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Access to sexual information has proliferated in specialty sex shops, sex exhibitions, daily press, radio, television, and the Internet. Developments such as virtual sex and chemical agents that affect sexuality are likely to lead to further changes in sexual expression.

There may be an assumption that more information leads to more sexual freedom, interest and satisfaction. Some of the information available is exaggerated and may do more harm than good by increasing performance anxiety. There is a need for realistic sex education.

Just as sildenafil has helped treat erectile dysfunction, so may future drugs enhance or inhibit sexual drive, romantic love, and bonding. This may seem "cold-hearted" compared with "natural" love or lust, but the misery experienced by those with excessive or too little sexual drive, or the inability to feel romance and bonding to another, would be aided by pharmacological modulation of these processes.

Enduring attachment between spouses may be associated with high levels of vasopressin and oxytocin, and low levels of testosterone.^12,13 The future may unveil a "love pill" or "family pill" to ensure marital harmony and encourage greater stability for child-rearing. Little imagination is required to conjure various circumstances when greater happiness would be achieved by changing sexual drive, romantic potential or bonding capacity.

Lowering of testosterone levels may become acceptable to maintain a happy long term relationship, while increasing testosterone levels may assist single or divorced men with lower than average testosterone levels to find and satisfy new partners. The same may apply to women, particularly those who have ovarian failure and low testosterone levels.

Broader sexual repertoires: The contraceptive pill has assisted the development of recreational sex. Sex is now for fun, love and intimacy, thanks to the greatly reduced risk of unwanted pregnancy. In the late 1950s, only 12% of American couples reported practising cunnilingus; today about 75% practise this art.¹⁴ Foreplay has increased from 10 to 15-17 minutes in the United States.¹⁵ The sexual act may become more varied as sexual aids, devices, lotions and drugs are developed, with increased knowledge of sexual biochemistry and pharmacology.

The female role in change: World attitudes about women's premarital sexuality are now becoming more permissive, although there are still marked differences between cultures.^16,17 As standards of health rise, contraception and therapeutic abortion become more widely available, and people become more interested in sex. As women gain economic independence, they become less likely to exchange sexual freedom for protection and financial support. Women are experimenting with sex earlier in life, living with partners outside marriage, expecting a wider variety of sexual techniques, using contraception and planning families, marrying later, and divorcing when spouses do not satisfy their social and sexual needs.¹⁷ The pace of change may increase even further.

Cybersex: A recent poll of 10 000 US households found 30% of individuals tuned in to "adult" sites on the Internet, talking about or having cybersex with strangers.¹⁸ Usually the participants write sexually explicit things to each other until one reaches orgasm.

Pornography on the Internet is no different to pornography in many ancient cultures, but may be viewed at a younger age. This exposure may encourage men and women to expand their sexual repertoire, or it may increase sexual anxiety.

Virtual sex: Sexual arousal and orgasm may be produced by virtual sex, which involves the projection of three-dimensional visual images in space so that sexual acts can be seen; viewers may become aroused and, if they wish, achieve orgasm. Virtual sex has numerous advantages: safety from sexually transmitted diseases, as an alternative to prostitution, and a sexual outlet for sexually shy or anxious persons. It may also enable people who have discontinued sexual intercourse as a result of a previous traumatic experience during coitus (eg, rape, violence or ridicule) to enjoy safe sexual arousal and orgasm.

Conversely, adverse interpersonal experiences associated with natural intercourse may be avoided.

Prostitution: The role of the prostitute may become more generally accepted, as in earlier centuries.¹⁹ Two-thirds of people in Melbourne believe it should not be against the law to sell sex from a brothel, and two-thirds of Victorians believe there is nothing wrong with paying for sex.^20-22

The role of prostitutes could be enhanced by education in secondary and tertiary institutions so they can act effectively as sexual and social counsellors and sexual surrogates. Prostitutes may become more involved in sexual education, counselling, and training of couples having difficulty establishing effective sexual relationships, a problem generally ignored by the medical profession.

Marriage: The importance of sexual intercourse in marriage, and marriage itself, may gradually change. Already there is a 40% divorce rate, and a high incidence of infidelity.^23-25 Sexual problems are the third most common reason for failed relationships. The ignorance and failure of sexual enjoyment in so many couples is a blight on those responsible for general education. Perhaps in the future education will embrace the realities of cohabitation, the different sexual needs of men and women, sexual techniques, and perhaps the use of sexual surrogates to assist with sexual problems.

Reproduction: Natural conception has the disadvantage that it is unpredictable, and it allows implantation of genetically abnormal embryos, sometimes resulting in therapeutic abortion if the defect is detected, or in birth of children with mental or physical disabilities (3% of births).²⁶

In future, women may be able to store eggs by a simple surgical procedure soon after puberty.²⁷ They will then be able to decide if and when they wish to conceive. In-vitro fertilisation (IVF) allows each embryo to be tested to avoid embryos with genetic abnormalities.²⁸

This will encompass a more understanding, liberal and satisfying time when both sexes practise and enjoy safe sex associated with a satisfactory emotional and intellectual experience.

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27. Trounson A, Kuleshova L, Gianaroli L. What can we expect from thawing gametes? [abstract]. Congress on Controversies in Obstetrics and Gynaecology, Prague, Czech Republic, 8 September 1999.
28. Trounson A, Wood C, Kausche A, et al. Oocyte maturation in vitro. The Fertility Society of Australia XIII Annual Meeting, Brisbane, October 1994.

Reprints will not be available from the author.
Correspondence: Professor C E Wood, 19 Simpson Street, East Melbourne, VIC 3002.
PROFWOODATmalvern.starway.net.au

©MJA 1999
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