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What is
Sexual Medicine?

What is a
Sexual Problem?

Definitions

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Dr John Dean

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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)

-Arousal
-subjective excitement
-genital arousal (erection or vaginal lubrication/swelling)

-Orgasm

-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

-Erectile dysfunction

-Inadequate vaginal lubrication/swelling/excitement (genital, subjective and mixed arousal disorders are recognised)

-Orgasmic Disorders

-Premature/rapid ejaculation

-Delayed or absent orgasm

-Sexual Pain Disorders (dyspareunia and Vaginismus may be components of the same sexual pain disorder)

-Dyspareunia

-Vaginismus

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 psychosomatic basis
-Accompanied by symptoms and signs of anxiety and sympathetic arousal

-May have a predominantly cognitive, voluntary motivation
-Sexual intimacy is perceived as frustrating or leading to an increase in feelings of sexual inadequacy
-Avoidance behaviours may impede resolution of sexual dysfunction
 

Diagram showing overlapping nature of sexual problems

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This site's description is: St Peter's Sexual Medicine Centre & West of England Sexual Medicine Service offer advice about any aspect of sexual function such as Erectile dysfunction, Peyronie's disease, Premature ejaculation, Problems with sex drive (libido), Problems with orgasm, Problems with arousal (excitement, genital lubrication, sensitivity),  Sexual pain disorders, menopause and contraception and genitalia and gender identity and the keywords associated with this website are: andrology sexual medicine centre harley street london, west england sexual medicine exeter, john dean st peter's andrology centre, holistic medical care,erectile dysfunction, peyronie's disease penile curvature, premature ejaculation ejaculatory problems, libido testosterone sex drive, sexual orgasm, pelvic pain prostatitis, infertility, varicocoele, vasectomy consultation reversal, genitalia gender identity, low arousal excitement genital lubrication vaginal sensitivity, sexual pain disorders, menopause contraception,medico-legal, legal, civil claim, clinical negligence report, transsexual, transgendered, transgender, trans-man, transman, trans-woman, transwoman, transperson, trans-person