494 CHAPTER 11
Sexual Dysfunctions
Let’s return to Laura and Mike, the married couple whose relationship—and sex
life—had become strained. Laura found that she didn’t particularly miss having
sexual relations with Mike. She did wonder how they had gotten to this point. In
fact, Laura didn’t have any sex drive, and the few times she and Mike had made
love, nothing “happened” for her—she didn’t have an orgasm or even fi nd herself
aroused. She couldn’t pinpoint where things had gone astray; she’d like to feel desire,
towant to have sexual relations with her husband, but she just didn’t know where
to start or how to get herself worked up about it. Was there something wrong with
their relationship, or with her? Or is such lack of interest entirely “normal”?An Overview of Sexual Functioning
and Sexual Dysfunctions
People engage in sexual relations for two general reasons: to create babies (reproductive
sex) and for pleasure (recreational sex). The vast majority of sexual acts are for plea-
sure, as opposed to procreation. Researchers have defi ned the “normal” progression of
sexual pleasure as the human sexual response cycle, discussed below. Sexual dysfunctions
are characterized by problems in the sexual response cycle. Let’s fi rst examine this cycle
and then consider various ways in which it can go awry for men and women.The Normal Sexual Response Cycle
What is a normal sexual response? In the 1950s and 1960s, researchers William
Masters and Virginia Johnson sought to answer this question by measuring in their
laboratory the sexual responses of thousands of volunteers. Based on their research,
Masters and Johnson outlined the sexual response cycle for both women and men as
consisting of four stages (see Figure 11.2): excitement, plateau, orgasm, and resolu-
tion (Masters & Johnson, 1966). Although it is convenient to organize these events
into stages, the boundaries between these stages are not clear-cut (Levin, 1994):1.Excitement. Excitement occurs in response to sensory-motor, cognitive, and
emotional stimulation that leads to erotic sensations or feelings. Such arousal
includes muscle tension throughout the body and engorged blood vessels, especially
in the genital area. In men, this means that the penis swells; in women, this means
that the clitoris and external genital area swell and vaginal lubrication occurs.2.Plateau. Bodily changes that began in the excitement phase become more in-
tense and then level off when the person reaches the highest level of arousal.- Reread Case 11.3 about Charles, and determine whether or not
his symptoms meet the criteria for frotteurism. Specifi cally, list
which criteria apply and which do not. If you would like more
information to determine his diagnosis, what information—
specifi cally—would you want, and in what ways would the infor-
mation infl uence your decision? - Reread Case 11.4 about the physician who spanked his wife, and
determine whether or not his symptoms meet the criteria for
sexual sadism. Specifi cally, list which criteria apply and which
do not. If you would like more information to determine his di-
agnosis, what information—specifi cally—would you want, and
in what ways would the information infl uence your decision? - Do you think the physician’s wife should be diagnosed with sex-
ual masochism? List the criteria that apply to her, and which do
not. If you would like more information to determine whether
she should be diagnosed with sexual masochism, what infor-
mation—specifi cally—would you want, and in what ways would
the information infl uence your decision?- Reread Case 11.5 about the 32-year-old man, and determine
whether or not his symptoms meet the criteria for fetishism.
Specifically, list which criteria apply and which do not. If you
would like more information to determine his diagnosis, what
information—specifi cally—would you want, and in what ways
would the information infl uence your decision? - Reread Case 11.6 about Mr. A, and determine whether or not
his symptoms meet the criteria for transvestic festishism.
Specifically, list which criteria apply and which do not.
If you would like more information to determine his diagnosis,
what information—specifi cally—would you want, and in what
ways would the information infl uence your decision?
Sexual dysfunctions
Sexual disorders that are characterized by
problems in the sexual response cycle.
Sexual response cycle
The four stages of sexual response—
excitement, plateau, orgasm, and
resolution—outlined by Masters and Johnson.