Sexual problems
Sexual problems Psychiatrists are sometimes portrayed as being obsessed with sex – a relic of Freudian theories, no helped by media portrayals of psychiatrists. The reality is rather different and more mundane. Nevertheless, an understanding of sexual problems and how to assess them is important in psychiatry. Auguste Rodin: The Kiss (Paolo and Francesca) 1886
Sexual problems • sexual dysfunctions, in which sexual performance fails to satisfy the subject or partner • sexual deviations, in which sexual practice departs from convention in a way that distresses the subject or offends others • gender-identity disorders • homosexuality, which is not a disorder, but is conveniently considered here
Sexual problems
These conditions, in which some aspect of sexual performance fails to satisfy the subject or partner, may be categorized in several ways but perhaps most clearly by relating them to the five stages in the model of normal sexual response described by Masters and Johnson. Sexual dysfunctions
Reduced libido in women, and erectile and ejaculatory problems in men, are among the most common reasons that couples present for advice. The terms ‘frigidity’ and ‘impotence’ are imprecise and judgemental, and should be avoided. Sexual dysfunctions
Causes Background factors: anxiety or ignorance about sex, past experience of sexual abuse, general disharmony between the couple concerned, a constitutional discrepancy in sex drive between the two partners, or a lack of physical attraction between them
Causes Ageing: sexual drive and performance in both sexes decrease with age, although the decline is more marked in males. For example, the prevalence of erectile dysfunction in men is about 2 percent at age 40, and 25–30 percent at age 65
Causes Psychiatric illness: most psychiatric illnesses, especially depressive illness and anxiety states, reduce sexual drive, performance, and pleasure. The exception is mania, in which sexual interest and activity increase. • Organic brain disease: the dementias, and lesions of the frontal lobe may produce sexual disinhibition. • Genital and pelvic pathology: for example, congenital abnormality, infection, and injury to the genitalia or spinal cord
Causes Endocrine and metabolic disorders: for example, diabetes, sex hormone deficiency, hyperprolactinaemia, hypertension, arteriosclerosis, and renal failure. Alcohol: impaired sexual function may result from intoxication, peripheral neuropathy, disturbed sex hormone metabolism due to cirrhosis of the liver, marital conflict, or treatment with disulfiram