 
pregnancy could have occurred can a physician be sure that a 
woman is pregnant? 
A. After the first month. 
B. After the second month. 
C. During the third month. 
D. When he can hear the baby's heart. 
E. When the woman can feel the baby move. « 
66. For how long after a woman becomes pregnant can she and her 
husband safely continue their usual pattern of sex relations? 
A. Intercourse should stop at once. 
B. They can continue for three months at their usual rate. 
C. They can continue for six months but less frequently than before. 
D. They can continue as long as the woman feels no discomfort. 
E. They should seek and follow the advice of their doctor. 
66. What usually happens to the cervix and the vagina when a woman 
ia having a baby? 
A. They relax and are stretched as the baby passes through. 
B. The vagina is held open by the doctor or midwife. 
C. These openings must be enlarged by surgery. 
D. These openings are torn by pressure of labor. 
E. Pregnancy causes them to grow larger in preparation for birth. 
67. What change usually occurs in the vagina as the result of having 
a baby? 
A. It is much larger. 
B. It is slightly larger. 
C. There is no change in size. 
D. The woman can feel greater pleasure in intercourse. 
E. The woman can feel less pleasure in intercourse. 
68. What does size of male or female sex organs indicate? A. Size indicates whether the man or woman will be a good sex partner. 
B. Large sex organs mean greater sex desire and capacity. 
C. Size indicates how much the man or woman has masturbated. 
D. Large sex organs mean much experience in intercourse. 
E. Size of sex organs indicates none of the above. 
69. Where can a person with low sex desire get a cream or a lotion 
that will cause him or her to want or be able to have sex relations 
more often? 
A. Drug stores sell them. 
B. They exist but contain harmful drugs and are not for sale. 
C. A doctor can prescribe these creams or lotions. 
D. Some people know how to make them from herbs, oils, etc. 
E. There are no such creams or lotions. 
70. What is indicated about her sex desire and responsiveness by the 
size of a woman’s breasts ? 
A. Women with large breasts are more responsive in sex relations. 
B. Women with small breasts are more responsive in sex relations. 
C. Women with large breasts want sex relations more often. 
D. Women with small breasts want sex relations more often. 
E. Breast size is not related to sex desire or responsiveness. 
Now go on to tk* next page. 
79 
Be sure to line up Page 8 with Column 8 of the answer pad 3 
71. What is the effect of eating certain foods such as oysters, raw 
eggs, olives, celery, etc., on sex desire and on capacity? 
A. Noticeable increase in desire in young adults. 
B. Noticeable increase in capacity in older adults. 
C. Noticeable increase in both desire and capacity for all ages. 
D. Noticeable increase in desire and capacity in young adults. 
E. Little or no increase in either desire or capacity at any age. 
72. What is the effect of masturbation on sex desire, on capacity to 
reach orgasm, and on ability to cause pregnancy or to become 
pregnant later in life? 
A. Has no physical effect on later desire, capacity, or ability. 
B. Has no psychological effect on later desire, capacity or ability. 
C. The effect depends on how much the man or woman has masturbated. 
D. Reduces later desire, capacity and ability in men. 
E. Increases later desire and capacity in women. 
73. How does masturbation affect intelligence and emotional control? A. Causes some loss in both. 
B. May cause a nervous breakdown. 
C. Slows the growth of intelligence. 
D. The effect depends on how much one masturbates. 
E. Has no effect on either one. 
74. What are the effects of masturbation on the human body? A. Less strength. 
B. Temporary reduction of sexual tension. 
C. Retarded growth. 
D. Enlarged sex organs. 
E. Reduced resistance to disease. 
75. To what extent can men and women with syphilis or gonorrhea 
have sex relations? 
A. They want and can have sex relations more often. 
B. They want and can have sex relations less often. 
C. They want and can have sex relations as usual. 
D. They want but can’t have sex relations. 
E. They neither want nor can have sex relations. 
76. What has happened to the man or woman who had a chancre of 
syphilis or a discharge from gonorrhea and these disappeared 
without medical treatment? 
A. The disease is cured; there is no further cause for worry. 
B. The uncured disease can not harm him or her but may harm others. 
C. The uncured disease may later harm him or her but will not others. 
D. The uncured disease is dangerous to the person and to others. 
E. The cured disease means the person is safe from having it again. 
77. How curable are syphilis and gonorrhea? A. Almost every case of either disease can be cured. 
B. Some cases of both diseases can be cured. 
C. Syphilis can not be cured; gonorrhea is easily cured. 
D. Gonorrhea can not be cured; syphilis is easily cured. 
E. These diseases can be cured only if treated soon after infection. 
78. How do sex relations during or after menopause affect a woman’s 
physical and emotional health ? 
A. This causes some physical distress or illness. 
B. This causes a nervous condition. 
C. This causes both physical and emotional illness. 
D. The effect depends on the woman’s age when menopause begins. 
E. There is no change from the effect before menopause begins. 
79. How soon after the beginning of menopause may a woman safely 
discontinue the practice of birth control ? 
A. As soon as she has missed three menstrual periods. 
B. As soon as she has missed six menstrual periods in a row. 
C. When she has not menstruated for one year. 
D. When she has not menstruated for two years. 
E. When she has not menstruated for four years. 
80. What happens to a woman’s sex desire and capacity for orgasm 
during and after menopause? 
A. She has less desire and a lowered capacity for orgasm. 
B. She has a large Increase in sex desire and capacity for orgasm. 
C. Her desire and capacity for orgasm remain about the same. 
D. Her desire and capacity are unchanged but sex relations are painful. 
E. There can be no orgasm after menopause. 
Put tk* Ttst Booklet aside and fill in the blanks on the answer pad. 
Form Y—Second Revision 
(First Printing) 
(Experimental Edition) File No. 
Sex Knowledge Inventory AND ANATOMY 
Developed by Gelolo McHugh 
Author of Training for Parenthood for FAMILY LIFE PUPLICATIONS, INC. 
DIRECTIONS: This inventory is for confidential use with you by your teacher, doctor, minister, or other coun¬ 
selor. It is tov help you understand better the constructive part sex may play in life. This is not an intelligence 
test. It is a measure of what you know about sex. Be sure to read carefully all directions. Answer every ques¬ 
tion. If you do not know, guess. If you are guessing, place an X by your answer. If you want more informa¬ 
tion about any question, draw a circle around your answer. Complete the blanks on this page; then turn the 
page and begin. 
DO NOT WRITE YOUR NAME ON ANY FART OF THE INVENTORY 
Age: years. Sex: (Check one) Q Male □ Female 
Marital Status: (Check one) □ Single □ Married Q Widowed □ Divorced □ Separated 
How many brothers? older younger. How many sisters? older younger. 
Education completed: (Circle highest grade completed) High School- 1 2 3 4 College- 12 3 4 
Other  
Your occupation:  
Your father’s occupation:    
Type of community in which childhood was spent: 
Country £2 Small Town, 1 [21 Small City Q Suburban □ Earge CtVy 
Childhood religious training: 
□ Catholic □ Protestant □ Jewish □ None □ Other — —  
Are you a parent? □ Yes □ No If so, how many children do you have?  
What is your state of health? Q Excellent □ Good □ Fair Q] Poor 
What physical handicaps, if any, do you have?   —-—  »  
ADVISORY COMMITTEE: Evelyn M. Duvall, Ph.D., National Council on Family Relations: Robert G. Foster, 
Ph.D., The Menninger Foundation; Lester A. Kirkendall, Ph.D., Oregon State College; Walter Stokes, M.D., George 
Washington University; Abraham Stone, M.D., Planned Parenthood Federation; Roy A. Burkhart. D.D., Ph.D., First 
Community Church, Columbus, Ohio; Floyd Boys, M.D., University of Illinois, Urbana; John M. Billinsky, Ph.D., 
Andover Newton Theological School; Robert M. Creadick, M.D., Duke University; Wayne E. Oates, Ph.D., Southern 
Baptist Theological Seminary; Russell L. Dicks, D.D., Duke University; Reuben Hill, Ph.D., University of North 
Carolina. 
Published by FAMILY LIFE PUBLICATIONS, INC., P.O. Box 6725, College Station, Durham, North Carolina 
Copyright, 1955 by Family Life Publications, Inc. All rights reserved. 
Printed in the United States of America 
81 
PART I 
DIRECTIONS: How well do you know the proper names for male and female sex parts? Given the proper name, 
vou are to identify each part by its number. In the blank space by each name write its number from the drawing. 
Be sure to fill all spaces. If you do not know, guess. If you are guessing, place an X by your answer. If you 
want to know more, draw a circle around your answer. The term sex part is used here to mean either sex 
organ or sex structure. Each drawing shows one half of a human body which has been divided through the center 
horn front to back. 
Cowper's gland 
epididymis 
foreskin 
glans penis 
penis 
prostate gland 
scrotum 
seminal vesicles 
testicle 
urethra 
vas deferens 
cervix 
clitoris 
Fallopian tube 
hymen 
labia 
ovary 
urethra 
uterus or womb 
vagina 
UJ 
cn 
H 
OC 
2 
X 
UJ 
CD 
UJ 
_J 
< 
UJ 
Now go on to the next page. 
82 
PART II 
DIRECTIONS: You may understand much about male and female sex part* without knowing their names. Answer 
the questions below with numbers only. Select a number from the drawing to fill in each blank space. Be sure 
to fill all spaces. If you do not know, guess. If you are guessing, place an X by your answer. It you want to 
know more, draw a circle around your answer. The term sex part is used here to mean either sex organ or sex 
structure. Each drawing shows one half of a human body which has been divided through the center from front 
to back. 
1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 
9. 
10. 
11. 
12. 
13- 
14. 
15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 
28. 
29. 
SO. 
31. 
32. 
MALE SEX PARTS 
What covers and protects the male reproductive glands? 
Where are the male reproductive cells formed? 
Where do the newly formed male reproductive cells accumulate? 
Which is the male sex organ or structure used in sex relations and urination? 
What male organ holds urine? 
During sexual excitement: 
a. What male sex part becomes larger and firmer: 
b. Where is the male most sensitive to touch? 
c. Which male sex part becomes moist?- 
Which is the male organ for sex relations? 
At the highest point of male sexual excitement fluids are added to the male reproductive cells 
by three glands. These three glands are: 
Which male sex part, if it is closed by disease, injury or surgery, will make it impossible for 
the male to become a parent? 
Which male sex gland supplies the male bloodstream with products important to physical 
growth and health? 
What male sex part is removed in castration? 
Which is the male sex part that is partially removed in circumcision? 
FEMALE SEX PARTS 
1. 
2. 
3. 
4. 
5. 
6a. 
6b. 
6c. 
7. 
9. 
10. 
11. 
12. 
Where are female reproductive cells formed? 13.— 
Which female sex part first receives the completely formed female reproductive cell? 14— 
What covers and protects the outside sex organs and structures of the female? 15.— 
During sexual excitement two female sex parts usually become moist. These are: 16.. 
During sexual excitement: 
a. What female sex part usually becomes larger and firmer? 17a— 
b. Where is the female most sensitive to touch? 17b  
Which is the female organ for sex relations? 18— 
Where does the male sex organ enter the female sex organ? 19.— 
At what place inside of the female organ for sex relations does the male sex organ usually 
discharge male reproductive cells? 20.— 
Where does a male reproductive cell meet and unite with the female reproductive cell? 21.— 
Where do the united male and female reproductive cells continue to grow until the baby is 
ready to be orn? 22- 
In being born a baby must pass through two female sex parts. These are: 23 j 
Where does a baby come out of its mother’s body? 24.— 
Which female sex part, if it is closed by disease, injury or surgery, will make it impossible for the 
female to become a arent? 25.— 
What.female sex gland supplies the female bloodstream with products important to physical 
growth and h l h? 26.— 
What female organ holds urine  27.— 
Which is the female part or structure for urination only? 28.— 
The menstrual flow comes from what female sex part  29.— 
In leaving the female body menstrual flow must pass through two sex parts. These are: 30..' 
Where does the menstrual flow leave the female body? 31.— 
In douching where is the nozzle of the syringe placed? 32.— 
When you finish, go on to Part III. 
83 
PART III 
DIRECTIONS: In the blank space beside each definition below, write the number of the word that best fits the defini¬ 
tion. He sure to fill all spaces in lx>th columns. If you do not know, guess. If you are guessing, place an X by 
your answer. If you want to know more alx>ut the meaning of a word, draw a circle around your answer. 
1. Caesarean 
2. banian 
3. conception 
I. douche 
5. labor 9. puberty 25. adultery 29. gonads 33. mistress 
6. menstruation 10. senility 26. fornication 30. hirsute 34. rape 
7. menopause 11. semen 27. frigidity 31. impotence 35.travesty 
8. pregnancy 12. sterilization 28. genitals 32. masturbation 36. vulva 
The stage of physical growth dilr)hg which l>oys 
 and girls become able to have children. 
 Flushing the vagina with a liquid. 
The birth of a baby through the alrdomen by a 
 surgical operation. 
 Fluid containing male sex cells. 
The shedding of a lining of blood cells by the 
 womb. 
A surgical operation which prevents a person from 
 Irecoming a parent. 
That time when a woman is losing her ability to 
 have children. 
 The joining of a male and a female cell. 
 The physical effort of giving birth to a baby. 
The condition of a woman from the time her baby 
 begins to develop until it is born. 
-Low degree of sex desire—especially in women. 
-Male and female sex parts. 
Sex relations of an unmarried male with an un- 
- married female. 
-Sex relations forced upon another. 
Sex relations of a married person with someone 
-other than husband or wife. 
- The outside, visible parts of the female sex organs. 
-Self-stimulation of one's sex organs. 
Lack of ability to perform normal sex relations— 
-especially in men. 
- Male and female sex glands. 
A woman who usually limits her sex relations to 
-one man to whom she is not married. 
13. climax 
14. coccyx 
15. copulation 
10. coitus 
17. ejaculation 
18. erection 
19. fervent 
20. intercourse 
21. orgasm 
22. ovulation 
23. ovum 
24. sperm 
The separation of the female egg from the gland 
where it forms. 
The highest point of sexual excitement in male 
or female. (Write tivo numbers.) 
The reproductive cells of the male. 
v S<*x relations. 
I (write three numbers.) 
Discharge of fluid by the male at the highest 
 point of sexual excitement. 
The enlarged and firm condition of the male sex 
 organ during sex arousal. 
 The reproductive cell of the female. 
37. abortion 
38. gonorrhea 
39. homosexual 
40. incest 
41. infamy 
42. miscarriage 
43. prophylactic 
44. promiscuity 
45. prostitute 
46. syphilis 
47. taboo 
48. Wassermann 
A disease of the blood which usually enters the 
 Ixxly through the sex organs. 
 The birth of a baby before it can live. 
A disease of the inside lining of male or female 
 sex organs. ' 
 A blood test for a venereal disease. 
Natural or intentionally caused birth of a baby 
 before it can live. 
 Sex relations with a close relative. 
A woman who offers to have sex relations for 
 pay. 
A person who has sex relations with a memhei 
 of the same sex. 
A device or chemical used to keep one from catch- 
 ing a j vencral disease through sex contacts. 
Sex activities with more than one person during 
 the same period. 
84, 
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