The latest edition of the Psychiatric Times has a special section on sexuality that discusses everything from dealing with sex-related problems as a clinician, to the science of sexual orientation.
It’s actually quite a refreshing change from much of the recent hype we’ve seen about sexual dysfunction, which usually suggests that a patch, pill or prostheses is an essential treatment for unsatisfactory sex.
Psychiatrists who develop an interest in clinical sexuality tend to employ 2 different paradigms, depending on the clinical situation. One is quite familiar to modern psychiatric continuing education. The patient has a disorder, we possess a range of medication treatments, and the etiological theories support our treatment. Lifelong premature ejaculation is an ideal example.
Another paradigm is necessary for most sexual disorders, however. We approach these disorders from the viewpoint of general etiology rather than disorder-specific causation. Sexuality unfolds in adolescence and continues to evolve over decades of adult maturation. The sexual problem serves as a window into personal development and individual and relationship psychology. Sex is understood to be about the unfolding of the individual self, the capacity to give and receive pleasure, the capacity to love and to be loved, the ability to be psychologically intimate, and the ability to manage expected and unexpected changes throughout adulthood.
Since few sexual dysfunctions have a specific treatment, diagnosis per se usually is not the determinant of treatment. Rather, it is the invitation to study the context in which the problem arose. Treatment rests on the clinician’s understanding of how biological, psychological, interpersonal, and cultural factors combined in this case to create the symptom. This second paradigm reminds psychiatrists that the management of sexual disorders often requires interest and skills in psychotherapy.
The fact that most sexual problems are a manifestation of wider difficulties with relationships, mood, or adjustment is taken as read by most clinicians working in the area.
Unfortunately, most of the messages we encounter from TV, magazines and V!aGr4 spam suggest sexual difficulties are nothing more than a physical problem that needs a fix – as if you could help someone drive better by selling them tyres.
Link to August Psychiatric Times.