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Sexual Dysfunction...Based on Whose Standards?
By: By Miriam Biddelman, CSW
Sexual dysfunction, what is it? Medical centers all over the world and esteemed manuals of psychiatry, including the most recent DSM-IV Diagnostic and Statistical Manual of Mental Disorders, are in the midst of quantifying sexual dysfunction and setting a standard by which we can all decide if we're "functional" or not. Interestingly, no one seems to be focusing on the definition of sex and what constitutes sexual behavior, but we are consumed with what is "functional sex" and "dysfunctional sex." It seems to me that until we define what "sex' is, we should stay away from setting a measurement by which to assess whether or not we're OK (unless we're unhappy with our sex lives) by a body of experts on the subject.
The Diagnostic and Statistical Manual defines sexual dysfunction as a "disturbance in the processes that characterize the sexual response cycle associated with sexual intercourse." The Manual goes on to explain the plethora of subtypes of dysfunction that are explained in detail in 45 subsequent pages. The descriptions of dysfunction can be awesome in terms of what can be wrong with you sexually.
While it may seem by this manual that we have a definite handle on sexual dysfunction, points of view in the field vary both in the definition and treatment. At the recent Female Sexual Function Forum, hosted by Boston University Medical School, professionals from various disciplines from all over the globe, came together to examine sexual dysfunction from psychosocial, relationship dyads, biochemical and hormonal perspectives. As I am in touch with the Chairmen of the Scientific Committee on a regular basis, he assures me that we are at the very beginning of understanding how to discover the basis for sexual pleasure and sexual disinterest. From a biological point of view and hormonal point of view there are many hypotheses, but one has to wait, I believe, years, until we truly understand how the sexual cycle really works, and be able to "tease out" the hormonal from the biochemical and psychosocial elements to truly understand, where there is a problem, where the source of the problem resides and how to most effectively treat it.
It was clear, at the meeting in Boston that this international, all-star team of researchers and clinicians could not at this point in time, come up with an international standard of what constitutes sexual dysfunction. The standard that the group seeks to develop is still at least a year away.
With the explosion of Viagra on the scene and the excitement around this groundbreaking drug, we were persuaded to believe that as long as a man can achieve and maintain an erection, everything is all right with the sexual world. Indeed, the number of men and couples I saw in sex therapy diminished, and one could make the assumption that addressing the issue of erectile dysfunction and "reversing it" would solve the problems we experience with sex. We could also come to the conclusion that good, functional sex is defined as having good, sustained erections and hard thrusting intercourse.
Indeed, we are finally addressing sex in both men and women, which is a necessary part of good physical and mental health and one's quality of life, and I am thrilled about that. But I am also worried. What concerns me is the professional need to present a gold standard of sexual functioning that is based on a medical model of the perfect human with perfect balance of hormones, biochemistry, nerve function, and a steady and unwavering desire to want sex and have an experience of the sexual cycle from desire to orgasm, when in fact sex can be so broadly defined as a garden of earthly delights and the pleasure and satisfaction, and harmony defined by the person or couple who experience their own sexual response.
There are a plethora of problems in human relations within marriages and partnerships that impact on ones sex life; if one wants the best quality of life they can attain, and they want to solve problems and address issues, they should seek professional help, without a doubt, but before they diagnose their own problems through the last column of Ann Landers, or a news clip, or the nightly news, they should let a professional, in the arena of sex therapy, help them define what the problem is, where the source lies, and go about administering help.
Even though the study of sexual function is in it's relative infancy, sex therapy has developed new techniques and strategies light-years beyond Masters and Johnson, and over-the counter aids for sex and pharmaceuticals for sexual health are not only available, but the research and development laboratories in pharmaceutical companies are working overtime to address the sexual needs of the population.
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