Dr John Dean
What is a Sexual Problem?
Let's start with what is “normal” sexual function. This encompasses…
A satisfactory experience of…
Desire, both appetitive (spontaneous, innate) and cognitive (by choice)
Ejaculation (this is not exclusively a male experience)
Physical and emotional pleasure
A sense of well-being, both personal and within the context of any relationship
An absence of physical and psychological pain, or interpersonal difficulty
The processes of “desire + arousal + orgasm/ejaculation” are sometimes described as the “sexual response cycle”. They do not always occur in the sequence shown in this very simple model; there are more complex models of the response cycle that may be better in helping us to understand some sexual concerns.
Sexual problems may be divided into “sexual concerns”, which cause bother to the affected individual and, perhaps, their partner, and “sexual dysfunctions”, which are clearly-defined complexes of symptoms that meet certain very specific diagnostic criteria.
Sexual concerns are common and can usually be resolved through education, counselling and simple behavioural change. They are not “medical” problems, although a Sexual Physician can help alleviate concerns by providing a thorough assessment and any necessary education, counselling and behavioural advice.
These are a normal part of the human experience
They usually stem from poor past experience, lack of knowledge and false beliefs
They may be resolved by positive sexual experience, education and behavioural advice
Sexual concerns are NOT dysfunctions or disorders
Unwarranted “medicalisation” of sexual concerns should be avoided
Unwarranted “medicalisation” may damage patient and public confidence in the care of “true” dysfunctions
Sexual dysfunctions are less common and are more often a medical issue, at least in part; the most widely used definitions are those found in the Diagnostic and Statistical Manual of the American Psychiatric Association, Version IV (Text Revised). The full definitions are found on our "Definitions" page. The main categories are as follows:
Sexual Desire Disorders
Hypoactive sexual desire disorder
Sexual aversion disorder
Sexual Arousal Disorders
Inadequate vaginal lubrication/swelling/excitement (genital, subjective and mixed arousal disorders are recognised)
Delayed or absent orgasm
Sexual Pain Disorders (dyspareunia and Vaginismus may be components of the same sexual pain disorder)
These definitions have evolved from “expert panel” discussion and consensus within the American Psychiatric Association over decades. They are not a recent invention. To be defined as a “dysfunction” these disorders must also cause marked distress or interpersonal difficulty, and not be exclusively due to a general medical condition.
A more-recently identified sexual dysfunction, Persistent Genital Arousal Disorder (PGSD, PSAD, PSAS) has been described in professional literature after the publication of DSM-IV(TR). It is likely to be included in the new DSM-V definitions, due for publication in 2010.
Finally, it is important to remember that these problems may co-exist.
Problems with one phase of the sexual response cycle often cause problems in other phases, leading to multiple or mixed dysfunctions
Anorgasmia + Low Desire + Poor Arousal + Sexual Pain
Low Desire + Poor Arousal + Anorgasmia +/- Sexual Pain
Poor Arousal + Sexual Pain +/- Anorgasmia + Low Desire
Some degree of anxiety or aversion often accompanies sexual dysfunctions
May have a predominantly involuntary
May have a predominantly cognitive,