Dr.Mubashar Mashqoor Mir
Sexual disorders may be affecting the reproductive system or they may have a psychological or functional component .Those with psychological or functional component are also known as psychosexual disorders. Psychosexual disorders may range from problems with desire, arousal, orgasm or resolution. Astonishing as it may sound, many of these disorders outrun some of the most commonly known diseases in their prevalence, affecting large percentage of population in both males and females.
This problem is even more serious in countries like ours where sex is seldom discussed and is considered a taboo and a secretive topic. With this the lack of sex education, cultural practices and superstitions make sex a bad word and thus amplify the misconceptions and psychological manifestations of sex illiteracy. While there have been appreciable improvements in sex education with regards to sexually transmitted diseases due to efforts made by the government , international agencies and local organisations , sex education in the context of its psychological domain is still lacking. Majority population is India especially in the rural parts is not sensitised to the scientific knowledge regarding sexuality and sexual function and as a result this large chunk of population is still vulnerable and exposed to unscientific myths and misconceptions and amenable to the risk of falling in the trap of quacks and self proclaimed sex doctors.
Males coming to clinics with sexual disorders are often shy to tell their problem at first and it takes great effort on their part to reveal the apprehensions and problems they are having in their sexual life .The magnitude of its implications on their own self esteem and the disastrous impact on their married life is often shocking. Often these males are young either in their teens or those who are about to get married or married middle aged men. Many teenage males especially those belonging to a cultural background where sex before marriage or masturbation is perceived as a sin or bad habit complain of loss of semen as such or during passing urine or of night falls. They are often preoccupied with a vague belief of various bodily problems which they attribute to loss of semen like feeling of weakness, lack of strength, poor mental alertness and loss of appetite. This condition has been described as Dhat Syndrome and needs proper counselling and reassurance to the patient .Many times it may be associated with other psychological manifestations like depression and patients may need additional help in the form of medicines and psychotherapy.
Males especially those who are about to get married owing to their lack of knowledge and unrealistic perceptions regarding sex obtained through hearsay , pornographic content and literature may be under extreme psychological stress and performance pressure during their premarital period and often visit us with doubts regarding the size/shape of their male organs, complains of short ejaculation time etc. More often than not these complains are based on misconceptions and lack of knowledge and can be allayed through patient counselling and reassurance by the doctor/psychologist.
In some cases the patient may actually have quick ejaculation time that almost always occurs within one minute of penetration and is called Premature Ejaculation .It is by far one of the most prevalent psychosexual disorders in males and has serious psychological implications affecting patient’s personal, professional and interpersonal life. Psychological treatment is the backbone of treatment along with use of drugs in cases when required. Two rewarding techniques which patients can practice on their own are Seman’s Stop Start technique where the Genital Stimulation is interrupted before orgasm till the sensation of heightened sexual arousal passes .The second technique is known as Masters and Johnson’s Squeeze Technique in which the male organ is squeezed at its tip known as glans till the phase of heightened sexual arousal passes. Other therapies include use of multiple condoms, condoms with local numbing agent, pelvic floor exercises etc.
Another common male sexual disorder is Erectile Dysfunction which is inability to attain or maintain a sustained penile erection for successful coitus. It can be either organic or functional .Psychological causes may include stress or conflict with spouse, performance anxiety, depression, apprehension regarding diseases affecting genital region. While most cases especially young healthy males have an underlying psychological cause, pathological causes are to be ruled out and relevant investigations are often undertaken by treating doctor. Lifestyle changes, stopping smoking, psychotherapy, and drugs can bring great improvement.
Male Hypoactive Sexual Desire Disorder is another problem seen in males who suffer from an absent or reduced sexual desire. It may be associated with psychological causes like stress; mood disorders etc or may be caused due to low circulating levels of the hormone testosterone.
FEMALE PSYCHO-SEXUAL DISORDERS:
Unlike males, females have a different sexual anatomy and more complex sexual function .Thus females suffer from a different set of sexual disorders. The commonest among these is the problem of low sexual desire in some known as Female Hypoactive Sexual Desire Disorder (FHSDD).Every one in ten females is believed to be suffering from this disorder. These females suffer from persistent or recurrent absence or decrease in sexual desire affecting their interpersonal life. It can be caused due to a number of causes like low hormone oestrogen levels, sexual abuse or childhood trauma , stress , depression , local genital diseases , conflict with spouse , cultural and social factors , drugs etc. A combination of psychological , behavioural therapies along with medications may help a female improve this sexual disorder.
Genital pain syndromes: Females may also suffer from chronic pain syndromes affecting parts of female genitalia such as vulvodynia , Vaginismus etc. which presents as chronic pain or discomfort involving the vulva or vagina for more than 3 months and lacks any organic cause. Patients may also complain of other symptoms like itching, burning, stinging etc. Avoidance of local irritants like soaps, over washing, psychological therapy, pelvic floor exercises and drugs like antidepressants and Gabapentin , pregabalin have been used in treatment.
Patients suffering from psychosexual disorders visiting the healthcare system represent just the tip of iceberg. Only those who exhibit serious psychosomatic features are the ones usually visiting clinics for help whereas most of the patients are too shy and embarrassed to discuss these issues with a healthcare professional. Psychosexual disorder patients are perhaps the most exploited by quacks and are exposed to the risk of harmful and unscientific medication due to the ignorance regarding the subject in the masses. As a rule, the most effective measure to address sexual disorders is sex education and effective steps from the government and at community level are need of the hour.
(The author is a Skin; Sex & VD
specialist based in Jammu).