Sex and sexuality are the primal instincts of civilizations. They form the central core of social bonds, couple dynamics, relationships, intimacy, and reproduction. It is a well-established fact that sexual expressions and manifestations are biopsychosocial constructs and have heavy bearing on cultural and ecological contexts.
Classically, three dimensions of sexuality have been defined: desire, attachment, and reproduction. Exploring these complex multidimensional interactions forms the basis of psychosexual health, which is in turn integral to sexual medicine.
It is not uncommon in clinical practice to routinely attribute sexual disorders and dysfunctions to a “functional cause,” thereby neglecting the emotional connotations, underlying distress, effect of medications, and concurrent medical conditions. This can lead to misdiagnosis, underdiagnosis of these disorders, and impaired sexuality and quality of life.
Up to 54% of women and 35% of men may experience sexual problems, and yet many can find these issues difficult to talk about. Suffering from a sexual disorder can have a very detrimental effect on relationships and on self-esteem, and become the source of anxiety, depression and stress, so it is important to seek treatment wherever possible. The causes of a psychosexual disorder can lie in feelings of guilt, stress, nervousness, fear, anxiety, or in previous emotional or physical trauma. Other factors based on psychosocial and cultural aspects, such as ignorance or improper sex education, conflicts of values to do with family or religion (for example, the attitude that sex is dirty or sinful) can also be a cause of psychosexual disorder symptoms.
There are three main categories of psychosexual disorder: sexual dysfunction, paraphilias and gender identity disorders.
- Sexual dysfunction is characterised by a lack of sexual desire, erectile dysfunction, premature ejaculation, painful sex, lack of sexual enjoyment, sexual addiction and sexual aversion.
- Paraphilias is unusual or abnormal sexual behaviour, including sexual attraction to unusual objects or activity, such as fetishism, exhibitionism, sadism and voyeurism, amongst others.
- Gender identity disorders manifest as a variation between a person’s biological sexual identity and their own sense of sexual identity, causing difficulties in adjusting to a normal lifestyle and a desire to alter sexual orientation by becoming a member of the opposite sex.