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Sexual Dysfunction? Based on Whose Standards? by Miriam Biddelman, CSW
Sexual dysfunction, what is it? Medical Centers all over the world, and esteemed manuals of psychiatry, 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 sex, 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 or not defined by a body of experts on the subject.
The Diagnostic Statistical Manual defines sexual dysfunction as “a disturbance in the processes that characterize the sexual response cycle or by pain 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.
It may seem by this manual that we have a definite handle on sexual dysfunction; however, points of view in the field vary both in the definition and treatment. At a meeting of
the Female Sexual Function Forum, hosted by the Boston University Medical School, professionals from various disciplines that touch on sexuality looked at female sexuality from psychosocial, relationship dyads, biochemical, and hormonal perspectives. It was clear from listening to this international all-star team of researchers and clinicians dedicated to working in the area of female sexuality that the international standard of what constitutes sexual dysfunction is still up for grabs.
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.
The opinion of this sex therapist is that we are finally addressing sex in both men and women, which is a necessary part of good health and the quality of life, and I am thrilled! But I'm worried too. What I'm worried about is presenting a gold standard of sexual functioning that is based on a medical model of the perfect human with a perfect balance of hormones, biochemistry, nerve function, and with a steady desire to have sex from puberty to death at least three times a week. If we judge ourselves against these unrealistic standards we will all come up sexually dysfunctional. If one is not orgasmic but takes pleasure in sex and the context of the sexual relationship, why define it as dysfunction? If one feels unhappy, and without pleasure sexually, he or she can easily identify him or herself and get help. Sex is a smorgasbord of pleasures, an intimate personal experience that can be experienced in the context of a kiss on the back of the neck, full-blown intercourse, or just lying next to someone, flesh to flesh!
Miriam Biddelman, CSW
Sex Therapist This article appears in the following topics:
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