Gender and Sexual Disorders 505
sexual encounters, and able to have erections on demand (Kleinplatz, 2001).
As women and men age, they are more likely to meet the criteria for a sexual
dysfunction even when there is no real “dysfunction”––only the body’s growing
older (Tiefer, 1987, 1991).- The criteria do not include any specifi c duration; people with symptoms that are
transient, perhaps as a result of the aftereffects of surgery or a diffi cult time in
a relationship, are grouped together with people whose symptoms are chronic
(Balo, Segraves, & Clayton, 2007). - The DSM-IV-TR defi nitions of various sexual dysfunctions for women are not
necessarily the ones used by those who specialize in the fi eld of human sexuality
(Basson, 2001). - Hypoactive sexual desire disorder in particular has been criticized
on several grounds (Basson, 2001). First, it is left to the clinician
to determine whether desire is suffi ciently lacking (accounting for
the individual’s age and the context of the problem), and clinicians
from diverse cultural and religious or spiritual backgrounds differ
in their assessments. Second, the DSM-IV-TR criteria can lead to
the diagnosis of a sexual dysfunction when there may be no actual
dysfunction, but rather the couple may have a discrepancy in de-
sire, where one partner desires sexual relations more or less often
than the other (Rosen & Leiblum, 1989). In fact, diminished sexual
desire may be an appropriate response to a relationship that isn’t
functioning well (Basson et al., 2001). Finally, different types of
problems with desire (such as lifelong versus acquired or situational
versus generalized) may require different treatments. Nevertheless,
DSM-IV-TR clumps all variations of hypoactive sexual desire disor-
der together (Heiman, 2002a). - Many researchers in the fi eld believe that dyspareunia should not be considered
asexualdisorder, but rather a type of paindisorder (Binik, 2005; Binik et al.,
2002).
Understanding Sexual Dysfunctions
In a sense, we can view Laura’s lack of sexual desire as being related, at least in
part, to Mike’s sexual diffi culties: As Mike pulled back from Laura, Laura’s desire
for sexual intimacy with Mike waned. Their experiences highlight the fact that sex-
uality does not exist in a vacuum. Sexuality and any problems related to it develop
through feedback loops among neurological (and other biological), psychological,
and social factors.
Neurological and Other Biological Factors
In this section, we fi rst consider how disease, illness, surgery, and medication can,
directly and indirectly, disrupt normal sexuality. We then turn to the effects of nor-
mal aging, which can produce sexual diffi culties.
Sexual Side Effects: Disease, Illness, Surgery, and Medication
Disease or illness can produce sexual dysfunction directly, as occurs with prostate
cancer or cervical cancer. In addition, surgery can lead to sexual problems: Half of
women who survive major surgeries for gynecological-related cancer develop sexual
diffi culties that do not become better over time (Andersen, Andersen, & DeProsse,
1989).
Disease or illness can also cause side effects of sexual dysfunction indirectly, asoccurs with diabetes or circulation problems that limit blood fl ow to genital areas.
Some physical problems can lead to sexual problems even more indirectly: People
who have had a heart attack may be afraid to engage in sexual activity for fear that
it will bring on another attack.
When a relationship has signifi cant problems, a
lack of sexual desire may be appropriate and not
a sign of a disorder.Rob Wilkinson/AlamyProlonged bike riding can sometimes crush the
nerves and arteries to the penis or clitoris, lead-
ing to arousal problems.Richard Price/Getty ImagesP SN