Sexual dysfunction may stem from psychological, cultural, medical and relationship factors.
SEXUAL health is closely linked to a person’s overall quality of life. Some people with sexual difficulties are not distressed by it but others are. This has led to the use of the terminologies, sexual difficulties and sexual dysfunctions, which essentially can be viewed as different parts of a continuum.
These difficulties and dysfunctions can interfere with intimacy, affect marital relationships and ultimately erode well-being and overall health.
There are two widely used definitions for sexual dysfunction, that from the World Health Organisation (WHO) and the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders 4th edition.
Both sets of definitions are founded on the physiological sexual response first described by Masters and Johnson and modified by Kaplan. Both regard sexual dysfunction to comprise physiological and psychological components and these can be separated.
The WHO definition states that “sexual dysfunction covers the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish. Sexual response is a psychosomatic process and both psychological and somatic processes are usually involved in the causation of sexual dysfunction.”
It may or may not be caused by a physical condition.
It classifies the types of sexual dysfunction that are not caused by organic disorder or disease as below:
>Lack or loss of sexual desire is the principal problem and is not secondary to other sexual difficulties, such as erectile failure or dyspareunia (painful sexual intercourse). This category includes frigidity and hypoactive sexual desire disorder.
>Sexual aversion and lack of sexual enjoyment. Either the prospect of sexual interaction produces sufficient fear or anxiety that sexual activity is avoided (sexual aversion) or sexual responses occur normally and orgasm is experienced but there is a lack of sexual enjoyment.
>Failure of genital response. The principal problem in men is erectile dysfunction (difficulty in developing or maintaining an erection suitable for satisfactory intercourse). In women, the principal problem is vaginal dryness or failure of lubrication.
>Orgasmic dysfunction. Orgasm either does not occur or is markedly delayed.
>Premature ejaculation is the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction.
>Excessive sexual drive is self explanatory and includes nymphomania and satyriasis.
Both the WHO and APA definitions have been criticised by many for not taking into consideration the important roles played by socio-cultural, economic, and relational factors in the development of sexuality and sexual problems, particularly in women.
This led to the publication of A New View of Sexual Problems – A Family Physician’s Response edited by KaschakandTiefer, which considers a multi-dimensional model of sexual function.
A person’s sexual problems, conflicts and ambiguous feelings about sexuality are considered in the context of his experience and societal background.
The therapeutic approach begins with a description of the sexual problem in context, rather than a diagnosis of the problem within a presumed format of desire, arousal, and orgasm.
The physiological aspects of the sexual experience and medical factors are not ignored, but the understanding and diagnosis of sexual problems have to include an investigation of the social factors.
The New View proponents define sexual problems “as discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience.”
According to their classification, the problems may arise due to: sociocultural, political, or economic factors; psychological factors; physiologic or medical factors; and partner and relationship factors.
Local epidemiological data on sexual difficulties and dysfunctions are available. Quek published their study on the “Prevalence of sexual problems and its association with social, psychological and physical factors among men in a Malaysian Population” in the Journal of Sexual Medicine in 2008. They reported that the prevalence of self-reported sexual erectile dysfunction (ED) and premature ejaculation (PE) were 41.6% and 22.3% respectively.
Anxiety was present in 8.1% and depression in 5.3% of the 430 subjects studied. ED was associated with diabetes, hypertension and age. PE was associated with psychological distress like anxiety and depression.
Sidi H published their study on “The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women” in the Journal of Sexual Medicine in 2007. The majority of the study population was below 50 years, predominantly Malays, and had high academic achievements.
The prevalence of female sexual dysfunction (FSD) in the study population was 29.6%. Of these, 59.1% reported lack of orgasms, 60.9% low sexual arousal, 50.4% lack of lubrication, 52.2% sexual dissatisfaction, and 67.8% sexual pain.
The risk factors of FSD were those who are older, Malays, married more than 14 years, have sexual intercourse less than one to two times a week, have more children, are married to an older husband (aged over 42 years), and have higher academic status. Lack of lubrication was found to be the main predictor for FSD in the study population.
By: Dr Milton Lum