Human Sexuality
God created human beings with many dimensions, one of which is their unique sexual nature. As men and women, we are physical, intellectual, emotional, relational, and spiritual beings, and thus distinguished from the rest of creation.
Many levels of sexual expression are possible between men and women.
One important expression of sexuality is friendship; the sexual differences between men and women enhance meaningful, warm, and healthy relationships. A second important area of sexual expression is intimacy between husband and wife. God has designed the most intimate expressions of sexuality, including intercourse, specifically for the marriage relationship. The Bible describes the covenantal relationship of love which God has for His people; the husband-wife relationship is analogous. Since God holds the marriage relationship close to His heart, its violation is a serious offense to Him.
Our integrated nature means that intimate sexual expression profoundly affects all dimensions of our being. While sexual expression outside of God's design may provide temporary pleasure, God's guidelines are meant to protect us from disease, fear, exploitation, and ultimately dehumanization.
CMDA affirms the biblical principles stated above. These principles are clarified further by the following statements:
1. Sexual intercourse is to be reserved exclusively for heterosexual marriage.
2. Single men and women who engage in sexual intercourse are outside of God's limits and are practicing sin.
3. Married people who have intercourse with anyone other than their marriage partner are defiling a marriage union which God has sealed and are in sin.
4. Like single heterosexuals who engage in heterosexual sex, or married persons who engage in extra-marital sex, homosexuals who engage in homosexual acts are practicing sin.
5. We condemn the perversion of sexuality in pornography, rape, incest, and all other forms of sexuality that deviate from the biblical norm for Christian marriage.
6. Family life teaching and sexual education are God-given responsibilities of parents. The Church's task is to assist both parents and youth in understanding their sexuality in the context of biblical values. When appropriate, sexual education should include risk behavior information and instruction on protective techniques to inhibit the spread of AIDS and all other sexually transmitted diseases.
7. Education and protective techniques alone, however, will not stop the spread of AIDS. Our society needs to understand and acknowledge that there are compelling emotional, philosophical, medical, sociological, and historical reasons for practicing abstinence before marriage and fidelity within marriage.*
CMDA calls our world to affirm these biblical sexual morals. We recognize and acknowledge that many persons struggle with sexual temptation and sin, and that all of us have fallen short of God's standards. We testify that God is just, merciful, loving, and faithful, and that He will, if we ask Him, forgive us of our sins and bring us into an intimate relationship with Him.
*From the CMDA Statement on AIDS
Approved by the CMDA House of Delegates
Passed unanimously
May 3, 1990. Toronto, Canada.
Explanation
One's sexuality is an important part of each individual. This is true for each patient, and it is equally true for each physician and dentist. God has disclosed in scripture clear instructions about the wise and proper expression of our human sexuality. These apply equally to patients and to professionals.
Many areas of medical practice deal with issues involving sexual practice, e.g. contraception, sterilization, masturbation, artificial reproductive technology, abortion, sexually transmitted diseases, etc., as well as many psychosocial issues. Christian healthcare professionals should have a clear understanding of the teachings of scripture both about the principles of beautiful sexual expression within marriage and about immoral sexual activity and the consequences thereof.
While there is near unanimity among Christians about the boundaries of sexual morality, there is not agreement on how the Christian healthcare professional should respond to patients who are seeking treatment for the consequences of sexual immorality, or who seek assistance with ongoing sexual practices which violate God s teachings.
Since the time of Hippocrates, the medical profession has made clear pronouncements regarding boundaries of impermissible behavior between physicians and their patients. The basis for those boundaries was (and is) not based on morality. The boundaries were established because of the fiduciary nature of the unequal professional relationship. Healthcare professionals have more knowledge and authority in their area of expertise than do their patients. Each patient comes to a professional for advice and treatment, and he or she should be able to trust that the professional person will use that knowledge and authority to seek the patient s best interests. The professional therefore must be trustworthy and must not exploit the vulnerable patient for his or her own interests. This clear professional boundary is consistent with the moral boundaries found in scripture.
The CMDS statement on Human Sexuality was written to affirm biblical teaching about sexual practice and as a reminder to physicians and dentists about the proper role of sexuality in their personal lives and in their professional relationships.
Human Sexuality Courses in Medical School
Medical students do not face issues in human sexuality for the first time in their human sexuality block, offered during the first or second year. From the initial urges and curiosities stirred up as puberty unfolded through junior high, senior high, and college years, the average student has discovered drives and questions that have been legitimately or illegitimately fulfilled, answered or unanswered. Whether through conversation or readings, courses or experimentation, romance or manipulation, some knowledge has been obtained on the subject before the first porno flick awakens groggy MS-II students during the introductory presentation in Human Sexuality 101. Whether married or single, male or female, unresolved issues usually accompany the student into the halls of clinical medicine; to some extent these issues are addressed in one's medical education. For the Christian medical student, however, the moral issues are firmly entwined with the medical issues and answers that fail to address the former leave the latter only partially fulfilled.
When these courses are elective, the decision about whether to enroll or not is a matter of individual conscience. These issues are certain to present themselves in one way or another to many clinicians. Where courses are rejected for their coarseness, some supplemental strategy should be engaged. Perhaps those who attend could offer a weekend or refined insight for absentees.
Given the interface between one's spirituality and one's sexuality, any consideration of sexual issues that ignores their moral dimensions is truncated, unidimensional, and immature. While it is not the intention of this brief section to address these concerns that life poses, the wise medical student would be resourceful in building a library of worthy volumes for self- directed learning. The bibliography (Section 2.3.4) should aid such an investment. Both for personal as well as patient benefit, such supplemental reading is mandatory so that the medical student who belongs to God may be efficient and equipped for good work of every kind (II Tim. 3:17, NEB). Such serious reading for the Christian presumes, obviously, the study of scripture where these topics are addressed.
Single Lifestyles
For the practicing Christian, self-discipline may be the central concern for the single student. But then self-discipline has its dividends. Any medical student or dental student already knows that: they wouldn't sit where they now sit if that had not been true in undergraduate days. Sexuality education obviously has its place---but how does one teach self- discipline, the central dynamic to successful living?
Given the pressures (cultural, hormonal, romantic) to be sexually active today, only the focused, self-disciplined, self-protecting (to say nothing of Christ-honoring) individual can see beyond immediate gratification to the joy of genuine, everlasting intimacy. If self-discipline is the key to admission to the nation's top colleges and universities, in joining the Olympic team, in being selected for an elite service unit, in joining a traveling ensemble, etc., it is a major key to successful marriage.
A significant number of Christian undergraduate and graduate students have responded to the primal urges without sufficient moral reflection; i.e. they have become sexually active without the benefit of bonding. Repentance, forgiveness, and restored discipline is the Christian paradigm, lived daily with innumerable issues other than those sexual, but equally applicable to those sexual. Don t let the world around you squeeze you into its own mold. (Rom. 12:1; Phillips)
If marriage is one's goal, then regular prayer for God's match-making skills to be sovereign and sufficient, observable and obvious is mandated. Marriage made in Heaven are usually the result of prayers sent to Heaven. A good question to ponder in the meantime---how sexually active do you wish your bride (groom) to be before you pledge your troth? With how many partners?
Issues in sexuality have personal as well as patient implications. Personal integrity is one major part of any counseling strategy. The clinician who knows the sexual dividends of honoring God s moral code is in a strong position to commend it to patients.
Marriage and Sexuality
Whether sexual curiosity, sexual education, or sexual dysfunction is the issue, the physician both as clinician and as lover needs to explore each of the major sexual themes I depth for patient as well as personal benefit. Some patient sexual concerns are specialty specific and residency training should provide answers and treatment plans appropriate to the inquiry or patient complaint.
Since the Christian faith teaches that sexual intimacy is reserved for marital intimacy, and since the God that Christians worship is pure love at the core of His Being, married Christians should be awesome lovers since covenantal commitment bonds both together in the arms of eros-agape.
Medicine is a most seductive mistress, both as clinical challenge in speeding health to hurting patients and as a proud profession conferring status on each practitioner. But nowhere does one become even close to being indispensable in life save as spouse and/or parent. Drop dead and twenty applicants will be available within a week for the job. While balancing priorities in such a demanding profession is very difficult, it is absolutely critical if integrity and intimacy are to be preserved. Severe caution should be exercised if joining committees in the church or community significantly intrudes on marital or family life. Rotating priorities over a lifetime encourages marital intimacy and preserves some sense of harmony in life. Doing everything at once is a recipe for disaster.
A fulfilling sexual life in a solid marriage provides a counseling platform where clinical expertise can blend with personal experience for patient benefit. This does not mean that indiscreet sharing is advocated. Rather that the physician will know what is preached is practiced and what is practiced is prescriptive for others because it meets medical-moral criteria for mature sexual functioning and personal happiness.
Homosexuality
One of the most controversial issues in the modern university and in the mainline denominations is the treatment of homosexual individuals. Christian clinicians need to learn to walk the high road above prejudice, alienation, disease, and politically-correct ideology in order to treat these patients with respect and dignity. Since all human beings are created in the image of God and since all individuals are a sum of their total segments, patients with this orientation merit sensitivity and competence regardless of their presenting complaint.
Competent clinicians will understand the Kinsey scale of heterosexual-homosexual orientation in order to interpret patient disclosure. HIV positive patients merit the latest interventions as well as compassion. It is possible to hold tradition moral/Biblical values in one hand while respecting the rights of these patients in the other. One of the virtues in the Fruit of the Spirit cluster is gentleness (Gal. 5:23). One of the characteristics of the attractive Christian is the ability to explain the Christian faith with gentleness and respect (I Peter 3:15).
As this debate progresses or regresses, serious reading in authoritative as well as theologically astute sources will be necessary.
Abstracts
Keighley JV. Contraceptives and the unmarried. CMDS Journal 1982; XII(2):27-30
This is a report of a study commissioned by the Christian Medical Fellowship in Great Britain regarding premarital intercourse and the supply of contraceptives to the unmarried. It compared the results of a survey of a small number of Christian young people (date not specified) to those of a large study published in 1969 done in a housing project near London which found that "extra-marital intercourse is the norm in this society." The Christian young people reported a high level of chastity and a good understanding of the biblical view of sexual activity.
The author discusses the dilemma of the Christian physician who is requested to prescribe oral contraceptives by an unmarried patient. She analyzes the potential benefits and harms and concludes that writing the prescription may sometimes be the right thing to do.
Jung BR. Physicians should not prescribe the pill for their unmarried patients. CMDS Journal Sept/Oct 1994; XXV(5):38-39
In this opinion piece, the author states that Christian physicians should not accede to the request for oral contraceptives from any unmarried patient because he does not believe that Jesus would respond in that way, but would instead tell the woman to "Go now and leave your life of sin." While it is quicker and easier to give the prescription, he believes he is morally obligated "to bring objective Truth to bear on her lifestyle, hoping she sill listen" and he states that his investment of time and energy is worthwhile.
Bibliography
Human Sexuality Data
Ashley BM, O Rourke KD. Sexuality and reproduction. Chapter 10 in Healthcare Ethics: A Theological Analysis. St. Louis: Catholic Hospital Association, 1989; pp224-299
Two Roman Catholic theologians address such issues as personal sexuality, contraception, family planning, sterilization, artificial insemination, IVF, rape, and " pastoral approach to problems of conscience that arise from an effort to live effectively as sexual human beings."
Green RM, ed. Religion and Sexual Health: Ethical, Theological, and Clinical Perspective. In Theology and Medicine book series. Dordrecht, Netherlands: Kluwer, 1992
More than a dozen authors address issues of sexuality from various Christian (Protestant and Roman Catholic) perspectives.
Knox D. Human Sexuality: The Search for Understanding. St Paul, MN: West Publishing Co., 1984; 635 pp.
A standard college and university textbook that provides basic data. The section on AIDS is very dated. Used by discriminating students in several Christian colleges.
McIlhaney JS. Sexually-transmitted disease, sexual activity and sex education. Chapter 5 in New Issues in Medical Ethics. Hollman J (ed). Bristol, TN: CMDS, 1995; pp 63-76
A Christian gynecologist starts with the presumption that sex is good, but like another good, fire, it can go out of control and injure or kill. After detailed discussion of STD s, including clinical and epidemiological information, he makes a strong case for teaching children that abstinence until marriage is normal, healthy, and achievable.
Michael RT, et al. Sex in America: A Definitive Survey. Boston: Little, Brown and Co., 1994; 300 pp.
"The only comprehensive and methodologically sound survey of America s sexual practices and beliefs" conducted by the National Opinion Research Center at the University of Chicago. Replaces the seriously flawed Kinsey surveys. Definitive. Authoritative.
Nicholi AM. Human sexuality: a psychiatric and biblical perspective. In God and Culture, ed Carson D, et al. Grand Rapids, MI: Eerdmans & Co., 1993.
A Christian psychiatrist who edited the Harvard Handbook of Modern Psychiatry now integrates Christian and psychiatric perspectives with difficult issues in human sexuality.
Penner C, Penner J. The Gift of Sex: A Christian Guide to Sexual Fulfillment. Waco, TX: Word Books, 1981; 352 pp.
This book "tells the married couple everything they want to know, to hope, to feel, to experience, and to sing about the gift of sex---and in a style that is as delightful as it is tasteful. The Penners are joyfully and genuinely Christian from start to finish." - Lewis Smedes
Sexuality Education / Parents
Jones S, Jones B. How and When to Tell Your Kids about Sex. Colorado Springs: NavPress, 1993; 272 pp.
A Wheaton College psychology professor and his wife write a sensitive, informative book for parents who want to educate their children in a psychologically and Biblically valid way. Well-documented with studies and authorities.
Lee PA. Straight Talk about Sex: A Doctor s Guide for the Christian Family. Old Tappan, NJ: Revell, 1989; 160 pp.
A Christian pediatric endocrinologist clearly outlines the facts of sexual development, fertility, pregnancy and birth. He also discusses frankly issues of sexuality including sexual behavior in children, masturbation, homosexuality, practical sexuality, and marriage. Chapter two directly addresses how and when parents should discuss sexuality with their children.
Sexual Ethics
Resources available online
Feinberg JS, Feinberg PD. Ethics for a Brave New World. Wheaton, IL: Crossway Books, 1993
Among the 14 chapters in this book by two conservative Christian theologians are those addressing sexual morality, birth control, homosexuality, divorce and remarriage, as well as the more customary treatment of abortion and other issues of contemporary medical ethics.
Gustafson JM. Marriage and family. Chapter 5 in Ethics from a Theocentric Perspective. Chicago: University of Chicago Press, 1984; pp153-186
One of the theological (Reformed) pioneers of modern medical ethics believes there are ethical issues at the junction of the "natural" communal aspects and the covenantal aspects of marriage and family. In this chapter, he addresses the theological foundation for marriage, addresses some of those ethical issues, and looks at the religious and moral wisdom of the marriage service.
Mickelsen A, ed. Women, Authority and the Bible. Downers Grove, IL: InterVarsity Press, 1986; 304 pp.
Twenty-seven leaders who participated in the 1984 Evangelical Colloquium on Women explore the key biblical passages which treat the subject of women s roles in the professions, in the church and in marriage. Necessary reading for Christians interested in these vital issues. A variety of sides to these issues are presented.
Small DH. Christian, Celebrate Your Sexuality. Old Tappan, NJ: Flemming H. Revell, 1974; 221 pp.
A former Bible teacher at Westmont College interacts with sexuality experts and writes in an engaging style to explore the issues Christians are concerned about. Develops a good section on a theology of human sexuality.
Smedes LB. Sex for Christians. Grand Rapids, MI: Eerdmans, 1976; 250 pp.
A Fuller Seminary professor of theology explores the meanings of Eros and agape, distortions in human sexuality, and sexual issues of concern to both single and married people. A paperback that has enjoyed wide popularity.
White J. Eros Defiled: The Christian and Sexual Sin. Downers Grove, IL: InterVarsity Press, 1977; 172 pp.
An associate professor of psychiatry at the University of Manitoba addresses the issues of petting, masturbation, homosexuality, adultery, premarital pregnancy, the Playboy philosophy, etc. for the benefit of Christian readers.
Single Lifestyles
Bilezikian G. Beyond Sex Roles, 2nd ed. Grand Rapids, MI: Baker Book House, 1985; 340 pp.
Eternity magazine s Book of the Year. This Bible professor from Wheaton College explores what the Bible says about a woman s role in the church and in the family.
Elliot E. Passion and Purity. Grand Rapids, MI: Fleming H. Revell (a division of Baker Book House), 1984; 192 pp.
Old love letters, journal entries, and memories provide a backdrop for the insights offered by this popular Christian author. Since the sexual drive in young adults is ever new, ever old, wisdom from one who has sought to bring every drive under the constraint of Christ could be engaging. It is.
Van Leeuwen MS. Gender and Grace. Downers Grove, IL: Intervarsity Press, 1990; 278pp
Trained in psychology and having been a senior editor for Christianity Today, this Eastern College professor examines current theories about nature and nurture to seek a Christian understanding of our society s contemporary role debate.
Medical Marriages
Resources available online
Gabbard GO, Menninger RW. Medical Marriages. Washington, DC: American Psychiatric Press, 1988; 181 pp.
An analysis of the medical marriage, reviewing physician personality traits, gender differences, social pressures, sources of marital and professional conflict, communication strategies, sexual problems, etc., this excellent collection of essays provides one of the finest discussions of the medical marriage available.
Vincent MO. The Doctor s Marriage and Family. CMDS Study Guide. Bristol, TN: CMDS, 1991, 59 pp
Four essays from a CMDS psychiatrist who has spent a regular part of his practice seeing physician and dentist couples in distress. His research interests have included the particular stresses of the female physician. With wit, data, and clinical experience combined with an insider s view of these distinctive stresses, this brief, practical study is without parallel.
Homosexuality
Resources available online
Nicolosi J. Reparative Therapy of Male Homosexuality: A New Clinical Approach. Northvale, NJ: Jason Aronson Inc, 1991; 355 pp.
A premier book offering definitive help for the male homosexual who wishes to change and reviewing in the process the developmental, physiological, social-psychological, familial, interpersonal, and gender-identity aspects of his sexual orientation.
Satinover J. Homosexuality and the Politics of Truth. Grand Rapids, MI: Baker Books, 1996; 280 pp.
A Christian psychiatrist reviews the politicization of the homosexuality debate, including the pressure on the APA to change its nomenclature, the debate over a "homosexual gene", the concern about the possibility of change, etc.
Schmidt TE. Straight and Narrow? Compassion and Clarity in the Homosexuality Debate. Downers Grove, IL: InterVarsity Press, 1995; 240 pp.
Finally, a superb analysis of the biblical texts in response to currently popular revisionism by a Cambridge-trained New Testament scholar who teaches at Westmont College. Excellent critique of John Boswell s ground-breaking, pro-gay interpretation of church history.
Sterilization
Biebel DB, ed. The Sterilization Option. Grand Rapids, MI: Baker Book House, 1995; 102 pp
Three physicians, a theologian, a clinical ethicist, and a pastor address the issue of surgical sterilization from a conservative Protestant perspective. East to read, medically reliable, and theologically sound.
Christian Bioethics April 1998;4(1) is a theme issue on "Sexual Ethics and Communal Judgments: On the Pluralism of Virtues, Values, and Practices" and focuses primarily on the ongoing Roman Catholic discussion of the legitimacy of voluntary sterilization in certain 'hard cases.'