In fact, it would appear that the more people of both sexes are using the Internet for these purposes, the more ways they are finding to do so. In this regard, Green and her associates point out that, "The fact that one can access sexually related materials and interact with others anonymously on the Internet has opened the doors even wider. Using anonymous screen names, individuals can explore and express their sexual interests with little fear that friends, coworkers, or even spouses will discover their activities" (2001, p. 303). Furthermore, the individuals who participate in these encounters can do so with other anonymous individuals without the risks typically associated with face-to-face relationships; if an anonymous online relationship turns sour, it is a simple matter to discontinue it.

In addition, and perhaps more importantly for this analysis as it applies to online encounters, gender identification in computer-mediated forums can be difficult - if not impossible -- because the individual's physical appearance is not in evidence unless he or she so desires by exchanging pictures or using video cameras). Today, Internet users "can literally change his or her gender (known as gender-bending), personality, or physical description at will. The Internet is a ripe environment for the experimentation and exploration of one's identities" (Green et al., p. 303).

Implications for Policymakers, Healthcare Practitioners and Sexually Oriented Enterprises.

While there are some clear gender differences in how online sexually oriented services are viewed, as well as some important community standards that come into play in this analysis. Because these sexually oriented services are projecting an increasingly prominent presence in both online and offline settings based in large part on the profitability of such enterprises, identifying how such activities tend to affect those who participate becomes an important consideration for policymakers and clinicians alike. For example, in their chapter, "Nudity and Sexual Appeals: Understanding the Arousal Process and Advertising Response," LaTour and Henthorne (2003) report that, "There is substantial need for addressing the issue of sex in advertising with insightful research and constructive debate. Furthermore, research and constructive debate must transcend both the realms of academic and applied practice so as to promote a mutually healthy interchange on this sensitive, highly consequential topic for all concerned" (p. 93).

According to Hill (2005), "Communities of learning reproduce what is judged as valuable and, by exclusion, teach what is not valuable -- in other words, what is taboo -- in the context of the group. In the latter case, silence is not neutral, but functions as part of disciplinary behavior. Communities establish, support, sustain, and challenge norms; they also foster negotiations around the socialization of members" (p. 76). In her study, "Pushing the Wrong Buttons: Men's and Women's Attitudes toward Online and Offline Infidelity," Whitty (2003) reports that:

The general consensus has been that men and women hold different viewpoints on offline monogamous relationships.... Satisfaction within a marriage is also often marked by these gender differences, with men more likely to report sexual problems and women more likely to indicate problems with affection as the cause of discord within the marriage. Noticeably, men are more likely to at least own up to having some type of extradyadic sexual experience compared to women. [Studies] found that men admitted more than women did to fantasizing about having sexual intercourse and giving and receiving oral sex with someone other than their partner. Moreover, men in the study were more likely to state that they had 'hit on' someone else. (Whitty, p. 570).

With more and more people turning to online sources for their education, entertainment, shopping and other activities that traditionally involved face-to-face encounters, the impact of "surfing the net" on males who do so compulsively can be severe. In this regard, Larue (2001) reports that, "Cybersex compulsive is a term coined in a recent study to define at least 200,000 American adults who visit sex sites at least 11 hours per...

According to researchers Cooper, Delmonico, and Burg, writing last year in the journal Sexual Addiction and Compulsivity, 'This is a hidden public health hazard exploding in part because very few are recognizing it as such or taking it seriously'" (emphasis added) (Larue, 2001, p. 44).
Furthermore, clinicians believe that many American males' increasing desire for pornography represents a serious problem that is only getting worse in their relationships with the opposite sex, a trend that could result in still more divorces and a higher incidence of sexual abuse in the future. Indeed, Larue emphasizes that, "Constant bombardment by images of buff, sleek, airbrushed, ideal women is giving rise to a new mental disorder among men: the centerfold syndrome. This is resulting not from any increase in the circulation of porn magazines -- with their steamy centerfold photos -- but from the vast upsurge in X-rated material on cable, videocassette, and the Internet" (Larue, 2001).

By any measure, then, American males appear to be engaging in such online visits and subsequent offline encounters for many of the same reasons they always have, but the virtually unlimited opportunities represented by the Web to engage in such behaviors appear to be further exacerbating these tendencies. Even though First Amendment advocates insist that the Internet represents that last bastion of truly free speech, many observers suggest that there is some room for regulation of these sexually oriented services at the community level at least. For example, the late U.S. Supreme Court Chief Justice Earl Warren believed that:

There is a long-recognized legitimate interest in regulating the use of obscene material in local commerce and in all places of public accommodation.... The States have the power to make a morally neutral judgment that public exhibition of obscene material, or commerce in such material, has a tendency to injure the community as a whole, to endanger the public safety, or to jeopardize the right of the states and the Nation... To maintain a decent society (cited in Larue, 2001, p. 44).

Conclusion

The research showed that there are a wide range of issues to be taken into account when considering the proliferation of online sexually oriented enterprises. Web sites such as San Francisco Red Book are not only increasingly commonplace, they may well represent the best opportunity in the near-term for the healthcare community to educate the American public in general and those at high-risk for acquiring sexually transmitted diseases in particular about the specific dangers involved in the types of sexual practices they prefer. It is time to put aside any prudish concerns about these online services and develop strategic partnerships between the healthcare community and sexually oriented enterprises to stop the spread of communicable diseases, especially the HIV / AIDS virus, and create a more open environment in which these issues can be discussed in meaningful ways because they are clearly not going to go away anytime soon.