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Sexology refers to the scientific study of sexual behaviour. Sexual behaviour is a very complex behaviour in human being and shows great diversity across cultures and function. Sexuality depends on four interrelated factors: sexual identity, gender identity, sexual orientation, and sexual behaviour. These factors affect personality growth, development and functioning. Sexuality is something more than ‘physical sex’ and something less than all behaviours directed towards attaining pleasure.
There are two basic concepts in sexology sexual identity and gender identity. Sexual identity is the pattern of a person’s biological sexual characteristics and gender identity is a person’s sense of ‘maleness or femaleness’. Modern embryological studies have shown that we all are anatomically female till six weeks of embryonic life. Fetal hormones play a significant effect on the brain on further life in developing the concept of sexuality. Gender identity is established by 2 to 3 years of age. According to Robert Stoller, gender identity refers to the psychological aspects of behaviour related to masculinity or femininity.
Gender role – are the psychological behaviour pattern which a person adapts to disclose himself or herself as having the status of boy (man) or girl (women). There are lots of behaviour pattern which distinguishes male pattern behaviour and female pattern behaviour. Sexual Orientation is a person’s sexual impulses. In sexual behaviour is further sub-classified into desire, excitement, orgasm and resolution. There are various hormonal and behaviour factors which influence the psychophysiological response of sexual behaviour.
Abnormal sexuality and Sexual Dysfunctions –
Defined as a disturbance in the sexual response cycle and is further subdivided into sexual desire disorders, sexual arousal disorder, orgasm disorder, sexual pain disorders, sexual dysfunction caused by a general medical condition and other sexual dysfunction. Thus sexual dysfunction can be symptomatic of biological, intrapsychic, interpersonal or combination of all these factors. It is affected by stress, emotional disorders and can be short lasting or permanent.
Sexual desire disorder –
(1) hypoactive desire disorder – deficiency or absence of sexual fantasies and desire for sexual activity.
(2) sexual aversion disorder – avoidance of sexual behaviour and act.
Lack of desire can be a result of chronic stress, anxiety or depression.
Sexual Arousal / Disorders
Female sexual arousal disorder and male erectile disorder.
Male Erectile Disorder / erectile dysfunction/ impotence. Can be lifelong, acquired or situational. Present in 10 to 20 % of the male population. The cause can be organic or psychological (commonest cause) or both. This is the commonest disorder for which a patient wants to seek medical help, nearly 50% of patients visiting sex therapist have the male erectile disorder. The treatment plan includes pharmacotherapy (use of drugs), psychotherapy. The course and outcome vary depending upon the severity and duration of the disorder.
Inhibited orgasmic disorder or anorgasmia. Can be female or male (retarded ejaculation). Premature ejaculations are also included in this group and these patients require a specific and proper treatment.
Sexual Pain Disorder
Recurrent or persistent pain after sexual activity. Common in females e.g. vaginismus, dyspareunia. Another group of sexual disorder is sexual disorder due to a general medical condition ( cardiovascular, neurological and endocrine disorders; side effects of drugs) and substance-induced sexual dysfunction ( alcohol, amphetamine, cocaine, opioids, sedative-hypnotics and anxiolytics). Certain pharmacological agents (medicines/ drugs) can cause a sexual adverse effect.
Treatment in General –
In the majority of sexual dysfunction, the treatment consists of psychotherapy either individual or couple (dual sex therapy). Treatment focuses on the exploration of unconscious conflicts, motivation, fantacy and various interpersonal difficulties. In dual therapy both the partners are actively involved in the therapy. Masters and Johanson technique and exercise, sensory focus, specific techniques and exercises for the specific disorder are advised. Behaviour therapy for reduction of anxiety includes systematic desensitization. Medication, hypnosis and special training in deep muscle relaxation are sometimes advocated in treatment. Group therapy – for intrapsychic and interpersonal problems.
Sexual myths, misconception are corrected and proper scientific knowledge is provided in group therapy, which definitely helps to reduce misconception and anxiety.There are very effective pharmacological agents (medicines) available in the market which are useful in erectile dysfunction (sildenafil, tadalafil. Appropriate antianxiety or antidepressants can be used to treat underlined anxiety or depression. There is another group of sexual disorder called Paraphilias which are abnormal expression of sexuality. Pedophilia, exhibitionism, sadism, masochism etc are few of the severe forms and requires intensive treatment. Sex addiction, unconsummated marriage, body image problem are few sexual disorder which are grouped into sexual disorder not otherwise specified.
The last category is gender identity disorder which is actually a separate entity in classification system. Gender identity is a psychological state that reflects a person’s sense of being male or female. Gender role is individuals external behaviour pattern which reflects masculine or feminine behaviours. Gender identity disorders involve persistent desire to be or the insistence that one is of the other sex and extreme discomfort with one’s assisted sex and gender role. These are complex and severe disorders and requires treatment by various medical specialities. Few of severe cases select sex reassignment surgery, they take hormone treatment or may have underlined psychiatric disorder, and require extensive treatment.