by Elaine Gottlieb
With subjects like cross-dressing and incest hot topics on talk shows and in
tell-all books, it seems like anything goes with sexuality these days.
As society's sexual mores constantly change, it's hard to determine what
constitutes a sexual disorder and what is acceptable in the sexual arena.
According to sex therapist Alexandra Myles, of Boston's McLean Hospital,
professionals "normalize" many desire disorders -- as long as they don't hurt
anyone, break the law or cause problems in a person's work or social
functioning. Desire disorders can range from common problems like low sexual
desire to more unusual behaviors like cross-dressing.
Dennis Sugrue, a sex therapist and clinical psychologist at the Henry Ford
Center Behavioral Services Program in West Bloomfield, Michigan, prefers to
label sexual behaviors as typical or atypical rather than dysfunctional or
abnormal. He views his role as a therapist as helping clients to feel okay about
themselves, whatever their form of sexual behavior. "If one's sexual expression
happens to deviate from the norm, this isn't necessarily a reflection of the
person's psychological health or worth as a human being," Sugrue asserts.
Whether you label different modes of sexual behavior as disorders, problems, or
just preferences, it helps to understand what they are and when to get help for
them.
Low sexual desire
People generally come into treatment for low sexual desire when their partner
notices it, according to Fay Heller, sex therapist at the Menninger Clinic in
Topeka, Kansas. This most frequent complaint can stem from many sources, she
says, including:
Medication
- Many drugs can suppress sexual desire and functioning, including high
blood pressure medicines, oral contraceptives and antidepressants. If you
notice a sudden change in sexual desire after taking a medication, consult
your doctor.
Hormones.
- Lower levels of estrogen or testosterone can affect sexual desire; it's a
good idea to have a physical exam to check for physical causes.
Relationship conflicts
- Low sexual desire often results from interpersonal problems in a
relationship. For example, one partner may withhold sex as a way of expressing
hostility, according to Myles.
Psychological problems
- Lack of desire can reflect a fear of intimacy. It can also be a symptom of
depression or more serious disorders such as narcissism or character problems.
These personality disorders make it hard to connect with others and integrate
love and sexuality.
Sexual abuse.
- Many people with low desire have histories of sexual abuse, reports Myles,
and have difficulty being sexually intimate in a safe, committed relationship.
Sexual boredom and aging.
- Even couples who were once strongly attracted to each other need to
reconnect and learn new techniques for revitalizing their sex lives. "A lot of
people believe that sex should be totally natural and you shouldn't have to do
anything to encourage it, but the truth is you do," says Myles. He recommends
using sex manuals and instructional videos to learn some creative ways to
spice up lovemaking.
Therapists report a high success rate in dealing with low sexual desire. Once
a medical cause is ruled out, sex therapists use a combination of psychotherapy
and behavioral techniques to help individuals and couples reclaim their
sexuality.
Sex addiction
When sex becomes compulsive and out of control, it is an addiction like
alcoholism or any other drug. In fact, many sex addicts also have drug or
alcohol problems, reports Heller. Some may even use sex to buy drugs.
Sex addiction can involve typical sex behavior such as promiscuity, or atypical
behavior such as exhibitionism. Like low sexual desire, sexual addiction can
have many causes. It can be due to a brain or biochemical abnormality; some new
antidepressants like Prozac and Zoloft are being used to treat the condition. In
cases involving rapists or exhibitionists, the drug Depo-Provera is prescribed
to control sexual desire.
Psychological causes can include depression or the manic phase of bipolar
disorder (also known as manic depression.) Compulsive sex isn't about the desire
for love or connection--it can reflect low self esteem and a need for
validation, a need for power, a history of sexual abuse, or a lack of a solid
sense of self. Sex addicts become locked in a cycle of guilt, shame, and disgust
as their addiction affects their work and relationships.
Treatment can include 12-step meetings (Sex and Love Addicts Anonymous),
medication, behavior therapy to control compulsivity, and psychotherapy to treat
underlying emotional problems.
Paraphilias
From the Greek for "beyond love," paraphilias include a range of atypical
sexual behaviors that are a person's primary way of experiencing sexual
satisfaction. Paraphilias are practiced predominantly by men, in a ratio of as
much as 20:1. Some people may experiment with a paraphilia, such as domination
and submission, for a thrill or novelty without it becoming their preferred
sexual outlet. Some identified paraphilias include:
Sado-Masochism (S&M)
- Real or simulated acts in which one person humiliates, beats, or binds
another. S&M can be violent or exploitive, but there are people who act out
these fantasies in a responsible way so that both parties control the activity
and no one is hurt. Their motto, according to Race Bannon in his book,
Learning the Ropes, is "safe, sane and consensual."
Fetishes
- Intense arousal by inanimate objects such as leather, lace or silk or body
parts such as feet. Just experiencing sensual pleasure from certain objects
doesn't make you a fetishist.
Cross-dressing
- Involves men dressing in women's undergarments in order to be aroused
Pedophilia
- sex with a child under 13; statutory rape is considered sex with a minor
under 16. Many active pedophiles have been sexually abused themselves.
Exhibitionism
- displaying genitals to unsuspecting people; can be a sign of shame around
self or sexuality.
Necrophilia
- sex with corpses; can be caused by severe trauma or a major psychological
disturbance.
Just having fantasies involving a paraphilia doesn't classify a person as
"sick". Neither does occasional experimentation with S&M or inanimate objects.
However, therapists agree that people who regularly engage in behaviors like
pedophilia, exhibitionism or necrophilia usually have major psychological
problems.
Overcoming shame around sexuality
While paraphilias are more likely to produce guilt and shame, so can typical
sexual behavior. "We live in a culture that has a long history of looking at
sexuality with suspicion if not disgust, so it doesn't take much to label a
behavior as sick or perverted," says Sugrue. When any sexual behavior causes
feelings of shame or is self-destructive or exploitive, therapists advise
getting professional help.