10.6 Sexual Disorders and Problems

KEY THEME

Sexual dysfunctions are consistent disturbances in desire, arousal, or orgasm that cause psychological distress.

KEY QUESTIONS

Almost every sexually active adult experiences an occasional glitch in responding sexually, such as failing to feel sexually aroused on a particular occasion. What can cause this to happen? There are a number of rather ordinary reasons. You might be feeling tired or grumpy with your sexual partner. Anxiety, including anxiety over your sexual performance, can also interfere with sexual functioning. Drinking too much alcohol can disrupt the ability to achieve sexual arousal or orgasm. And, of course, it’s possible that your well-intentioned partner is doing something that you don’t find sexually stimulating, as in “Let’s just skip the whipped cream next time, okay?”

For most people, such disruptions in sexual response are temporary. In contrast, some people experience persistent sexual problems, or sexual dysfunctions. Sexual dysfunctions cause significant disturbances in a person’s ability to respond sexually or to experience sexual pleasure (American Psychiatric Association, 2013).

sexual dysfunction

A consistent disturbance in sexual desire, arousal, or orgasm that causes psychological distress and interpersonal difficulties.

How Common Are Sexual Problems?

Sexual dysfunction among adult Americans is much higher than you might think: According to one comprehensive survey, nearly half of women and almost a third of men suffered from at least one sexual problem (Lewis & others, 2004). Data from the NSSHB suggest that in their most recent sexual experience, 17% of men and 35% of women reported some degree of difficulty with either erection or vaginal lubrication (Herbenick & others, 2010a, 2010b).

For about 20% of women, low sexual desire was a common sexual problem. And, about 20% of men report difficulty achieving or maintaining an erection (Derogatis & Burnett, 2008). Generally speaking, health problems and aging are associated with a greater likelihood of sexual problems, especially among men.

Nevertheless, one large study found that sexual problems were most common among young women and men older than age 50 (Laumann & others, 1999, 2000). Older men tended to report sexual problems related to the aging process: erection difficulties and lack of interest in sex. In contrast, sexual problems tended to decline with age in women, perhaps because older women were more likely to be in stable, less stressful relationships.

Not Rising to the Occasion: 1 in 5 Males From NASCAR to the NFL, it’s hard to escape the advertising pitches for Viagra and its pharmaceutical rivals, Levitra and Cialis. In one year alone, direct-to-consumer advertising for the three erectile dysfunction (ED) drugs topped $300 million in the U.S. (Consumer Reports AdWatch, 2008). Of the three medications, Viagra is most commonly prescribed. In the first decade since its introduction, over 1 billion little blue Viagra pills have been dispensed (Lyons, 2008).
Viagra, Cialis, and Levitra temporarily alleviate erectile dysfunction by increasing blood flow to the penis. ED is often a symptom of some other serious condition impairing or restricting the body’s blood flow, such as diabetes, cardiovascular disease, high blood pressure, obesity, or smoking (Tostes & others, 2008; J. C. Lee & others, 2010).
Rob Tringali SportsChrome/Newscom

Categories of Sexual Dysfunctions

Both sexes can experience psychological distress or interpersonal difficulties caused by having little or no sexual desire, a condition called hypoactive sexual desire disorder (Hackett, 2008; West & others, 2008). Of course, the frequency with which people want to have sex varies over the lifespan and according to personal preference. Moreover, some researchers argue that people who identify as asexual should not receive a diagnosis of hypoactive sexual desire. Researchers differentiate between asexuality as an identity and low sexual desire as a disorder based on whether a person experiences distress (Brotto, 2010).

hypoactive sexual desire disorder

A sexual dysfunction characterized by little or no sexual desire.

Some sexual dysfunctions can be experienced by men only or women only. For example, women can experience chronic genital pain before, during, or after intercourse, a condition called genito-pelvic pain/penetration disorder (American Psychiatric Association, 2013). When a woman experiences distress over consistent delays in achieving orgasm or the complete inability to achieve orgasm, it’s called female orgasmic disorder. When a man experiences a recurrent inability to achieve or maintain an erection, it’s called erectile dysfunction, or ED (Lewis & others, 2008). At the opposite extreme, an erect man may experience recurring delays or a complete absence of the ability to achieve orgasm through intercourse, a condition called male orgasmic disorder. Although the man may not be able to achieve orgasm during intercourse, he may be able to do so through other means, such as by being manually or orally stimulated by his partner. A man may experience considerable stress over recurrent episodes of premature ejaculation, in which he reaches sexual climax too soon, often immediately before or shortly after penetration.

genito-pelvic pain/penetration disorder

A sexual dysfunction characterized by genital pain before, during, or after intercourse.

female orgasmic disorder

In females, sexual dysfunction characterized by consistent delays in achieving orgasm or the inability to achieve orgasm.

erectile dysfunction (ED)

In males, sexual dysfunction characterized by a recurring inability to achieve or maintain an erect penis.

male orgasmic disorder

In males, sexual dysfunction characterized by delayed orgasm during intercourse or the inability to achieve orgasm during intercourse.

premature ejaculation

In males, sexual dysfunction characterized by orgasm occurring before it is desired, often immediately or shortly after sexual stimulation or penetration.

What causes sexual dysfunctions? Physical or medical conditions are involved in some disorders, such as erectile dysfunction. ED is often a symptom of an underlying medical condition that impairs the body’s blood flow, such as diabetes, cardiovascular disease, high blood pressure, or obesity. Smoking can also cause ED by constricting blood vesicles (Tostes & others, 2008). Other problems, such as premature ejaculation, often involve psychological factors, such as anxiety about sex, sexual performance, or unpleasant past sexual experiences. Fortunately, many sexual dysfunctions can be treated by psychologists and physicians who are specially trained in sex therapy (Meston & others, 2008; Rowland & McMahon, 2008; Wincze & Carey, 2012).

The Paraphilic Disorders: UNUSUAL SEXUAL FANTASIES, URGES, OR BEHAVIORS

When a person’s sexual gratification is highly or completely dependent on fantasies, urges, or behaviors that fall outside the socially accepted range of sexual behavior, the person is said to have a paraphilia or a paraphilic disorder. As the description implies, what gets defined as a paraphilia is strongly influenced by social mores and cultural traditions (Bhugra & others, 2010). For example, most western cultures no longer define homosexuality as a disorder, but not all cultures share that view. Fetishes, transvestism, and masturbation are other sexual behaviors that may or may not be considered a paraphilia depending on the culture.

paraphilia

(pair-uh-FILL-ee-uh) Any of several forms of nontraditional sexual behavior in which a person’s sexual gratification depends on an unusual sexual experience, object, or fantasy.

paraphilic disorder

(pair-uh-FILL-ick) A sexual disorder in which a person engages in a paraphilia that causes distress or harm to that person or to someone who is the target of their paraphilia, or that causes impairment in that person’s life.

Robert Weber The New Yorker Collection/The Cartoon Bank

Are the paraphilias and paraphilic disorders merely unusual behaviors or preferences? In many cases, paraphilias are simply unusual sexual practices. Sometimes, however, a paraphilia coincides with the diagnosis of a paraphilic disorder. With a paraphilic disorder, the paraphilia leads to distress or harm to the person or to a nonconsenting partner or target, or to impairment in the person’s functioning (American Psychiatric Association, 2013; Moran, 2013). So, a paraphilia on its own is not a disorder, but a paraphilia must be present to be diagnosed with a paraphilic disorder. In general, paraphilias and paraphilic disorders include fantasies, urges, and behaviors that may involve suffering or humiliation, children, another nonconsenting adult, or nonhuman objects. As a rule, men are more likely than women to exhibit a paraphilia (Gijs, 2008; Bhugra & others, 2010).

Exactly what kinds of fantasies, urges, or behaviors are we talking about? Here are brief descriptions of the most common paraphilic disorders:

Unlike the person with a sexual dysfunction, the person who has a paraphilic disorder is often not psychologically distressed by it. Rather, these people typically come to the attention of mental health professionals only when their behavior has created a conflict with their sexual partner, has been discovered by a family member or coworker, or has resulted in arrest (Gijs, 2008). Some paraphilias, such as pedophilia and voyeurism, are illegal.

What causes a particular paraphilia to develop? Theories involving biological and psychological causes exist, but there are no solid answers. The exact causes of paraphilias remain obscure (Lussier & others, 2008).

Sexually Transmitted Infections

No discussion of human sexuality would be complete without discussing the dangers of sexually transmitted infections, abbreviated STIs. STIs are also known as sexually transmitted diseases, or STDs. An estimated 19 million cases of STIs are diagnosed annually in the United States. Given that statistic, consider this additional fact: Young people aged 15 to 24 account for almost half of those cases (Satterwhite & others, 2013).

sexually transmitted infections (STIs)

Any of several infectious diseases that are transmitted primarily through sexual intercourse or other intimate sexual contact. Also known as sexually transmitted diseases, or STDs.

Transmitted primarily through sexual contact, STIs include bacterial, viral, and parasitic infections (see TABLE 10.2 below). Bacterial STIs include gonorrhea, syphilis, and chlamydia. Pubic lice is an example of a parasitic STI. Both bacterial and parasitic STIs can be cured with appropriate treatments, such as antibiotic medications or antiparasitic shampoos. In contrast, viral sexually transmitted infections, such as genital herpes, human papilloma virus (HPV), and AIDS, cannot be cured. However, their symptoms can often be reduced with treatment. In addition, researchers are developing vaccines for some of the viral diseases. There is currently an available vaccine for HPV, the most common viral sexually transmitted infection. Currently, HPV infects just about every sexually active person in the United States (Markowitz & others, 2013), although this may change as more of the population is vaccinated. AIDS is discussed in more detail below.

Table : TABLE 10.2
Major Sexually Transmitted Infections
  Symptoms
Bacterial  
Gonorrhea Men: yellowish penile discharge; burning or painful urination
Women: often no early symptoms; vaginal discharge; burning or painful urination
Syphilis Painless chancre, or sore; swollen lymph nodes
Chlamydia Men: many are symptom-free; burning or painful urination
Women: most are symptom-free; painful urination and vaginal discharge
   
Parasitic  
Pubic lice Intense itching in the pubic area
   
Viral  
Genital herpes Painful blisters on or inside the genitals; sometimes accompanied by fever, swollen lymph nodes, bodily aches and pains
Human Papilloma Virus (HPV) Often no early symptoms; genital warts in some cases; can lead to cancer in rare cases
AIDS (acquired immune deficiency syndrome) Initial HIV infection may be accompanied by mild flulike symptoms; HIV virus can be dormant for years; AIDS is characterized by severe weight loss and increased susceptibility to other diseases and infections

MYTH !lhtriangle! SCIENCE

Is it true that you usually know if you’ve contracted a sexually transmitted infection?

Left untreated, many STIs can eventually create significant health problems. This is especially troubling because it is completely possible for a person to be unaware that he or she is infected with an STI. For example, chlamydia is a bacterial infection that occurs most commonly among young women and often does not produce symptoms (Centers for Disease Control and Prevention, 2014). Although it can easily be cured with antibiotics, chlamydia can cause severe health consequences for women if left untreated, including pelvic inflammatory disease and infertility. Equally troubling, an infected person can unknowingly pass on an STI to sexual partners.

Nelson Mandela: “A Tragedy of Unprecedented Proportions” Mandela is shown here with actor Will Smith at the June 2008 “46664” concert in honor of Mandela’s 90th birthday. 46664 was Mandela’s prisoner identification number during his 27-year imprisonment for anti-apartheid activity in South Africa. Today, 46664 is a global campaign that focuses on HIV prevention. The number symbolizes Mandela’s insistence that no human being should ever be reduced to a simple number—including the millions of people living with HIV. In Mandela’s words, “A tragedy of unprecedented proportions is unfolding in Africa. Today in Africa, AIDS is claiming more lives than the sum total of all wars, famines, and floods, and the ravages of such deadly diseases as malaria. We must act now for the sake of the world.” After a long, inspiring life, Nelson Mandela died on December 5, 2013.
REUTERS/Andrew Winning

HIV AND THE AIDS EPIDEMIC

AIDS, or acquired immune deficiency syndrome, is a disease that gradually depletes and weakens the human immune system. It is caused by the human immunodeficiency virus (HIV), which enters the bloodstream through the exchange of infected bodily fluids, primarily semen, vaginal fluids, and blood. HIV is typically transmitted by having unprotected sexual intercourse or by sharing needles or syringes with an infected person. HIV can also be transmitted by an infected mother to her infant during pregnancy, birth, or breast-feeding. Less commonly, it can be transmitted by receiving a transfusion of infected blood.

AIDS (acquired immune deficiency syndrome)

Disease caused by the human immunodeficiency virus (HIV), which selectively attacks helper T cells in the immune system, progressively weakening the body’s ability to fight infections and diseases.

human immunodeficiency virus (HIV)

A retrovirus that infects, destroys, and reduces the number of helper T cells in the immune system, producing AIDS.

As you can see in TABLE 10.3, an estimated 872,990 people in the United States are infected with HIV (Centers for Disease Control and Prevention, 2013b). 18% of these people do not know they are infected (Kaiser Family Foundation, 2013). Among young people ages 13–24, the rate is even higher: 60% of those who have HIV do not know that they are infected (Centers for Disease Control and Prevention, 2012). Even though HIV-infected, a person may not show signs of AIDS. Hence, the term AIDS refers to the most advanced stages of HIV infection. As the HIV virus progressively weakens the immune system, the person becomes highly susceptible to other diseases, including different forms of pneumonia, tuberculosis, cancer, cardiovascular disease, and encephalitis (inflammation of the brain and spinal cord). Eventually, the immune system becomes so deficient that the person succumbs to some opportunistic infection that overwhelms the weakened body.

Note: Children defined as ages 0–14 years for global figures; 0–12 years for U.S. figures.

Table : TABLE 10.3
The AIDS Epidemic: A Snapshot from 2011
  United States Globally
People living with HIV 872,990 34.0 million
Women living with HIV 216,966 17+ million
Children living with HIV     2,895 3.3 million
People newly infected in 2011   49,273 2.5 million
Children newly infected in 2011        192 330,000  
AIDS-related deaths   19,343 1.7 million
Deaths since 1981 636,048 25+ million
Sources: Data from Kaiser Family Foundation, 2012; UNAIDS/WHO, 2012, 2013; Centers for Disease Control and Prevention, 2013.

In the United States, the three groups at greatest risk of becoming infected by HIV are: (1) men who have sex with men, (2) intravenous drug users, and (3) heterosexuals who have sex with people who are already at high risk for HIV infection. However, no one is immune to HIV. Heterosexual transmission accounts for about 27% of the new HIV infections each year in the United States (Centers for Disease Control and Prevention, 2013a). And as you can see in FIGURE 10.4, most HIV infections are acquired before age 50.

Figure 10.4: FIGURE 10.4 Estimated New HIV Infections in the U.S., by Age, 2009
Source: Data from Centers for Disease Control and Prevention, 2013.

The annual rate of new HIV infections has been stable in the United States for over a decade. Approximately 50,000 Americans are newly infected with HIV each year (Centers for Disease Control and Prevention, 2013). By itself, race is not a risk factor for HIV infection. However, African Americans are more severely affected by HIV than any other racial or ethnic group in the United States (see FIGURE 10.5). Black Americans make up just 12% of the population, but account for approximately 44% of the new HIV infections each year. Conversely, whites account for 64% of the population but just 31% of new infections. Hispanics, 16% of the population, account for 21% of new infections (Kaiser Family Foundation, 2013). One contributing factor to the higher rate of infection among African Americans is the lack of access to health care and the stigma associated with being HIV-infected (Centers for Disease Control and Prevention, 2008a, 2008c).

Figure 10.5: FIGURE 10.5 New HIV Infections in the U.S., by Race/Ethnicity, 2010
Source: Data from Kaiser Family Foundation, 2013.

Technically, HIV is classified as a retrovirus. Although researchers have yet to discover a cure for HIV/AIDS, the progression of the disease can be slowed by taking a combination of antiretroviral drugs continuously and permanently. In one way or another, the different antiretroviral drugs work by slowing the virus’s rate of reproduction rather than by killing the virus.

Adding to the treatment challenge is that as HIV reproduces itself, variants of the HIV virus emerge in the person’s body. Some of these variations can display resistance to a particular antiretroviral drug. To counteract this, people infected with HIV take a combination of different kinds of antiretroviral drugs to suppress the virus. These antiretroviral “cocktails” have improved both the quality and duration of life for those who are HIV infected. On the other hand, the combination drug treatments often have many side effects, are complicated to administer, and are expensive.

The AIDS Epidemic: Looking at the One “If I look at the mass, I will never act. If I look at the one, I will.” Mother Teresa’s famous quote is reflected in the actions of many people who are responding to Africa’s AIDS epidemic, one person at a time. One of those who acted was 33-year-old internist Dr. Patrick Ingiliz, who spent a year in the African nation of Malawi as part of a doctor exchange program. As a relative holds the young mother’s baby, Dr. Ingiliz checks the woman’s AIDS-related symptoms. One of the poorest economies in the world, Malawi has been hard hit by AIDS. Of its 15 million citizens, close to 1 million were positive for HIV in 2011. In 2011, an estimated 44,000 people in Malawi died because of AIDS, a decline from the estimate of 63,000 in 2001, but still quite high. One urgent priority for Malawi’s government is caring for the more than 610,000 orphans whose parents have died of AIDS (UNAIDS/WHO, 2012, 2013).
Daniel Rosenthal/laif/Redux

Because of antiretroviral drug treatments, the death rate from AIDS has sharply decreased and stabilized in the United States and other industrialized countries. At present in the United States, about 15,000 people a year die from AIDS (Centers for Disease Control and Prevention, 2008a).

However, the story is different in developing nations, where drug-treatment programs only recently became available on a large scale. In some areas of Africa, infection rates are extremely high. In Botswana and Swaziland, for example, approximately 25 percent of adults are infected with HIV, a decrease from about 35% a decade ago, but still quite high. As you can see in TABLE 10.3, worldwide, more than 34 million people are currently living with HIV and AIDS (UNAIDS, 2012), and more than 25 million people have died because of AIDS (UNAIDS/WHO, 2008a). However, in recent years there has been a concerted effort, much of it overseen by the United Nations organization, UNAIDS, to increase access to drug treatment. As a result, there has been a marked improvement in the HIV/AIDS situation worldwide. For example, the global rate of new infections declined by 20% from 2001 to 2011 and deaths related to AIDS declined by 24% from 2005 to 2011 (UNAIDS, 2012).

THE ABCS OF PREVENTING STIS

Despite widespread public awareness of the dangers of STIs, engaging in risky, unprotected sexual behavior remains common (J. Brown & Vanable, 2007; Kashubeck-West & Szymanski, 2008). For instance, one study found that 38% of sexually active students in grades 9–12 did not use a condom during their last experience of sexual intercourse (Eaton & others, 2010).

There are steps that any person can—and should—take to reduce the likelihood of getting a sexually transmitted infection. The ABC model summarizes three strategies as follows:

A = Abstinence

B = Be faithful

C = Condoms

Abstaining from oral, anal, and vaginal sex is the one obvious way to avoid becoming infected with an STI. That said, if you choose to have sex, do so responsibly. If neither you nor your sexual partner is infected with any kind of STI, you can greatly limit your potential exposure to STIs by maintaining a monogamous sexual relationship. In other words, no cheating or casual hook-ups. Correctly and consistently using condoms and spermicides during sex is another precaution you can take to promote “safer” sex.

Question 10.13

cCenbLJm4q+E8xfzaoQRVovZNB0JXrzLqt5IRnO1wAGn6uR/gk2DrpwgffC0jnBo/6F4twChDWCd9rSnW83SVRim8Cj8H93RZ988S+KheAyQMXHNSktPII5uFJfGAjE5pvrsBL0JBmFAEo90g/wSak9WMDuM5hc+I7McZqxoDXDPN6YKchhPah6hQ1EXYw5SffObNPDJzANolKsUN/7Sp9fsZNQL35PIsZuXSPtPM1IqLqqNmcod84cTPkRRoxz4Nw64jOby7bvvSrQzKiIM0Q==
Possible sample answer: Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are primarily transmitted through sexual contact. Infection or disease can be viral, bacterial or parasitic and left untreated can cause significant health problems with long term complications and chronic illness. One major problem with STIs is that the individual often does not know they have become infected. They can inadvertently pass the infection on to others especially as many of the STIs are asymptomatic.

CONCEPT REVIEW 10.3

Sexual Behavior, Disorders, and Problems

Indicate whether each of the following statements is true or false.

1. According to NSSHB data, young, single adults have the most active sex lives.

A. True
B. False

2. The most common sexual behavior for both men and women aged 18 to 59 is oral sex.

A. True
B. False

3. Sexual problems are most common among young adult women and men over the age of 50.

A. True
B. False

4. Paraphilic disorders are more common among women than among men.

A. True
B. False

5. According to NSSHB data, over 70% of U.S. adults had one or no sexual partner in the past year.

A. True
B. False

6. ABC is an acronym used to promote safer sex practices. The letters stand for: attitude, behavior, communication.

A. True
B. False

Closing Thoughts

From birth, each of us is profoundly influenced by the biological, social, cultural, and psychological forces that shape our gender identity and expression of sexuality. As you’ve seen in this chapter, a person’s gender identity is firmly entrenched by late childhood and adolescence.

Throughout adulthood, the expression of sexuality centers on stable interpersonal relationships that are based not only on physical intimacy but also on emotional and psychological intimacy. Even in old age, the need for physical, emotional, and psychological intimacy remains strong.

Over the course of life, much of who we are is defined by our gender and sexual identities. Often without our awareness, those identities shape the activities we are drawn to, the relationships we form, and how we react in many situations. Most people develop a conventional sense of gender identity and sexual orientation and form sexual relationships that follow the predominant patterns endorsed by society. But other people, like James, are faced with the challenge of accepting themselves in a society that is often not very tolerant of sexual difference.

We hope that in reading this chapter, you’ve developed not only a greater appreciation of your own gender and sexual identities but also a better understanding of people whose gender identity or sexual orientation is different from your own. In Psych for Your Life, we’ll provide suggestions for overcoming gender differences that can interfere with the resolution of conflicts in intimate relationships.