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 What Every
Mental Health
Professional
Needs to Know
About Sex
Stephanie Buehler
 What Every Mental Health
Professional Needs to Know
About Sex
Stephanie Buehler, MPW, PsyD, CST, is a licensed psychologist and sex thera-
pist. Dr. Buehler is the author of Sex, Love, and Mental Illness: A Couple’s Guide to
Staying Connected and multiple articles for professionals and the lay public on
sexuality and relationships. She is a graduate of University of California at Los
Angeles, University of Southern California, Pepperdine University, and Alliant/
California School of Professional Psychology. Dr. Buehler has worked in settings
that range from San Diego Children’s Hospital to the Marine Corps Air Station
at El Toro. She is Director of The Buehler Institute in Newport Beach, California,
providing sex therapy to men, women, and couples, and continuing education
opportunities for professionals. She resides in Orange County, California, with
her husband of more than 25 years; together they have an adult daughter Anneka.
What Every Mental Health
Professional Needs to
Know About Sex

Stephanie Buehler, MPW, PsyD, CST

Copyright © 2014 Springer Publishing Company, LLC

All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any
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Library of Congress Cataloging-in-Publication Data

Buehler, Stephanie (Stephanie J.)
What every mental health professional needs to know about sex / Stephanie Buehler, MPW, PsyD, CST.
   pages cm
Includes bibliographical references and index.
ISBN 978-0-8261-7121-4 (alk. paper)
1. Sexual health. 2. Sex therapy. 3. Sexual abuse victims—Rehabilitation. 4. Older people—Sexual
behavior. I. Title.
RA788.B84 2014
613.9—dc23
2013020630

Special discounts on bulk quantities of our books are available to corporations, ­professional
associations, pharmaceutical companies, health care organizations, and other qualifying
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Printed in the United States of America by Edwards Brothers.

 Contents

Foreword   Paul Joannides, PsyD  vii

Preface  ix
Acknowledgments  xv

Part I: The Courage to Treat Sexual Problems

1. Sexuality and the Mental Health Profession  3

2. Making the Shift: Comfort With Sexuality  11
3. Sexual Anatomy and Psychosexual Development  17
4. Defining Sexual Health  35

Part II: Assessing and Treating Sexual Concerns

5. Assessing Sexual Problems  51

6. Women’s Sexual Health Problems  65
7. Men’s Sexual Problems  85
8. Common Problems in Couples Sex Therapy  103
9. Parents’ Questions About Sex  121
10. Therapy With Sexual Minorities  135
11. Sexuality and Mental Health Problems  147

v
vi  contents

12. Sexual Recovery in Childhood Sexual Abuse Survivors  163

13. Sexual Pain Disorders  175
14. Sexuality and Reproduction  189
15. Sexuality and Medical Problems  201
16. Sexuality and Aging  217
17. Problematic Pornography Viewing Behavior  231
18. Alternate Sexual Practices  241

Part III: Ethics and Practice of Sex Therapy

19. Ethical Management of Sex Therapy Casework  253

20. Sex Therapy: Now and in the Future  263

Bibliography  269
Index  295
 Foreword

W hen I speak at colleges about sex, I often start by asking students in

the audience “How many of your parents told you what a clitoris is
when you were growing up?” In an audience of 300 students, perhaps five
will raise their hands. When I ask “How many of your parents explained
to you what masturbation is or told you what orgasms are?” Ten or fifteen
hands will go up. These are students at some of the top colleges who were
raised by some of the smartest parents on the planet during the 1990s—not
the 1950s.
When parents are not comfortable giving their children words for some
of the most powerful physical and emotional experiences they will have in
life, a veil of secrecy is created around the subject of sex that children carry
with them into adulthood. This is why there is such a great need for a book
like What Every Mental Health Professional Needs to Know About Sex. It doesn’t
matter if the therapy we do is cognitively based, psychodynamic, interper-
sonal, or experiential, this book explores aspects of sex that are essential for
therapists of all orientations to know.
Sex is an important part of most people’s lives, yet few mental health
professionals receive any instruction about sex other than learning how to
report suspected abuse. As a result, we aren’t always comfortable talking
about sex and sexual pleasure with our patients. While reading this book
won’t turn us into Kinseys or Masters and Johnsons, it will help us to relax
more and to listen better. And that, in itself, is an important accomplishment
regardless of how much or how little familiarity we have with sex education
and sex research.

vii
viii  foreword

I have written a 1,200-page book on sex that is used in dozens of college

and medical school sex-education classes. I have also read countless studies
on sexual orientation, gender, pornography, paraphilias, sexual pain, low
sex drive, high sex drive, casual sex, pedophilia, and the physiology and
neurology of sexual response. Yet when I am with a patient or when a fellow
mental health professional is consulting with me about a patient’s sexual
issues, the most important thing I can do, besides being kind and caring, is
to listen without making judgments. This is not always easy when you are
raised in a culture with no shortage of shame-based messages about sex.
For example, consider our perceptions about women versus men when
it comes to casual sex. Few of us would haul out our DSM-5s when a male
informs us he has had 10 or 15 lifetime sexual partners. But if a woman has
had 10 or 15 partners, or 20 or more, many of us would assume she was
abused as a child, or she’s bipolar or borderline, or she’s a “sex addict.” And
what if she enjoys having threesomes, or she asks her partner to spank her
or to act out rape fantasies? What if she wants sex way more than her part-
ner does?
This book was written by a highly experienced and sensible mental health
professional who encourages readers to listen and think rather than to auto-
matically pathologize or apply assumptions about sexual behavior that are
50 years out of date. It reminds us that sexual behaviors that could reflect a
psychological struggle for one person might reflect psychological health for
another. One of our jobs is to evaluate which is which.
One of the biggest challenges we face in evaluating sexual behaviors is
how multifaced sex can be. Sexual feelings often begin as an erotic tension
somewhere within our psyche or soma. They are then sifted through the
labyrinth of our cognitive, cultural, and religious beliefs. When something
is going wrong sexually, there are multiple layers where the problem can
reside. I can’t imagine trying to help a patient sort through sexual issues
without knowing what Dr. Buehler explains in the pages that follow.
And finally, I want to caution you about the current state of sexual knowl-
edge and sexual research: Our knowledge of human sexuality remains
elementary. Researchers are still struggling to define what women’s sex-
ual orientation is and how it develops over the life span. Several of the top
researchers are questioning the validity of the state-of-the-art fMRI brain
studies about sexual behavior that the media loves to sensationalize and
therapists love to quote. And it’s difficult to know if studies about sex and
relationships apply to anyone besides the students in college psychology
courses who are getting extra credit for participating in them.
Fortunately, we have Dr. Stephanie Buehler’s very thoughtful, approach-
able, and well-written book to help us with this process.

Paul Joannides, PsyD

Author of Guide to Getting It On!, Seventh Edition
 Preface

A n endocrinologist with whom I once ran an integrated wellness ­center

encouraged me to become a sex therapist, explaining that many of her
patients request hormone testing because they had no sex drive. “But,” she
said, “It is hardly ever their hormones that need adjusting.” I already had a
background in treating people with chronic illness, and I understood right
away that sexual problems were, perhaps, the ultimate expression of mind/
body symptoms. But how, I wondered, did one become a sex therapist?
One thing I knew for certain, the 10 hours in human sexuality that I was
required to take to become a psychologist wasn’t anywhere near what I
needed to know to talk to our shared clients about sex. I hadn’t learned
much of anything in those 10 hours, except that there existed some mighty
peculiar old sex education films and that many therapists in the audience
were squeamish about sex. I wasn’t squeamish at all. I grew up in a liberal
household in Los Angeles during the sexual revolution. Nothing offended
me. But if I was going to truly hang out my shingle as treating sexual prob-
lems, I was in sore need of education and training.
Like many psychotherapists—who tend to be an introverted bunch—my
first stop was to do some background reading. I chose a book online and
as soon as it arrived I sat down to read, highlighter in hand. It wasn’t long
before I closed the book, my mind reeling. It wasn’t because there was any-
thing wrong with the writing itself. All of the contributing authors appeared
to know their topic well. However, I still had no sense of “This is how to do

ix
x  preface

sex therapy.” I felt rudderless, adrift in a sea of technical language, with bits
and pieces of various theories floating past like flotsam and jetsam.
Perhaps joining an appropriate organization might help me, I reasoned. I
joined the American Association of Educators, Counselors, and Therapists
and learned they had a certification process that included education and
supervision. I chose Stephen Braveman, MFT, as my supervisor, and through
his patient guidance and generous spirit (he sent me away with a duffle bag
of materials on human sexuality), I began the 2-year trek to learn all I could
to be an effective sex therapist.
Along the way, I received an entirely different education. First, colleagues
and other professionals questioned my choice to become a sex therapist.
Wouldn’t I be dealing with pedophiles and other pariahs? Second, some
confused me with a sexual surrogate, a type of person who operates under
the legal radar to teach people about their sexuality in a way that a pro-
fessional license prohibited, for example, touching clients or having them
examine bodies, both their own and that of the surrogate. Third, it struck
me again and again how ludicrous it was, with all my education, that none
of my college professors at the g ­ raduate level had ever really talked about
sex. Why didn’t I know anything about the connection between eating dis-
orders and sexual problems? How come I had never heard of painful sex
and what to do about it? Didn’t I need to know how to assess persons who
had been sexually abused about their current ability to function normally
in their adult relationships?
Additionally, I began to pay attention to what clients said when they
found my services. If they were referred by another therapist, it was often
because the therapists “didn’t ‘do’ sex.” If they had been in therapy but were
self-referred, it might be that they felt the therapist would be uncomfortable
if they brought up the topic. Others were in therapy for years, but since the
topic never came up, they never said anything. It was only when they real-
ized that all the time and money they were spending had zero effect on their
sexual pleasure that they searched for someone who would help them with
the “real” problem.
I held two feelings about this. On one hand, I was happy that I received
appropriate referrals. On the other, I was upset that other therapists added to
the client’s shame about sex. By refusing or neglecting to ask about the client’s
sex life, therapists reinforced the cultural message that “nice people don’t talk
about sex.” But if people (nice or not) can’t talk about sex in the therapist’s
office, where can they talk about it? Clearly something needed to change.
Back I went to thinking about my own evolution as a therapist. Information
about treating sexual problems, I knew, was difficult reading. Few of the
books take the therapist by the hand and lead them through the entire pro-
cess of assessment and treatment from the moment of the intake call through
termination. None of them deal with one of the most important issues of all:
the sexuality of the therapist. Unless the therapist is comfortable with sex,
  preface   xi

there would be no discussion of the topic in the ­therapy office. That fact
alerted me that if I were to write a book on how to do sex therapy, I needed
to start there, with helping the reader to make sense of what sexuality is
and how to understand one’s own development, experiences, thoughts,
­attitudes, and beliefs about sex.
In your hand or on your screen, you have the text I envisioned for every
therapist to have as a reference on his or her bookshelf. Whether you want to
embrace sex therapy as a niche for your practice, or you want to be a thera-
pist who “does” sex, my hope is that What Every Mental Health Professional
Needs to Know About Sex will be a clear, pragmatic entrance into helping
clients of all kinds resolve sexual concerns—a boat of sorts to help you navi-
gate what can be a confusing area of human experience. I also hope that it
will become a book you can turn to again and again when a client presents
with a sexual concern to remind yourself that there exists an approach and
information to calmly tackle common, and uncommon, sexual problems.
Human sexuality is perhaps one of the most complicated on the planet.
Shrouded in secrecy, regulated by religion and law, and assigned meanings
from original sin to the ultimate expression of sacred joy, sexuality can per-
plex even the wisest therapists. Sexuality is often a topic ignored in graduate
programs in psychology, marriage and family therapy, and social work. In
California where I practice, a psychologist is required to merely complete
12 hours (not course hours, hours) of instruction in sex therapy. This training
was disembodied, that is, it had no connection to the 4 to 5 years of course-
work learning about all other aspects of the human mind.
What Every Mental Health Professional Needs to Know About Sex is a straight-
forward, plain-language book designed to take the therapist who knows
very little or who might be uncomfortable about sex, to a place of knowledge
and competence. To accomplish this, Part I: The Courage to Treat Sexual
Problems begins in Chapter 1 with a rationale regarding the reasons why
all mental health professionals need to be able to address clients’ sexual con-
cerns, especially the fact that our current social climate has raised clients’
expectations about pleasure. In Chapter 2, the reader will find topics con-
cerning one’s own sexuality, including overcoming any associated shame
and guilt related to sexual behavior, improving attitudes toward sexual
pleasure, and embracing sexual diversity—not only the LGBTQ community,
but sexuality in those who are ill or aging, or who engage in alternative
sexual practices, for example, fetish behavior. Psychosexual development
and the physiology of sex are covered in Chapter 3, while Chapter 4 is an
examination of definitions of sexual health generated by various experts
and organizations.
Part II: Assessing and Treating Sexual Concerns begins with an introduc-
tion to the thorough assessment of sexual problems that relies on two models
and that forms a core part of the book. The first is Annon’s PLISSIT model,
described in detail in Chapter 5; the second is an ecosystemic framework for
xii  preface

understanding and solving a client’s symptoms across different contexts.

The PLISSIT model is ideal for a mental health professional at the early
stages of treating sexual problems, as it guides the professional in deciding
whether the presenting problem will benefit from psychoeducation and rec-
ommendations, or if more intensive, long-term therapy will be required. The
ecosystemic framework, based on the work of Bronfenbrenner (1977), is an
expansion of the biopsychosocial model as it includes interactions between
two systems, which in the case of sex therapy relates to the frequency that
couples present for treatment. A thorough sexual assessment is included,
to use when it is determined that the presenting problem will require more
intensive work.
The next two chapters cover women’s and then men’s common sexual
complaints as they pertain to the individual, their biological make-up,
development, relationship, and culture. Chapter 5 on women’s sexual prob-
lems covers sexual aversion, which occurs in both men and women. Chapter
6 includes delayed ejaculation, a problem once considered rare but is on the
upswing as some men desensitize their arousal levels by viewing pornog-
raphy, as well as the fact that people’s expectations of men as they age have
increased. Both chapters include informational worksheets for the client’s—
and therapist’s—benefit.
Addressing common sexual problems in couples explodes the myth that
by fixing the couple’s relationship, their sex life will ­automatically improve.
In fact, even couples that get along ­sometimes have s­ exual problems. As
the therapist will learn in Chapter 8, whether the ­relationship is blissful
or chaotic, most couples benefit from good s­ exual information; improved
communication about sex; encouragement to explore the boundaries of
their sexuality; and suggestions to help them. The most common problem
is a discrepancy in sexual desire, which requires the therapist’s problem-­
solving skills to help the couple to stop blaming one another and learn how
to derive solutions when the problem is sex.
Chapter 9 includes material I have not yet seen in any other book for ther-
apists on the topic of treating sexual complaints: helping parents address
their concerns about their children’s sexual development and answering
their children’s questions about sex. The chapter also provides a framework
as to when to refer to a specialist for evaluation of atypical sexual behavior
or development. The entirety of Chapter 10 is devoted to understanding the
needs of LGBTQ clients who may, ironically, have suffered because of their
parents’ lack of information about sexual orientation.
Good mental health is essential to good sexual health, while mental ill-
ness can contribute to sexual dysfunction. In turn, feelings of guilt, shame,
and sexual inadequacy can sometimes lead to mental health problems. In
2010, I wrote a ground-breaking book entitled Sex, Love, and Mental Illness:
A Couple’s Guide to Staying Connected in which I addressed the effects of
depression, anxiety, substance abuse, eating disorders, AD/HD, and other
 preface  xiii

disorders on the individual’s ability to function sexually and in a relation-

ship. Chapter 11 is a broad summary of this review of the literature, while
Chapter 12 provides an in-depth guide to understanding and treating sexual
problems in adults related to sexual abuse experienced as a child or teen.
Chapters 13 to 16 are related in that they each cover an aspect of sexuality
that is intimately tied to biology. Chapter 13 covers the effects of pelvic and
genital pain on sexuality in men and women, which affects large numbers of
people who sometimes have great difficulty finding appropriate treatment,
lending to their suffering. In Chapter 14, therapists will learn what happens
when recreation meets procreation, or how sexuality is affected by infertil-
ity. Sexuality can also be affected by all kinds of medical conditions, from
diabetes to spinal lesions and paralysis, which is the topic of Chapter 15. The
effects of aging on sexuality and relationships are the focus of Chapter 16.
Rounding up Part II, Chapters 17 and 18 explore what happens when
people traverse conventional or expected boundaries, with Chapter 17
­
focusing on sex and the Internet, and Chapter 18 on paraphilias, also known
as “alt sex” (as in “alternative”). Though sexual images have seemingly been
in existence since ancient cultures constructed phallic and other fertility-
related symbols, there has been an e­ xplosion in sexual imagery of all kinds
since the dawn of the Internet. The enormous availability and variety of
pornography has both helped (people can indulge in fantasy material in
private, such as looking at people having sex while wearing latex or furs)
and hurt in that viewing pornography may drain sexual energy away from
a primary relationship. Meanwhile, those who practice alt sex need all kinds
of care and support from therapists, from absolution from shame to helping
them accept and perhaps participate in their partner’s erotic life.
Part III: Ethics and Practice of Sex Therapy wraps up the book with
Chapter 19 on the ethical challenges of working with people who have
sexual concerns, including respecting boundaries regarding touch;
managing romantic or sexual transference and countertransference;
managing secrets in conjoint therapy; and considering special topics
such as treating people whose sexuality differs from one’s own and the
effects of the field of sexual medicine on sex therapy. Finally, Chapter 20
completes the book with a look forward toward the future of sex therapy
and the integration of sex therapy into one’s practice.
As with any book, there were some challenges presented. One challenge
was the unwieldy term “mental health professional” used in the book’s title.
Rather than shortening the term to “MHP,” which seemed impersonal, I
most frequently use the term “therapist” to refer to the variety of people
working in the helping profession. Both “mental health professional” and
“therapist” refer to psychiatrists, psychologists, psychiatric nurses, social
workers, marriage and family therapists, and professional counselors,
including those medical providers who discuss sexual problems with their
patients.
xiv  preface

Another challenge was the use of gendered pronouns. As much as pos-

sible, I have used the word “partner” rather than “man,” “woman,” “hus-
band,” “wife,” and so forth. Although gay, lesbian, bisexual, transgender,
and queer (those individuals who do not identify strictly as male or female,
or who question their orientation) roles and relationships are not strictly
analogous to traditional heterosexual experiences, I have drawn from my
clinical observation in classifying some components of all erotic relation-
ships as being universal. Sexual desire, arousal, and orgasm are not exclu-
sive to any group of people, and when two people hold one another as
special and dear, it is nearly always called love.
A third challenge is culture as it relates to sexuality. In some areas, as with
infertility, there exists a decent body of literature about the effect of culture
on sexual beliefs or behaviors. In others, such as paraphilias, almost noth-
ing has been written, although it can be assumed that an individual from a
conservative family and culture may have different feelings about having a
fetish than one from a more open and permissive culture. Fortunately, there
exists online a tremendous resource, The Continuum Complete International
Encyclopedia of Sexuality (Francoeur & Noonan, 2004), which any therapist
can access to learn about the sexual practices of over 50 cultures.
Lastly, my hope is that the reader will find What Every Mental Health
Professional Needs to Know About Sex to be a jumping off point for addressing
the sexual concerns of clients and not the definitive or final word on how
to do sex therapy. My own understanding of human sexuality continues to
evolve, as does the field as experts research the multiple biopsychosocial
factors that make us think and act as we do between the sheets. If I have
done my job, your own interest in sexuality will be piqued and you will con-
tinue to deepen your knowledge and ability to be a therapist who “does sex.”
 Acknowledgments

T his book would not be possible without the support of my family,

friends, and colleagues.
First, I’d like to thank my small but mighty family. To my wonderful
husband Mark, thank you for providing love and support, and those life-
preserving weekend beach walks. To my daughter Anneka, thank you for
sending humorous material from afar; a true demonstration of Buehler
affection. Also, thanks to Bodhi, my “therapy parrot,” for distracting me
with squawks and squeaks during long hours at the keyboard.
Thank you to my dear friend Jacqueline Richard, who supplied much-
needed cheerleading from the sidelines whenever my will to write flagged.
To my friends Barbara and Stuart Bloom, Piet and Judi Dwinger, and
Christauria Welland, I appreciate your encouraging words, hugs, and
humor. While I appreciate all my interns, I want to especially thank Liz
Dubé for her patience with me as I wrote this book.
Finally, I have an amazing network of colleagues who have inspired me
and enabled me to become the professional I am today. Stephen Braveman,
my sex therapy supervisor, I thank you for your i­ncredible generosity; I
carry your words of wisdom with me into the pages of this book. I also
have too many wonderful professional friends to thank to list them all
individually. Therefore, I want to express tremendous appreciation to
fellow members of the f­ ollowing o­ rganizations whom I consider friends

xv
xvi  acknowledgments

too numerous to count: American Association of Sexuality Educators,

Counselors, and Therapists; Society for Sex Therapy and Research;
International Society for the Study of Women’s Sexual Health; Society
for the Scientific Study of Sexuality; Orange County Psychological
Association; and California Psychological Association. Your ­knowledge
and support have been invaluable to me.
 I
The Courage to Treat
Sexual Problems
 1
Sexuality and the Mental
Health Profession

W hen I decided to become certified in sex therapy, my supervisor

Stephen Braveman early on stated, “In our culture, no one escapes
having some form of sexual damage.” Unfortunately, this statement also
describes the influence of culture on mental health professionals across
the lifespan. Consider how other systems, such as family, school, or peers,
influenced your own sexual development. Perhaps you experienced being
sexually harassed on the schoolyard or the workplace. You may be the one
in four women or one in six men who were molested as children and who
did not feel supported enough by parents or school to tell. You may have
engaged in sex when you didn’t want to—or you even coerced someone into
having sex with you—which changed your cognitive framework and your
approach to sex, even in safe relationships. Or perhaps you were educated
as a therapist in a setting influenced by the larger culture, where sexuality
was a marginalized topic of study.
With any luck, you grew up to be a sexually functioning adult capable
of emotional and physical intimacy with a partner of your choosing, but
there is a strong likelihood that you have had struggles with your sexual-
ity, as do surprisingly large numbers of men and women in the popula-
tion at large (Laumann, Paik, & Rosen, 1999). It is in regard to our sexuality
that we are perhaps most like our clients, kept in the dark about its nature

3
4   I: the courage to treat sexual problems

and discouraged from opening the door to understanding. Insight and

­knowledge into sexuality requires that therapists pay attention to their own
development, but our training reflects the reluctance of our culture as a
whole to “go there.” For most therapists, learning how to address sexual
topics requires specialized training that may be difficult to access, requiring
travel and other expense.
What happens to our clients if we, ourselves, don’t have or make the
opportunity to understand our own sexuality? Can we call ourselves com-
petent if we don’t assess or treat the entire spectrum of human experience,
including those that are baffling or taboo? As self-appointed healers of
mental health, I believe we must take responsibility to heal the whole per-
son, including the sexual part of the self. Otherwise, we may inadvertently
sustain or contribute to a client’s struggle with sexuality. Mental health and
medical professions have yet to fully recognize that sexual problems can
contribute to depression, anxiety, trauma, eating disorders, substance abuse,
pain disorders, and so on; conversely, such problems can affect a person’s
sexuality, yet remain unaddressed in the therapist’s office. Yet if we don’t
“do sex” as part of our practice, we may miss out on an essential part of
what is troubling our clients.
Consider Len, a client in his mid-60s who was so guilt ridden after his
first attempt at intercourse that he struggled with erectile dysfunction for all
the years that followed. Len became depressed after a divorce and sought
relief through therapy, medications, and, at times, alcohol. In all his years of
counseling, no one had asked him about his sex life—until he mentioned a
urology appointment. Concerned he might be ill, the therapist asked more
about the appointment. The question prompted Len to cry as he told her
about his impotence. Fortunately, the therapist soon realized this was a
long-standing, complex issue for Len and a referral was made for my help.
After months of treatment with Len and his partner, he was, at last, able to
resolve his sexual concerns.
But how different might Len’s life have been if someone had earlier
inquired, “How’s your sex life?” Len’s treatment was influenced by a ­culture
in which nonspecialized therapists lack training or comfort discussing sex-
ual topics. He also needed a therapist who could use a systemic approach to
understand why his struggle was so long-standing and intense, which had
to do with his development in an extremely restrictive family, church, and
community environment. The restrictive environment caused Len undue
shame about his sexual needs, which in turn caused him to lose his erection
in his first sexual encounter. Later in life, changes in Len’s biological system
made attaining any kind of erection almost impossible, adding further frus-
tration. Only when Len’s frustration was more painful than his secret could
he break out of his shell and reach out for help.
 1: sexuality and the mental health profession   5

Clients come to us to help them solve all kinds of problems, which may
include sexual concerns. The Laumann survey (Laumann, Paik & Rosen, 1999)
of male and female sexual problems—the largest of its kind—reported that
about 60% of women and 30% of men have had some type of sexual dysfunc-
tion. With numbers like these, it is safe to assume that a good portion of your
current clients have a sexual problem. If you do not ask, however, you may
never hear about these issues. But clients sometimes do tell me, as an identi-
fied sex therapist, some of the reasons why they left a former therapist who
didn’t talk about sex:

●● One woman found the courage to seek help for the fact that she was
still a virgin 7 years after her wedding night due to vaginismus (spasm
of the vagina that prevents penetration), but she could not bring her-
self to tell the therapist about her problem. Since the therapist never
asked about sex, the client got the message loud and clear: Sex is not
spoken here.
●● A couple trying to get past an affair that nearly destroyed their marriage
couldn’t bring themselves to tell their “uptight” therapist that they had
enjoyed swinging early in their relationship. The couple’s history added
to their confusion about boundaries and rules in the marriage, but their
weeks in therapy were useless because they feared the therapist would
judge them if they disclosed their early history.
●● Sam and Cynthia sought a therapist’s help for Cynthia, who believed
she had a low sex drive as a result of being molested as a child. Because
the couple had difficulty talking about sex, the therapist changed
the topic from sex to finances because, explained Sam, “the therapist
thought if we made more money, we’d be happier.” Two years later,
Cynthia still had a low sex drive; fortunately, the couple sought appro-
priate help.

No one, least of all our clients, wants to be judged as defective, naive, or

perverse. People want reassurance that they are essentially normal, or that
they can become more what they think normal is for them. When thera-
pists don’t talk about sex, they may convey a belief that the client is weird
for wondering about their own sexuality. Of course, some therapists do ask
about sex. In one survey, about half of therapists reported that they “always”
ask about sex (Miller & Byers, 2009). But people in general (including thera-
pists) over-report when it comes to sexuality, as they want to appear normal
or current. What about the other half of therapists? There is an adage that we
are always communicating, even if we say nothing. Therapists’ silence about
sex in the therapy room sends many messages, but perhaps the loudest is
please don’t talk about sex!
6   I: the courage to treat sexual problems

WHY THE SILENCE ABOUT SEXUALITY?

Almost everyone is raised in an atmosphere of secrecy when it comes to

emotional and psychological aspects of sex. The reasons are complex.
Depending on one’s religious perspective, a person’s very conception can
be shrouded with mystery. As we grow, we covertly observe romantic and
sexual behaviors between adults of which we are told little. We experience
our own biological urges, such as a desire to masturbate, but are given nei-
ther tacit nor explicit permission to ask questions. When we do ask, we may
not get an answer—or we may get a lecture on why some sexual topic is
naughty or dirty, something good girls and boys avoid. Although many
of today’s parents talk openly with their children about sex, there are still
households where sex is a forbidden topic. People still bar their children
from attending formal sex education classes in school, and people from
other countries, for example, Saudi Arabia, may not have been offered any
sex education opportunities at all.
Our physical and psychological sexual development takes place on
entirely different planes, and interactions between systems reflect this.
Secondary sexual characteristics signal to adults around us that we must be
protected from such risks as unwanted pregnancy or diease. Meanwhile, we
are left to privately grapple with sexual dreams and fantasies, curiosity, and
desire. Reflecting what is still often a Puritanical culture, we aren’t given
information about giving and receiving sexual pleasure. The complexities
of a sexual relationship are explained away with myths like, “All men are
interested in is sex,” or “Once you get married, your sex life will disappear.”
We certainly aren’t told how to manage feelings of sexual inadequacy, so
if a problem comes up like difficulty having an orgasm or getting an erec-
tion, we may keep it under wraps for decades. As a society, we also may act
as if sexual problems appear suddenly in adulthood. However, as I have
learned from my clients, teens (who on average in the United States begin
having intercourse at 15) have sexual problems that plague them, sometimes
leading to depression, eating disorders, alcoholism, and other mental ill-
ness. As therapists know all too well, secrecy and silence are associated with
feelings of shame and guilt that can contribute to overall poor mental health.
Nowhere, perhaps, is this truer than when it affects our sexual development.
It doesn’t help that sex does have a murky side. Subjects like sexual abuse,
assault, and rape tend to be hushed by the victim and, if they learn about
it, family members or friends. If the media gets hold of such a story, it is
sensationalized, which may cause victims to further retreat, away from
possible unwanted attention. Meanwhile, media attention on cases such as
Jerry Sandusky, the Penn State football coach convicted of molesting chil-
dren, do little to address underlying problems such as the need to educate
children at an early age about appropriate physical boundaries, the right to
say no to unwanted touch, and permission to tell if someone harms them.
 1: sexuality and the mental health profession   7

Our culture also has done a poor job of acknowledging that pedophiles and
people with other difficult sex and social problems do exist and frequently
deserve compassionate treatment (Cantor, 2012).
For teens and young adults, date rape is distressingly common on col-
lege campuses; many young women have shared with me that the reputed
response of campus security was so lukewarm that they made a decision
not to report. Yet, its effects can linger well into adulthood. Today’s young
adults are also the first to grow up in the digital age. Many have spent so
much time viewing Internet pornography that they neglected to develop the
social and sexual skills to have a real partner. How might things be differ-
ent if they were raised in a culture that acknowledged sexual needs, made it
easy to attain contraception, and talked openly about what it means to be in
a healthy sexual relationship?
Therapists are not immune to such sexual negativity. Pope and Feldman-
Summers (1992) report that about two-thirds of female and one-third of male
therapists responding to a survey regarding sexual abuse among therapists
had experienced molestation, the majority of incidents with a close relative.
It isn’t difficult to surmise that one reason therapists may avoid the topic of
sex may be that they have been victims of sexual abuse or exposed to other
types of negative sexual experiences, from mild harassment to outright
assault. Although therapists may be drawn to the field to help other victims
become survivors, they may be disappointed with how little attention their
graduate training gives to the sexual late effects of abuse.
The negative effects of such experiences may intensify what Saakvitne &
Pearlman (1996) called vicarious traumatization. Vicarious traumatization is
defined as “the therapist’s inner experience as a result of his or her empathic
engagement with and responsibility for a traumatized client.” Listening to
sexual material can be difficult for therapists if they have their own sexual
struggles. Like our clients, we may have trouble setting appropriate sexual
boundaries; struggle with questions about the morality of sexual practices
(anything from casual “hook-ups” to looking at—or even engaging in the
making of—hardcore pornography); be dealing with our own sexual inhibi-
tions; be worrying about a partner’s sexual function after cancer or other
illness; or simply have basic concerns about our own physical appearance
and sexual attractiveness. Discussing such matters may create such distress
for the therapist that they are simply avoided.
Another reason for many therapists’ silence about sex is the fear of becom-
ing isolated or being ostracized by colleagues. Not only do therapists fear
being judged by clients for expressing interest in their sex life, but also by
other therapists who find dealing with sexual problems too uncomfortable
or distasteful. For example, I recently lucked upon an opportunity to share
space in a pretty office with a psychoanalyst. My deposit was promptly
returned because, on reflection, the analyst decided that my sex therapy
practice was not a good fit for her office, presumably since she and her clients
8   I: the courage to treat sexual problems

might happen upon my (drooling?) clients in the waiting room. Working with
sexual problems can also feel unsafe in certain ­communities because of the
social and political climate. Where I live in Southern California, ­condoms
and lubricants are sold over the counter at the drugstore, but there are still
parts of the country where such items are difficult to procure. Designating
oneself as a sex therapist in such areas can mean opening one’s self up to
ridicule or harassment.
Therapists may also be quiet about sex due to strict training in laws and
ethics concerning sexual contact with clients, a topic covered in detail in
Chapter 19. Therapists are rightly warned that because there is an inherent
power differential in relationship with the client—who is dependent on us
for emotional support—the potential for doing serious emotional damage
by acting out sexual urges comes with enormous risk. Little is said, how-
ever, about reconciling the need to manage one’s sexual attraction or arousal
while discussing sex in a therapeutic manner with the client. In any case,
stern warnings about curbing one’s sexual feelings may send the message
that it’s best not to deal with sex in the treatment room.
A final reason for therapist reticence about sex concerns diversity. While
learning to tolerate cultural differences has been a priority in training pro-
grams, tolerance of a wide range of gender, orientation, and sexual behaviors
has not. In my area of California, for example, human sexuality credits for
marriage and family therapists have been cut to the minimum requirement in
several schools. If therapists are to properly address client sexuality, then they
must not only have appropriate training, but they also must become sexually
sensitive—a tall order for those raised in an American society that lags in
tolerance behind many developed countries, including neighboring Canada.
On the other hand, perhaps none of these concerns about being silent
about sex applies to you! You might be a therapist like my intern Liz Dube,
who, upon reading this chapter for a requested critique, quipped that the
only thing that held her back from talking to clients about sex was lack
of knowledge. Speaking for herself, she has had a long abiding passion to
help people have satisfying sex lives. If that describes you, then you’re in
luck, because this book will give you information that will help you fulfill a
desire to help clients with their sexual struggles.
Otherwise, consider that you are about to become at least one step ahead
of your clients as you learn more about sexuality. You won’t be a therapist
who “doesn’t ‘do’ sex.” You will be able to help clients overcome their deep-
est fears so that they can enjoy one of life’s pleasures without undue shame
or guilt. Increasing a client’s capacity to love and be loved often has a ripple
effect in the client’s life, giving them the optimism, confidence, and freedom
to tackle other developmental milestones such as finding a healthy relation-
ship or even making a much-feared job change. Our sexuality is such a core
part of who we are, and as therapists we are fortunate to be in a position to
help our clients achieve health in this critical area of human existence.
Another random document with
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are characteristic for each species. The Nematus larvae that inhabit
galls possess all the characteristics of those that feed externally. As
a rule the skin of the larva is naked and free from hair, but it is often
minutely tuberculate, and in a few species it is armed with
remarkable forked spines. These spines may exist during part of the
larval life, and completely disappear at one of the moults. The
creatures are as a rule very sluggish, and move about much less
than Lepidopterous larvae; many of them, when alarmed, have the
power of exuding a disagreeable liquid, either from the mouth or
from pores in the skin; in the latter case it may be sent as a sort of
spray to some little distance from the body. This operation is said to
be very efficacious as a means of protecting the larvae from the
attacks of parasitic flies that are desirous of laying eggs in their
bodies. One peculiarity as to their colour has attracted the attention
of Réaumur and subsequent naturalists, namely, that in the case of
many species a great change takes place in the colour during the life
of the larva, and more especially at the period of the last moult. The
change to the pupal state usually takes place in a cocoon, and some
species have the peculiar habit of forming a double cocoon, the
outer one being hard and coarse, while the inner is beautifully
delicate. The cocoon is sometimes formed in the earth, and in that
case it may be to a large extent composed of earthy matter. The
Insect frequently remains a long time in its cocoon before emerging
as a perfect Insect; however long this time may be, it is nearly all of it
passed in the larval state; when the Insect does change to a pupa it
speedily thereafter emerges as a perfect Insect. In the pupa the
parts of the imago may be seen enveloped in a very delicate,
transparent skin.

In Brazil Dielocerus ellisii, a sawfly allied to Hylotoma, constructs a

nest in which the cocoons of many specimens are crowded together,
being packed side by side like the cells in the comb of the bee, while
the whole mass is protected by a thick outer wall. It is not known in
what manner this communal work is carried out, but it is interesting
to note that the cocoons assume to a considerable extent the
hexagonal form of the cells in the comb of the bee. Some doubt was
expressed as to the interpretation put on this structure by Curtis, but
his observations have been confirmed by Smith and Peckholt.

Several species of sawflies are known to be very injurious to crops.

One of these—the sawfly of the turnip, Athalia spinarum (centifoliae
Panz.)—sometimes commits excessive depredations on the turnip
crops in this country as well as on the continent of Europe; its life-
history and anatomy were described by Newport in an essay
published by the Entomological Society in 1838. The eggs, it
appears, are laid singly at the edges of the leaves in the month of
May, as many as 200 or 300 being deposited by one female; as the
parent flies are usually gregarious, appearing in large numbers in
fields of turnips, it is not difficult to form an idea of the serious nature
of their depredations. The egg grows very considerably; the
development of the embryo is rapid, occupying, even in unfavourable
weather, only seven or eight days, while in quite congenial
circumstances it is probable that the eggs may hatch about the
fourth day after their deposition. The young grub immediately begins
to feed, and in about five days changes its skin for the first time; it
repeats this operation twice at similar or slightly longer intervals, the
third moult thus occurring when the larva is three or four weeks old; it
is then that the larva begins to be most destructive. Sunshine and
warm weather are very favourable to it, and under their influence it
grows so rapidly that in a few days a field may be almost completely
stripped of its foliage. This larva is of a sooty black colour, and will
live on other Cruciferous plants quite as well as on the turnip. When
full grown it buries itself to a slight depth under the surface of the
earth, and forms an oval cocoon of a firm texture, and with many
particles of earth closely adherent to it. The perfect fly emerges
towards the end of July, and a second brood will be produced in the
same season if circumstances are favourable; in that case the
resulting larvae enter the ground for the formation of their cocoons in
September or October, and pass the winter in their cocoons, but still
in the larval state; changing to pupae in the following spring, and
appearing as perfect Insects in May. From this account it appears
not improbable that the offspring of a single female existing in the
April of one year may amount by the following May—three
generations having been passed through in the interval—to as many
as 27,000,000 larvae. Fortunately the creatures are, as Frauenfeld
observed, destroyed in very large numbers by a parasitic fungus and
by a Nematode (Filaria).

We have, earlier in the chapter, alluded to the fact that the

phenomena of parthenogenesis prevail somewhat extensively
among sawflies. It is the rule in the family that males are very much
less numerous than females, and there are some species of which
no males have been discovered. This would not be of itself certain
evidence of the occurrence of parthenogenesis, but this has been
placed beyond doubt by taking females bred in confinement,
obtaining unfertilised eggs from them, and rearing the larvae
produced from the eggs. This has been done by numerous
observers with curious results. In many cases the parthenogenetic
progeny, or a portion of it, dies without attaining full maturity. This
may or may not be due to constitutional weakness arising from the
parthenogenetic state. Cameron, who has made extensive
observations on this subject, thinks that the parthenogenesis does
involve constitutional weakness, fewer of the parthenogenetic young
reaching maturity. This he suggests may be compensated for—when
the parthenogenetic progeny is all of the female sex—by the fact that
all those that grow up are producers of eggs. In many cases the
parthenogenetic young of Tenthredinidae are of the male sex, and
sometimes the abnormal progeny is of both sexes. In the case of
one species—the common currant sawfly, Nematus ribesii—the
parthenogenetic progeny is nearly, but not quite, always, entirely of
the male sex; this has been ascertained again and again, and it is
impossible in these cases to suggest any advantage to the species
to compensate for constitutional parthenogenetic weakness. On the
whole, it appears most probable that the parthenogenesis, and the
special sex produced by it, whether male or female, are due to
physiological conditions of which we know little, and that the species
continue in spite of the parthenogenesis, rather than profit by it. It is
worthy of remark that one of the species in which parthenogenesis
with production of males occurs—Nematus ribesii—is perhaps the
most abundant of sawflies.
Although many kinds of Insects display the greatest solicitude and
ingenuity in providing proper receptacles for their eggs, and in
storing food for the young that will be produced, there are extremely
few that display any further interest in their descendants; probably,
indeed, the majority of Insects die before the eggs are hatched, one
generation never seeing the individuals of another. It is therefore
interesting to find that a fairly well authenticated case of maternal
attachment, such as we have previously alluded to as occurring in
earwigs, has been recorded in Perga lewisii, an Australian sawfly of
the sub-family Cimbicides. The mother, having deposited about
eighty eggs on the leaf of a Eucalyptus, remains with them until they
hatch, after which she sits over her brood with outstretched legs, and
with admirable perseverance protects them, so far as she is able,
from the attacks of parasites and other enemies; she quite refuses to
be driven away from her charges. Mr. Lewis, to whom we are
indebted for this account,[427] states that the sawfly does not
recognise her own special brood, but will give equal attention to
another brood if she be transferred thereto; and he adds that many
of the batches of larvae were destitute of any maternal guardian.

There are about 2000 species of sawflies known. A large majority of

them are found in the European and North American regions; still, a
good many are known to live in South America, and Perga—one of
the genera of the family containing many species of large size—is
peculiar to the Australian region. Although the family includes so
many species, very few anomalies of structure have been detected
in it; one species, Pompholyx dimorpha Freymuth, is described as
being apterous in the female, and as having the thorax curiously
modified in its form. There are no very small Insects in the family,
and none over the middle size. Nearly 400 species have been
detected in Britain; this number could certainly be increased by
persevering researches. The palaeontological record has hitherto
given only a very meagre evidence about sawflies. Several species
have been preserved in amber, and three or four are known from
Tertiary strata in Europe and North America.
 CHAPTER XXIII

HYMENOPTERA PETIOLATA–PARASITIC HYMENOPTERA–CYNIPIDAE OR

GALL-FLIES–PROCTOTRYPIDAE–CHALCIDIDAE–ICHNEUMONIDAE–
BRACONIDAE–STEPHANIDAE–MEGALYRIDAE–EVANIIDAE–PELECINIDAE–
TRIGONALIDAE.

We now pass to the consideration of the Hymenoptera of the sub-

Order Petiolata, or Apocrita, as they are styled by Brauer. We should
make use of the term Petioliventres, for it contrasts naturally by its
termination with Sessiliventres, were it not that the word is so
uncouth that we think it better to adopt the shorter and more
euphonious expression, Petiolata.

The members of this sub-Order, without exception, have the hind

body connected with the thorax by means of a deep constriction, so
that the base of the abdomen (Fig. 336, B, b) is very narrow; the
articulation between the two parts is effected by means of a complex
joint allowing great play, and facilitating the operations of boring and
stinging, processes that are of extreme importance in the economy
of the great majority of the species. The petiole is sometimes
extremely short, but it may be so long that it appears like a stalk, at
whose extremity is borne the remaining part of the abdomen (Fig.
369). When the petiole is very short the abdomen reposes close to
the back of the thorax (Fig. 331, C), and in this case the abdomen is
usually described as sessile; while, when it is evidently stalked, it is
said to be petiolate. These terms are, however, unsuitable, as the
words sessile and petiolate should be reserved for the conditions
characteristic of the two sub-Orders. We shall therefore use the
terms pseudo-sessile and pedicellate for the two conditions of the
Petiolata.

The Hymenoptera Petiolata comprises an enormous majority of the

Order. Although it includes many of the most interesting and
important of Insects, its classification is but little advanced, for a
great many of the forms are still rare or unknown. Three series may
be adopted for the purposes of nomenclature.

1. Parasitica.—Trochanters of two pieces, female with an ovipositor.

2. Tubulifera.—Trochanters undivided; abdomen consisting of only

three, four, or five visible segments.

3. Aculeata.—Trochanters undivided; abdomen consisting of six or

seven visible segments; female furnished with a retractile sting.

In the absence of any clear distinction between sting and ovipositor,

these groups are merely conventional. The character furnished by
the trochanters is unfortunately subject to some exceptions, there
being a few parasitic forms in which the trochanters are not divided,
and a few aculeates in which the reverse is more or less distinctly
the case; moreover, the division, when it exists, is in some cases
obscure, and the two pieces are of unequal size. Ratzeburg calls the
upper division, which is frequently much larger than the other, the
trochanter, and the lower division the apophysis. There is much
reason for believing that the apophysis is really merely a secondary
division of the femur. The Tubulifera are a comparatively small
group, and will probably be merged in one of the other two, when the
anatomy and morphology of the abdomen have been more
thoroughly elucidated.

Fig. 345.—Divided (ditrochous) trochanter of an Ichneumon: a, coxa; b,

the two divisions of the trochanter; c, femur. (For monotrochous
trochanter see Fig. 335, A, c.)
 Hymenoptera Parasitica or Terebrantia.

This is one of the most extensive divisions of the class Insecta.

There can be little doubt that it contains 200,000 species, and
possibly the number may be very much greater than this. It is,
however, one of the most neglected of the great groups of Insects,
though it is perhaps of greater economic importance to mankind than
any other.

Insects derive their sustenance primarily from the vegetable

kingdom. So great and rapid are the powers of assimilation of the
Insect, so prodigious its capacity for multiplication, that the Mammal
would not be able to compete with it were it not that the great horde
of six-legged creatures has divided itself into two armies, one of
which destroys the other. The parasitic Hymenoptera are chiefly
occupied in destroying the tribes of vegetarian Insects; the parasites
do this by the simple and efficient device of dwelling in the bodies of
their hosts and appropriating the nutriment the latter take in. The
parasites do not, as a rule, eat the structures of their host,—many of
them, indeed, have no organs that would enable them to do this,—
but they absorb the vegetable juices that, in a more or less altered
state, form the lymph or so-called blood of the host. The host could
perhaps starve out his enemies by a judicious system of abstention
from food; instead, however, of doing this, he adopts the suicidal
policy of persistent eating, and as the result of his exertions,
furnishes sufficient food to his parasites, and then dies himself,
indirectly starved. Ratzeburg considers that the traditional view that
the larvae of parasitic Hymenoptera live by eating the fat-body of
their host is erroneous. They imbibe, he considers, the liquid that fills
the body of the parasitised Insect.[428]

The wide prevalence of Insect parasitism is appreciated only by

entomologists. The destructive winter moth—Cheimatobia brumata
—is known to be subject to the attacks of sixty-three species of
Hymenopterous parasites. So abundant are these latter that late in
the autumn it is not infrequently the case that the majority of
caterpillars contain these destroyers. Although Lepidoptera are very
favourite objects with parasitic Hymenoptera, yet other Insects are
also pertinaciously attacked; there is quite a host of Insect creatures
that obtain their sustenance by living inside the tiny Aphididae, or
"green-flies," that so much annoy the gardener. A still larger number
of parasites attack eggs of Insects, one or more individuals finding
sufficient sustenance for growth and development inside another
Insect's egg. As Insects have attacked Insects, so have parasites
attacked parasites, and the phenomena called hyperparasitism have
been developed. These cases of secondary parasitism, in which
another species attacks a primary parasite, are extremely numerous.
It is also pretty certain that tertiary parasitism occurs, and Riley is of
opinion that even quaternary destruction is not outside the range of
probability.

The physiological problems connected with Insect parasitism are of

great interest to the entomologist; the modes of nutrition and
respiration of these encaged creatures could not fail to be most
instructive were we fully acquainted with them. It is obvious that
when an Insect-egg is laid inside another Insect's egg, and the
parasite has to undergo the whole of its growth therein, it is in the
strangest condition as regards nutrition. It is unnecessary for the
intruded egg to have yolk of its own; moreover, the embryonic mode
of nutrition may be continued during what would, with other Insects,
be the larval period. And it seems to be the case that both these
conditions are actually met with in the lives of egg-parasites. The
embryology and post-embryonic development of parasitic
Hymenoptera have already been ascertained to be of the most
extraordinary nature. Great variety, however, will no doubt be found
to exist, as will be readily understood if we tabulate the conditions of
the early life of various parasitic Hymenoptera.

1. The egg may be laid outside a larva, and the embryonic and larval
developments may both be passed on the exterior.
2. The egg may be laid and the embryonic development passed
through, outside the host, but the parasite on hatching may enter the
host, so that the post-embryonic development is passed in the lymph
of the host.

3. The egg may be laid inside the host, both embryonic and post-
embryonic developments being gone through in the fluids of the
host.

4. The egg may be laid inside another egg, the embryonic and post-
embryonic developments being passed therein.

We shall find that all these conditions exist in the Insects we are
about to consider.

We shall treat the series as composed of ten families; but we must

remind the student that this great subject is still in a very
unadvanced state; the combined efforts of generations of naturalists
will be required to perfect it. Of the ten families five are
comparatively insignificant in number of species. Many of the
Cynipidae are not parasitic in habits, but live in galls. After what we
have said as to the mode of nutrition of parasites it will be
understood that the physiological conditions of life may not be so
different in a gall-dweller and a parasite as would at first be
supposed; and it is perhaps not a matter for much surprise that good
characters cannot be found to separate the gallicolous from the
parasitic forms.

Fam. I. Cynipidae—Gall-flies.

Wings with very few cells, with no dark patch (stigma) on the
anterior margin; pronotum fixed to the mesonotum, and at each
side extending back to the point of insertion of the front wing.
Antennae not elbowed but straight, composed of a moderate
 number (12-15) of joints. Early stages passed either in galls or
as parasites in the bodies of other Insects.

Fig. 346.—Neuroterus lenticularis. Britain.

The Cynipidae are always small, frequently minute, Insects; usually

black or pitchy in colour. The simple structure of the antennae and
the number of their joints are of importance as an aid in identifying a
Cynipid. The mesonotum is usually remarkably convex, and has,
behind, a prominent scutellum, which more or less overhangs the
small metanotum and the median segment; these are perpendicular
in their direction; the sculpture of these posterior parts of the alitrunk
is usually deep and remarkable. The abdomen has usually only a
short petiole, so as to be pseudo-sessile; but there are some genera
in which this part is rather long. The abdomen is generally so very
much changed in outer form that its structure is not easily
understood. The visible portion is frequently in larger part made up of
the greatly enlarged dorsal plate of the second or third segment, or
of both. These large plates are really chiefly composed of free flaps,
and on lifting them up the large ventral plates are disclosed, although
these appeared previously to be nearly or quite absent. In the female
there is a very slender ovipositor, of which only a small part
protrudes, although the organ is really elongate; it is drawn into the
abdomen by means of a peculiar series of structures, the modified
terminal segments to which it is attached being folded over into the
interior of the body in such a way that the posterior part becomes
situated anteriorly. In conformity with this arrangement, the ovipositor
is bent double on itself, the anterior and the middle portions of the
borer being carried into the body, leaving only a small part projecting
beyond the extremity. The Cynipid ovipositor is an instrument of
much delicacy, and is capable of a great deal of movement; it is
usually serrate just at the tip, and although it looks so very different
from the cutting apparatus of the sawflies (Fig. 344), it seems that it
is really composed of pieces similar in their origin to those of the
Tenthredinidae.

Fig. 347.—Ovipositor of Neuroterus laeviusculus. (After Adler.) a, a,

The ovipositor partially coiled; b, extremity of posterior plate; c, c,
muscles.

The wings frequently bear fine hairs; the paucity of nervures and the
absence of the "stigma" are of importance in the definition of the
family. The most important of the cells is one called the radial cell,
situate just beyond the middle of the front part of the wing.

We cannot enter into a consideration of the classification of the

family, as authorities are not agreed on the subject.[429] As regards
their habits Cynipidae are, however, of three different kinds: (1) the
true gall-flies, or Psenides, which lay an egg or eggs in the tissues of
a growing plant, in the interior of which the larva lives after it is
hatched; this mode of life may or may not, according to the species,
be accompanied by formation of a peculiar growth called a gall: (2)
Inquilines,[430] or guest-flies; these lay their eggs in the galls formed
by the gall-makers subsequent to the growth of the galls, of which
they obtain the benefit: (3) Parasites; these live, like most
Ichneumon-flies, in the interior of the bodies of other living Insects;
they prey on a considerable variety of Insects, but chiefly, it is
believed, on Aphididae, or on Dipterous larvae. These parasitic flies
belong to the sub-family Figitides.

A great deal of discussion has occurred relative to the nature and

origin of galls, and many points still remain obscure. Considerable
light has been thrown on the subject by the direct observations of
modern naturalists. Previous to Malpighi, who wrote on the subject
two hundred years ago, it was supposed that galls were entirely
vegetable productions, and that the maggots found in them were due
to spontaneous generation, it having been an article of belief in the
Middle Ages that maggots in general arose from the various organic
substances in which they were found, by means of the hypothetical
process called, as we have said, spontaneous generation. Malpighi
was aware of the unsatisfactory nature of such a belief, and having
found by observation that galls arose from the punctures of Insects,
he came to the further conclusion that the growth of the gall was due
to the injection by the Insect into the plant of a fluid he termed Ichor,
which had, he considered, the effect of producing a swelling in the
plant, something in the same way as the sting of a bee or wasp
produces a swelling in an animal. Réaumur also made observations
on the gall-Insects, and came to the conclusion that the latter part of
Malpighi's views was erroneous, and that the swelling was not due to
any fluid, but simply to irritation caused by the prick; this irritation
being kept up by the egg that was deposited and by the subsequent
development of the larva. Observations since the time of Réaumur
have shown that the matter is not quite so simple as he supposed,
for though in the case of some galls the development of the gall
commences immediately after the introduction of the egg, yet in
other cases, as in the Cynipidae, it does not occur till some time
thereafter, being delayed even until after the hatching of the egg and
the commencement of the development of the larva. Galls are
originated by a great variety of Insects, as well as by mites, on many
plants; and it must not be concluded that a gall has been formed by
Hymenoptera even when these Insects are reared from one.
Extremely curious galls are formed by scale-Insects of the sub-family
Brachyscelides on Eucalyptus trees in Australia; they are much
inhabited by parasitic Hymenoptera, and Froggatt has obtained 100
specimens of a small black Chalcid from a single dead Brachyscelid.
[431] The exact manner in which many of these galls originate is not
yet sufficiently ascertained; but the subject of the galls resulting from
the actions of Cynipidae has received special attention, and we are
now able to form a conception of their nature. They are produced by
the meristematic or dividing tissue of plants, and frequently in the
cambium zone, which is caused to develop to an unusual extent, and
in a more or less abnormal manner, by the presence of the Insect.
The exact way in which a Cynipid affects the plant is perhaps not
conclusively settled, and may be found to differ in the cases of
different Cynipidae, but the view advocated by Adler and others, and
recently stated by Riley,[432] seems satisfactory; it is to the effect that
the activity of the larva probably affects the meristem, by means of a
secretion exuded by the larva. The mere presence of the egg does
not suffice to give rise to the gall, for the egg may be deposited
months before the gall begins to form. It is for the same reason
improbable that a fluid injected by the parent fly determines the gall's
growth. It is true that the parent fly does exude a liquid during the act
of oviposition, but this is believed to be merely of a lubricant nature,
and not to influence the development. It is said that the gall begins to
form in some cases before the larva is actually hatched, but the eggs
of some Hymenoptera exhibit remarkable phenomena of growth, so
that the egg, even during development of the embryo in it, may in
these cases, exert an influence on the meristem. It is to reactions
between the physiological processes of the meristem and the
growing Insect that the gall and its form are due.

The investigations of several recent naturalists lend support to the

view that only the meristematic cells of the plant can give rise to a
gall. Riley says that the rate of growth of the gall is dependent on the
activity of the meristem, galls on catkins developing the most quickly;
those forming on young leaves also grow with rapidity, while galls
formed on bark or roots may take months to attain their full size.

Fig. 348.—Bedeguar on rose, cut across to show the cells of the

larvae; in some of the cells larvae are seen.
It is a curious fact that Cynipid galls are formed chiefly on oaks, this
kind of tree supplying a surprising number and variety of galls. The
plants that furnish Cynipid galls in Europe are not numerous. A list of
them is given by Cameron.[433] Several species, of the genus
Rhodites, attack rose-bushes. One of the best known of our British
galls is the bedeguar, found in various parts of the country on both
wild and cultivated rose-bushes (Fig. 348), and caused by Rhodites
rosae (Fig. 349). This gall has the appearance of arising from a twig
or stem, but it is really a leaf gall. Pazlavsky[434] has described the
mode of formation of the bedeguar. The female Rhodites in the
spring selects a rose-bud—not a flower-bud—that should produce a
twig and leaves, and pricks this bud in a systematic manner in three
places. The three spots of the bud pricked by the Insect are the three
undeveloped leaves that correspond to a complete cycle in the
phyllotaxis of the plant. The three rudiments do not develop into
leaves, but by a changed mode of growth give rise to the bedeguar.
Usually this gall, as shown in our figure, is of large size, and contains
numerous cells; but abortive specimens are not infrequently met
with; sometimes a small one is seated on a rose-leaf, and it is
thought that these are due to a failure on the part of the Insect to
complete the pricking operation. Cynipidae will not go through their
gall-making operations except under natural conditions. Giraud[435]
attempted to obtain oviposition, on gathered twigs of oak, from flies
in confinement; but, although he experimented with thousands of
specimens, they on no occasion laid their eggs in the fresh shoots
placed at their disposal, but discharged their eggs in little heaps,
without attention to the twigs. The same observer has also called
attention to the fact that after being deposited in a bud the eggs of
certain species of Cynips will remain dormant without producing, so
far as can be seen, any effect on the tree for a period of fully ten
months, but when the bud begins to develop and the egg hatches
then the gall grows.
 Fig. 349.—Rhodites rosae, female. Cambridge.

The exact mode in which the egg is brought to the requisite spot in
the plant is still uncertain. The path traversed by the ovipositor in the
plant is sometimes of considerable length, and far from straight; in
some cases before it actually pierces the tissues, the organ is thrust
between scales or through fissures, so that the terebra, or boring
part of the ovipositor, when it reaches the minute seam of cambium,
is variously curved and flexed. Now as the canal in its interior is of
extreme tenuity, and frequently of great length, it must be a very
difficult matter for the egg to reach the tissue where it should
develop. The eggs of Cynipidae are very remarkable bodies; they
are very ductile, and consist of a head, and of a stalk that in some
cases is five or six times as long as the head, and is itself somewhat
enlarged at the opposite end. Some other Hymenoptera have also
stalked eggs of a similar kind (Fig. 357, A, egg of Leucospis). It has
been thought that this remarkable shape permits of the contents of
the egg being transferred for a time to the narrower parts, and thus
allows the broader portion of the egg to be temporarily compressed,
and the whole structure to be passed through a very narrow canal or
orifice. It is, however, very doubtful whether the egg really passes
along the canal of the borer. Hartig thought that it did so, and Riley
supports this view to a limited extent. Adler, however, is of a different
opinion, and considers that the egg travels in larger part outside the
terebra. It should be remembered that the ovipositor is really
composed of several appendages that are developed from the
outside of the body; thus the external orifice of the body is
morphologically at the base of the borer, the several parts of which
are in longitudinal apposition. Hence there is nothing that would
render the view of the egg leaving the ovipositor at the base
improbable, and Adler supposes that it actually does so, the thin end
being retained between the divisions of the terebra. Riley is of
opinion that the act of oviposition in these Insects follows no uniform
system. He has observed that in the case of Callirhytis clavula,
ovipositing in the buds of Quercus alba, the eggs are inserted by the
egg-stalk into the substance of the leaf, and that the egg-fluids are at
first gathered in the posterior end, which is not inserted. "The fluids
are then gradually absorbed from this exposed portion into the
inserted portion of the egg, and by the time the young leaves have
formed the exposed [parts of the] shells are empty, the thread-like
stalk has disappeared, and the egg-contents are all contained within
the leaf tissue." He has also observed that in Biorhiza nigra the
pedicel, or stalk, only is inserted in the embryonic leaf-tissue, and
that the enlarged portion or egg-body is at first external. The same
naturalist also records that in the case of a small inquiline species,
Ceroptres politus, the pedicel of the egg is very short, and in this
case the egg is thrust down into the puncture made by the borer, so
that the egg is entirely covered.

Some Cynipidae bore a large number of the channels for their eggs
before depositing any of the latter, and it would appear that it is the
rule that the boring of the channel is an act separate from that of
actual oviposition. Adler distinguishes three stages: (1) boring of the
canal; (2) the passage of the egg from the base of the ovipositor,
where the egg-stalk is pinched between the two spiculae and the
egg is pushed along the ovipositor; (3) after the point of the
ovipositor is withdrawn, the egg-body enters the pierced canal, and
is pushed forward by the ovipositor until it reaches the bottom.[436]

About fifty years ago Hartig reared large numbers of certain species
of gall-flies from their galls, obtaining from 28,000 galls of Cynips
disticha about 10,000 flies, and from galls of C. folii 3000 or 4000
examples of this species; he found that all the individuals were
females. His observations were subsequently abundantly confirmed
by other naturalists, among whom we may mention Frederick Smith
in our own country, who made in vain repeated attempts to obtain
males of the species of the genus Cynips. On one occasion he
collected in the South of England 4410 galls of C. kollari (at that time
called C. lignicola), and from these he obtained 1562 flies, all of
which were females. A second effort was attended with similar
results. Hartig, writing in 1843, after many years' experience, stated
that though he was acquainted with twenty-eight species of the
genus Cynips, he had not seen a male of any one of them. During
the course of these futile attempts it was, however, seen that a
possible source of fallacy existed in the fact that the Insects were
reared from collected galls; and these being similar to one another, it
was possible that the males might inhabit some different gall. Adler
endeavoured to put the questions thus raised to the test by means of
rearing females from galls, and then getting these females to
produce, parthenogenetically, galls on small oaks planted in pots,
and thus completely under control. He was quite successful in
carrying out his project, and in doing so he made a most
extraordinary discovery, viz. that the galls produced by these
parthenogenetic females on his potted oaks, were quite different
from the galls from which the flies themselves were reared, and
were, in fact, galls that gave rise to a fly that had been previously
considered a distinct species; and of this form both sexes were
produced. Adler's observations have been confirmed by other
naturalists, and thus the occurrence of alternation of generations,
one of the two generations being parthenogenetic, has been
thoroughly established in Cynipidae. We may mention one case as
illustrative. A gall-fly called Chilaspis lowii is produced from galls on
oak-leaves at Vienna at the end of April, both sexes occurring. The
female thereafter lays eggs on the ribs of the leaves of the same
kind of oak, and thus produces a different gall from that which
nourished herself. These galls fall off with the leaves in the autumn,
and in July or August of the following year a gall-fly is produced from
them. It is a different creature from the mother, and was previously
known to entomologists under the name of Chilaspis nitida. Only
females of it occur, and these parthenogenetic individuals lay their
eggs in the young buds of the oak that are already present in the
autumn, and in the following spring, when the buds open and the
leaves develop, those that have had an egg laid in them produce a
gall from which Chilaspis lowii emerges in April or May. In this case
therefore the cycle of the two generations extends over two years,
the generation that takes the greater part of the time for its
production consisting only of females. Adler's observations showed
that, though in some species this alternation of generations was
accompanied by parthenogenesis in one part of the cycle, yet in
other species this was not the case. He found, for instance, that
some gall-flies of the genus Aphilothrix produced a series of
generations the individuals of which were similar to one another, and
were all females and parthenogenetic. In some species of the old
genus Cynips no males are even yet known to occur. A very curious
observation was made by the American, Walsh, viz. that of galls
gathered by him quite similar to one another, some produced
speedily a number of both sexes of Cynips spongifica, while much
later on in the season the remainder of the galls gave rise to females
only of an Insect called Cynips aciculata. It is believed that the galls
gathered by Walsh[437] were really all one species; so that parts of
the same generation emerge at different times and in two distinct
forms, one of them parthenogenetic, the other consisting of two
sexes. It has, however, been suggested that Cynips spongifica and
C. aciculata may be two distinct species, producing quite similar
galls.

Turning now to the questions connected with inquiline or guest-flies,

we may commence with drawing attention to the great practical
difficulties that surround the investigation of this subject. If we open a
number of specimens of any kind of gall it is probable that several
kinds of larvae will be found. In Fig. 350 we represent four kinds of
larvae that were taken out of a few bedeguar galls gathered on one
day in a lane near Cambridge. It is pretty certain that No. 1 in this
figure represents the larva of Rhodites rosae, and that Nos. 2 and 3
are larvae of inquilines, possibly of Synergus, or of a parasite; while
No. 4, which was engaged in feeding on No. 3 in the position shown,
is possibly a Chalcid of the genus Monodontomerus, or may be
Callimome bedeguaris. It is clear that, as we cannot ascertain what
is inside a gall without opening it, and thereby killing the tenants, it is
a most difficult matter to identify the larvae; the only safe method is
that of observation of the act of oviposition; this may be
supplemented by rearing the flies from galls, so as to ascertain what
variety of flies are associated with each kind of gall. This last point
has been well attended to; but the number of cases in which
oviposition of inquiline gall-flies in the galls formed by the Psenides
has been ascertained by direct observation is still very small; they
are, however, sufficient to show that the inquilines deposit their eggs
only after the galls are formed.

Fig. 350.—Larvae inhabiting bedeguar gall at Cambridge. 1, Rhodites

rosae in cell; 2 and 3, larvae of inquilines; 4, larva of a parasitic
Hymenopteron.

Bassett recorded the first case of the kind in connexion with a North
American species, Cynips (Ceroptres) quercus-arbos Fitch. He says:
"On the first of June galls on Quercus ilicifolia had reached their full
size, but were still tender, quite like the young shoots of which they
formed part. Examining them on that day, I discovered on them two
gall-flies, which I succeeded in taking. They were females, and the
ovipositor of each was inserted into the gall so deeply that they could
not readily free themselves, and they were removed by force."

The great resemblance of the inquiline gall-fly to the fly that makes
the gall both dwell in, has been several times noticed by Osten
Sacken, who says "one of the most curious circumstances
connected with the history of two North American blackberry galls is,
that besides the Diastrophus, which apparently is the genuine
originator of the gall, they produce another gall-fly, no doubt an
inquiline, belonging to the genus Aulax, and showing the most
striking resemblance in size, colouring, and sculpture to the
Diastrophus, their companion. The one is the very counterpart of the
other, hardly showing any differences, except the strictly generic
characters! This seems to be one of those curious instances, so
frequent in entomology, of the resemblance between parasites and
their hosts! By rearing a considerable number of galls of D.
nebulosus I obtained this species as well as its parasite almost in
equal numbers. By cutting some of the galls open I ascertained that
a single specimen of the gall frequently contained both species, thus
setting aside a possible doubt whether these Insects are not
produced by two different, although closely similar galls."[438]

The substance of which galls are composed, or rather, perhaps, a

juice they afford, is apparently a most suitable pabulum for the
support of Insect life, and is eagerly sought after by a variety of
Insects; hence by collecting galls in large quantities many species of
Insects may be reared from them; indeed by this means as many as
thirty different kinds of Insects, and belonging to all, or nearly all, the
Orders, have been obtained from a single species of gall. Some galls
are sought by birds, which open them and extract their tenants, even
in cases where it might be supposed that the nauseous flavour of the
galls would forbid such proceedings.

Not more than 500 species of Psenides and Inquiline Cynipidae are
known from all parts of the world; and of described Parasitic
Cynipidae there are only about 150 species. The British forms have
recently been treated by Cameron in the work we have already
several times referred to.[439]

A few Cynipidae have been found in amber; and remains of

members of the family, as well as some galls, are said by Scudder to
have been found in the Tertiary strata at Florissant.

Fam. II. Proctotrypidae, or Oxyura.