SEXUAL FUNCTION, DYSFUNCTION, & DEVIATION
Fred Cutter,Ph.D.
San Luis Obispo CA

All sex functions have a history of one trial learning where the first sexual contact (usually in childhood) is imprinted with fear, pleasure, or mixtures of both. Subsequent repetitions are reinforced by the pleasure of arousal and orgasm, or the release from intense anxiety whether or not it is enhanced by sexual climax.

1. Sex functions usually allow the full range of sexual arousal, performance and orgasm within the physical limitations of the individuals and the mutual consent of the couple.

2. Sexual dysfunction include erectile difficulties in men, and anorgasmia in women, whose medical histories document sufficient health, but expected performance is disappointing.

3. Sexual deviations (Exhibitionism, pedophilia, fetishism, rape, etc) are more compulsive disorders with less responsiveness to any known psychotherapy or medication specifics. Incest is in- cludable with the above, but has additional characteristics worthy of note.

POSSIBLE SOLUTIONS

1. Normal sexual functions When dissatisfactions occur, one or both partners are said to have a sexual dysfunction.

2. Sexual dysfunction Sex therapy today uses a Masters and Johnson type reconditioning of behaviors associated with orgasm, and allows attitudes towards sexual activities to change. Prerequisite to starting a couple accepts a ban on orgasms during the period of therapy. This is needed to give both partners a non demand environment in which to seek improvement of their dysfunctions. Sex therapy includes assigned homework. which often stimulates recollections, and debriefing of first sexual events. Such reviews help to change attitudes, which allows more satisfying sexual performance in the areas of dysfunction. As improvements are experienced couples will often elect to stop therapy when they are comfortable with their personal and joint sexuality,

Specific medications for erectile dysfunction can play a role, but are usually subordinate to attitude changes. Some couples will abort sex therapy at the prospect of medication options, such as the recent availability of Viagra. The psychological risk of continuing sexual dysfunction, is very real, but no harm in trying since the motivation for sex therapy is distracted by the prospect of an easy fix.

Female specifics are minimal. There are suggestions that Viagra may help. Antidepressants often contribute something to women with anorgasmia, since a case can be made for "masked depression"; i.e. the usual depressive symptoms are absent, and the distress is masked from visible expression by displacement to sexual dysfunction. The same may be true for eating disorders or other behavior patterns, e.g pms.

2. Sexual deviation People who seek orgasms through deviant sources share the history of one trial learning in the origin of their desire for gratifi- cation from the unusual. Pedophilia is the most common of all. Girl molesting occurs twice as often as boy molesting, assuming male perpetrators. Female perpetrators do not present very often. Child molesting for same sex partners is likely to lead to adult homosexuality. However, not all molested boys nor girls grow up to be gay. Those child victims that become heterosexual adults, have detectable attitudes in their sexual activities (counterpho- bias, Don Juan or womanizing for men; arousal failures, and anorgasmia for women). Opposite sex boy or girl molesting victims are also at risk for changes in their attitudes towards adult sexual activities as suggested above.

Early and mutual sex play among same age children is included in the one trial learning ideas, but do not take on negative adult attitudes unless parents detect and over react in how they define the behavior.

Psychological care for all of these conditions is less effective than usual because the emotion that should be associated with deviant behavior is not experienced by the client. The deviant behavior is said to be ego syntonic rather than alienated or distressing.

Sometimes with the pressure of family, or police, sexually devi- ant perpetrators get anxious enough to be reachable, but the therapeutic window of opportunity tends to be of very short duration.

Psychotropics are not reported as helpful medications for sexu- ally deviant people.

Incest behavior is a special case of deviant sexuality. It is mentioned separately because it perverts a current parental relation into that of a lover between a father and an underage daughter; or also, but less often a mother and a son. Families where this occurs are more disorganized, meaning closer to non functionality, divorce, or frank psychotic disorders in at least one member. Sibling sexuality is includable here and associated with the same kinds of family breakdowns.

Psychological Care for incest is also quite limited, unless anxiety or distress can be induced by the social or legal conse- quences. When these strong feelings of distress are resolved, removed, or denied; usually before the achievement of stated goals, the client stops psychotherapy. There are no known specif- ic Psychotropics that can be applied to the perpetrator of in- cest.