Psychological Perspective on Sexual Dysfunction

 We know that sex is a physiological need and as important as food, water. It helps in creating more intimate bond between people. Sex is a pleasurable sensation for both physical and mental health.

But do people experience any unpleasantness during this pleasurable process??...

The answer is YES. In fact, sexual dysfunction is not just a man's world; it is prevalent in both males and females but unfortunately sexual dysfunctions among women are not often discussed!! 

Now you all could be having so many questions, thoughts running in your head like what is this dysfunction???...Why does it occur???...What are the causes behind it???...or am I suffering from any???...Is it my partner???...

Well....take a deep breath and relax...we are here to clear all your queries and dilemmas about this topic...so happy reading!! :)

Sexual Dysfunction : What is it??

According to Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR), the major difficulty in evaluating sexual dysfunctions is that there are no accepted guidelines for determining what is 'normal' sexual functioning. The threshold for normal sexual functioning varies with the person's age, prior sexual experiences, the availability and novelty of partners and the expectations and standards characteristic of the person's cultural, ethnic or religious groups.

Moreover, it must be remembered that occasional sexual dysfunction is an inherent part of human sexuality and is not indicative of a disorder unless it is persistent or recurrent and results in marked distress or interpersonal difficulty.

Before deciding that any sexual dysfunction is mediated strictly by psychological factors, it is important to consider the possible contribution of a medical condition or substance, including medication side effects. But it is also important to remember that the identification of a specific etiologic general medical condition, medication or drug of abuse does not negate the important contribution of psychological factors to the etiology of dysfunction.

According to DSM-5, sexual dysfunctions are a heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person's ability to respond sexually or to experience sexual pleasure. An individual may have several sexual dysfunctions at the same time, in that case, all the dysfunctions should be diagnosed.

According to International Classification of Diseases-10 (ICD-10), sexual dysfunction is an inability of an individual to participate in a sexual relationship as he/she would wish. Sexual response is a psychosomatic (an illness caused mentally rather than physically) process and both psychological and somatic processes are usually involved in the causation of sexual dysfunction.

Apart from this above explanations, there is one more factor that is involved in sexual dysfunction, i.e., the Sexual Response Cycle.

Significant disturbances in the Sexual Response Cycle = Sexual Dysfunction

To understand the dysfunction better, we need to know about the normal Human Sexual Response Cycle -

A normal human sexual response cycle can be divided into 5 phases - 

1. Appetititve Phase : The phase before the actual sexual response cycle. This consists of sexual fantasies and a desire to have sexual activity.
2. Excitement Phase : The first true phase of the cycle which starts with physical stimulation and/or by appetitive phase. The major changes during thus phase are -

• Penile erection due to vasocongestion (swelling of bodily tissues caused by increased vascular blood flow and a localized increase in blood pressure) of corpus cavernosa (singular 'corpus cavernosum' - 'cave-like body' of the penis, is one pair of sponge like regions of erectile tissue which contain most of the blood in the penis during an erection); elevation of tests with scrotal sac or scrotum (a small, muscular sac, part of the external male genitalia located behind and underneath the penis that contains and protects the testicles, blood vessels, and part of the spermatic cord) - For Males.

• Lubrication of vagina by a transudate (a filtrate of blood); erection of nipples (in most women); erection of clitoris; thickening of labia minora (smaller inner folds of the vulva) - For Females.

          The duration of this phase is highly variable and may last for several minutes or longer.

     3.  Plateau Phase : The intermediate phase just before actual orgasm, at the height of excitement. It is often difficult to differentiate the plateau phase from the excitement phase. The following important changes occur during this phase -

• Sexual flush (inconsistent); autonomic hyperactivity; erection and engorgement of penis to full size; elevation and enlargement of tests; dew drops on glans penis (head or tip of the penis) - For Males.

• Sexual flush (inconsistent); autonomic hyperactivity; retraction of clitoris behind the prepuce (the fold of skin surrounding the clitoris); development of orgasmic platform in the lower 1/3rd of vagina with lengthening and ballooning of vagina; enlargement of breasts and labia minora; increased vaginal transduate - For Females.

          The duration of this phase may last from half to several minutes.

     4.  Orgasmic Phase : The phase with peak of sexual excitement followed by release of sexual tension and rhythmic contractions of pelvic reproductive organs. The important changes are as follows -

• 4-10 contractions of penile urethra, prostate at about 0.8 second intervals; autonomic excitement becomes marked in this phase; doubling of pulse rate and respiratory rate and 10-40 mm increase in systolic and diastolic BP occur; ejaculatory inevitability precedes orgasm; contractions of external and internal sphincters - For Males.

• 3-15 contractions of lower 1/3rd of vagina, cervix and uterus at about 0.8 second intervals; no contractions occur in clitoris; autonomic excitement becomes marked in this phase; doubling of pulse rate and respiratory rate and 10-40 mm increase in systolic and diastolic BP occur; contractions of external and internal sphincters - For Females.

          The duration of this phase may last from 3-15 seconds.

     5.  Resolution Phase : This phase is characterized by the following common features in both sexes - a general sense of relaxation and well-being after the slight clouding of consciousness during the orgasmic phase; disappearance of sexual flush followed by fine perspiration; gradual decrease in vasocongestion from sexual organs and rest of the body. Refractory period (a period immediately following stimulation during which a nerve/muscle is unresponsive to further stimulation) for further orgasm in males varies from few minutes to many hours; there is usually no refractory period in females.

Sexual Dysfunction : Not caused by Organic Disorder or Disease

There are some factors which have been identified by DSM and ICD as the reasons or etiologies behind sexual dysfunction.

DSM-5 has given 3 sub-types to designate the onset of the difficulty - 

1. Lifelong which refers to a sexual problem that has been present from first sexual experiences.
2. Acquired applies to sexual disorders that develop after a period of relatively normal sexual function.
3. Generalized refers to sexual difficulties that are not limited to certain types of stimulation, situations, or partners, and situational refers to sexual difficulties that only occur with certain types of stimulation, situations, or partners.

In addition to the lifelong/ acquired and generalized/situational sub-types, a number of factors must be considered during the assessment of sexual dysfunction, given that they may be relevant to etiology and/or treatment, and that may contribute, to varying degrees, across individuals -

• Partner factors (e.g., partner's sexual problems; partner's health status).

• Relationship factors (e.g., poor communication; discrepancies in desire for sexual activity).

• Individual vulnerability factors (e.g., poor body image; history of sexual or emotional abuse).

• Psychiatric comorbidity (e.g., depression, anxiety), or stressors (e.g., job loss, bereavement).

• Cultural or Religious factors (e.g., inhibitions related to prohibitions against sexual activity or pleasure; attitudes toward sexuality).

• Medical factors relevant to prognosis, course, or treatment.

Sexual response has a requisite biological underpinning yet is usually experienced in an intra-personal, interpersonal, and cultural context. Thus, sexual function involves a complex interaction among biological, socio-cultural, and psychological factors. But in many clinical contexts, a precise understanding of the cause of a sexual problem is still unknown.

I hope this post made you eager to know more about this area. I will discuss about the different types of dysfunctions later in this blog. If you have any queries please write it in the comment section.

*A detailed explanation of what sex and gender actually is has been posted earlier in this blog - https://psychedbloggers.blogspot.com/2020/08/are-sex-and-gender-similar.html

Till then keep reading and be content.

See you in the next post :)

~Mousumi Gayen.