I am in the midst of researching and drafting a book manuscript on sexuality and mental illness and coming to the increasing realization that because the field of psychology hasn’t embraced sexual dysfunction, things have gotten way off track.

Here’s what I mean:  In my studies as a psychologist, sexuality was kept out of most coursework.  Even in courses about child development, there was little that was specific to sexual development outside the usual Freudian psychosexual framework (oral, anal, phallic, latency, genital stages).  So if I was learning about generalized anxiety, hypochondriasis, or eating disorders, I was learning about every aspect except sexuality.

This splitting off of sexual dysfunction from other types of disorders means a couple of things.  One is that psychologists, marriage and family therapists, and social workers don’t ask about sexual problems when someone comes into their office complaining of, say, panic attacks.  A second is that when people have a sexual concern, they see it as being distinct from other aspects of their psyche.  And a third is that it allows pharmaceutical companies to develop symptom-targeted medications that don’t address the root cause of many sexual problems.

If you are experiencing a sexual concern, try not to see it in a vacuum.  Have you always had anxiety?  Depression?  Is there a history of trauma in your background?  Does your partner complain that you are “obsessive”?  Do you have issues with becoming truly intimate with another human being?  What else is going on with you that you haven’t wanted to address and that is now coming out as a sexual symptom?

Sexual symptoms send people to a sex therapist because, in general, people like sex and want to be physically and emotionally close to a partner.  But sexual symptoms like erectile dysfunction, vaginismus, and lack of sexual arousal can be more difficult to keep hidden than other types of psychological problems.  After all, if you have a fear of spiders, you can just avoid walking in the woods.  But if you have an intimate relationship, it becomes rather obvious that something is wrong.

In my ideal world, all therapists would be knowledgeable about sexual dysfunction, and all clients would accept the connection between other psychological problems and sexual symptoms.

But I think we have a long, long way to go.

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