India still remains a rather conservative society, where sex is almost a tabooed topic, with very little emphasis on sexual health. In consequence, there are several myths and misperceptions shrouding sex and sex-related disorders. It is no wonder therefore, that sexual problems remain under-recognized despite their high prevalence, and sufferers invariably fall into the hands of quacks, which at times might have disastrous consequences.
Sexual problems not only cause emotional and physical distress to the affected person, and affect their quality of life, often the entire family suffers without even knowing the reason why. Hence, it is very important to address and manage them. Family therapists being the first point of contact for patients, are in the best position to help patients with sexual disorders.
Dr Reshma Agarwal, DGO, DNB (Psych), is a well-known Psychiatrist and Consultant, Wholistic Wellness, presently based in Washington DC and a former Senior CMO, Dept. of Psychiatry, GB Pant Hospital, New Delhi, India.
In this Course on “Sexual Health”, she elaborates on some common sex-related disorders and she de-mystifies them. It will help Family Therapists learn more about their diagnosis and management, and especially about the timely referral to a psychiatrist for further evaluation and management.
- Learn about the four phases of normal sexual response
- Learn the truth about some myths associated with sexuality such as:
- Small penis size affects sexuality
- Testosterone is a sex tonic
- Circumcision affects sexuality
- Homosexuality is a perversion
- Most people are ignorant about paraphilias being a disorder.
- Various types of paraphilias include voyeurism, frotteurism, exhibitionism, zooophilia, among several others.
- They begin in adolescence; their onset in middle age is rare.
- Paraphilias are difficult to manage – they are controllable and not curable. Medications have limited role.
- Referral to psychiatrist is a must as lifetime therapy is needed.
- Transsexualism causes severe distress to the individual and the family due to ignorance about the condition.
- Gender identity disorder is not homosexuality.
- Early intervention can prevent transsexual behavior later in life.
- All patients must be referred to psychiatrist for thorough evaluation as management is complicated and multidisciplinary.
- Sexual arousal is the 2nd phase of normal sexual response
- Sexual arousal disorder is much more common in men, but is also seen in women
- To make a diagnosis, other differential diagnoses such as dyspareunia or lack of arousal, medical causes especially hormonal, other psychiatric disorders such as anxiety, depression, or prescribed medications must be ruled out
- Several disorders are associated with the last phase of the sexual cycle
- Two common disorders of the resolution phase are postcoital dysphoria, postcoital headache
- These disorders often remain undiagnosed and lead to interpersonal difficulties.
- The first phase of normal sex response is desire.
- There is a common myth that aphrodisiacs increase sexual desire or performance.
- Sexual dysfunction disorders associated with desire are: Low desire, sexual anhedonia, sex phobia, sexual addiction.
- Orgasm is an individual’s unique perception of peak physical reaction and release.
- Masturbation and premature ejaculation are common orgasm-related disorders.
- Inhibited orgasm is also a disorder in both men and women.
- Counsel and reassure the patient.
- Psychiatrist referral is needed in managing such cases.
- Orgasm is the third phase of the normal sexual cycle after arousal.
- Some common myths associated with orgasm are:
- Orgasm is same as ejaculation.
- Larger ejaculated means more pleasurable orgasm.
- Coitus necessarily means orgasm.
- Multiple orgasms are common in a man at the same time
- Masturbation is a normal human behaviour, but there are many myths surrounding it.
- Masturbation is healthy and harmless except when out of control or preferred to a partner who is available.
- Women do masturbate.
- Genital self stimulation is seen in babies especially 15-19 months of age.
- Erectile dysfunction or impotence is a very common but poorly understood condition.
- Hence, it is often mismanaged.
- ED is treatable in almost all cases today.
- Medications are useful.
- Mechanical devices and surgery are indicated in selective cases.
- All cases need psychological treatment.