Basic Assumptions About Sexual Dysfunction

Basic Assumptions About Sexual Dysfunction

The basic assumptions about male sexual dysfunction can be deciphered through study of both the way the field defines the basic problem and the types of solutions proposed.

Definition of the Problem

Considerable media attention recently welcomed an article published in the Journal of the American Medical Association (JAMA) that suggested sexual dysfunction is relatively common and poorly treated in the United States. The article, “Sexual Dysfunction in the United States: Prevalence and Predictors”  was an outgrowth of the authors analysis of data from the 1992 National Health and Social Life Survcy. Among the well published findings were indications that  43% of women and 30% of men have sexual dysfunctions,  persons with sexual dysfunctions tend to have poorer quality of life indicators and problematic relationships, and  less than 20% of women and men seek medical consultation for their problems.

It is hard to quarrel with either the methodology or important public health implications of this research. Sexual dysfunction is widespread and minimally addressed. Yet. when one attends closely to the structure and assumptions of this research, disquieting issues arise. To begin with the most rudimentary issue, what was actually being examined? Not surprisingly, the authors adopted the standard medical definition of sexual dysfunction the definition found in the Diagnostic and Statistical Manual of Mental Disorders.

According to the DSM-IV sexual dysfunction is “characterized by a disturbance in the processes that characterize the sexual response cycle or by pain associated with sexual intercourse.” These processes of the sexual response cycle are desire, excitement, orgasm, and resolution. Based on the literal wording of this definition, one could infer that “sexual dysfunction” could include any type of “disturbance” in the process or any type of “pain” associated with sexual intercourse. Theoretically, this could include too many sexual fantasies (situations in which someone cannot function because of excessive sexual fantasies that interfere with the present sexual encounter or someone is preoccupied with sexual fantasies in inappropri ate situations) or ftv much sexual excitement (erections at the wrong time). Likewise, “pain associated with sexual intercourse” could theoretically refer to psychic pain (anxiety or guilt during or following sexual intercourse because of excessive sexual fantasies thai interfere with the present sexual encounter or someone is preoccupied with sexual fantasies in inappropriate situations) or too much sexual excitement (erections at the wrong time). Likewise, “pain associated with sexual intercourse” could theoretically refer to psychic pain (anxiety or guilt during or following sexual intercourse that is inappropriate).

It would be erroneous, however, to interpret the DSM-IV definition in this way. When one reads on, it becomes clear that the official definition of sexual dysfunction includes only too little sex or not enough physical pleasure. Therefore, within the official way of thinking, clinicians should not attend too much to a client’s sexuality in context that is, when they get aroused, with whom, and whether the sexual activity produces any thing other than physical pleasure.

My second major concern about this article is its reinforcement of another aspect of the dominant discourse about male sexuality: When we define sexual health and dysfunction only in terms of frequency and adequacy of sexual performance, we end up with an odd exemplar of sexual vigor—the adolescent male. Ever ready for sexual encounters, with frequent and enduring erections, the young male escapes the attention of sexual dysfunction experts, while women (43%) and older men (the bulk of the 30%) are identified as sexually unhealthy. This is consistent with age old dominant discourses and sexual stereotypes about women as frigid or sexual repressed and older men as enfeebled, mere shadows of themselves in their sexual prime of life.

Third, this article presented an interesting argument about the relationship between a person’s sexual activity and his or her life satisfaction. Although the authors “stress that concomitant outcomes cannot be causally linked as an outcome of sexual dysfunction”, they did not hesitate to make that very argument—sexual dysfunction creates a low quality of life. For example, they boldly stated that studied data suggest that “sexual dysfunction is a largely uninvestigated yet a significant public health problem”.

It would be hard to argue with this statement, since persons who do not have sex may well be more likely to be unhappy and unfulfilled. What concerns me is what the authors did not say. They omitted any reference to the interaction between quality of life and sexual functioning. That is. Wouldn’t we expea that a person’s sex life would suffer if he or she has very poor relationships and generally unsatisfactory life circumstances? In fact, shouldn’t it be considered odd if a person could have abundant sexual activity at such a time?  online indian pharmacy

The authors made the fascinating observation that, for women, high rates of partner turnover and the resultant stressful sexual encounters provide the basis for “sexual pain and anxiety”. They further noted that “young men are not similarly affected.” Unfortunately, since they made no further comment, one is left with the impression that young men are more sexually resilient, while young women are somehow incapacitated by trivial questions such as. “Do I know this person?” and “Do we care about each other?”

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