Gender and Sexual Disorders 509
peers told us) and indirectly (through observations of family members or friends
and from television, movies, books, and the Internet). Some people are taught that
sexual relations outside of marriage are wrong, whereas other people are taught
that sexual experimentation before marriage is a good thing. Such direct and indi-
rect lessons help shape each person’s notion of appropriate or normal sexuality. De-
pending on what an individual learned about sex, he or she may be primed to have
sexual diffi culties in some situations.
The interplay of factors is seen in the contrasting examples of two men, eachof whom has an experience of erectile dysfunction. One man has a history of poor
self-esteem and worry (psychological factors), as well as anxiety about his sexual
performance (neurological and psychological factors). Although he is very attracted
to his partner and generally has a positive view of sex (psychological and social fac-
tors), he worries that his partner may get annoyed at his “performance failure” and
perhaps leave him. This leads him to be even more anxious the next time they have
a sexual encounter (neurological and social factors), and he again has diffi culty at-
taining or maintaining an erection, and thus develops persistent erectile dysfunc-
tion. In contrast, the other man, who also has a positive attitude toward sex and
is attracted to his partner, drinks too much—which leads to an episode of erectile
dysfunction. However, this man does not have the general “performance” worries
of the fi rst man, nor is he anxious about how his partner may respond. He expects
(psychological factor) later to have his usual erections and to be able to satisfy his
partner, which is in fact what happens.
Thus, neurological, psychological, and social factors infl uence each other incomplex ways that predispose an individual to develop a sexual dysfunction, and
that precipitate and maintain it once it develops.
Assessing Sexual Dysfunctions
Many people fi rst seek help for sexual problems from a physician, who may in-
vestigate the extent to which medical factors—rather than psychological or social
factors—contribute to the problems. A physician, in turn, may refer the patient to
a specialist. Patients may see a sex therapist—usually a mental health clinician—
trained to assess and treat problems related to sexuality and sexual activity. Before
sex therapists begin to treat people for sexual dysfunctions, they usually make sure
that the patients have a thorough assessment to identify specifi c factors that con-
tribute to the dysfunction. The results of the assessment guide which factor(s) are
targeted for treatment and which specifi c treatments the therapist suggests. Sexual
dysfunctions can be assessed by examining neurological and other biological fac-
tors, as well as psychological and social factors.
Assessing Neurological and Other Biological Factors
Mental health professionals who assess and treat sexual problems want to know
about an individual’s health status and sexual response cycle. Such information
may be obtained through lab tests that measure endocrine and hormone levels,
ultrasound imaging to assess internal organs, and tests to assess the functioning
of sensory nerves. Testing for men may include a plethysmograph to assess penile
response, and testing for women may include vaginal probes to measure lubrica-
tion and the vagina’s ability to relax and dilate. Genital swelling and lubrication—
or their lack—in a woman do not necessarily refl ect her subjective sense of sexual
arousal or pleasure (Basson, 2005).
Assessing Psychological Factors
An assessment by a sex therapist may include personality tests and inventories such
as the MMPI-2 (see Chapter 3), as well as questions about symptoms of depression
(which can lead to problems of sexual desire). In addition, the sex therapist will as-
sess the patient’s thoughts, feelings, and expectations regarding his or her partner
and about sexual activity, as well as past masturbatory and other sexual experiences