Sexual Disorders - Evolving Models

Most of the clinicians involved in the treatment and research of sexual dysfunctions are probably not very fulfilled with the current nomenclature, which is mostly unidimensional and not including all nuances and aspects of intimate issues. The nomenclature does not deal with psychological, relational, and situational factors of human sexuality. Some of these issues, particularly the ones referred to female sexuality.

A 26-year-old male who complains being distressed because ejaculating within 30 60 sec after penetration during sexual activity with his wife, but reports no quick ejaculation while masturbating technically meets the diagnostic standards for premature ejaculation. Nonetheless, the diagnosis of premature ejaculation does not in full account the scope and psychology of his sexual disfunction. The same could be implied in the case of 67-year-old married male who began to obsessively masturbate around 2 years ago. He thinks about other men being around at times while masturbating, or at times he masturbates just without any thoughts, in different places, for example, while driving. Is his diagnosis sexual disorder not otherwise specified? Or obsessive-compulsive disorder? Do these diagnoses-labels help the clinician in any way?

The recent diagnostic scheme, rephrasing Winston Churchill, is probably the worst diagnostic system except for all those that have been tried. It for certain could be improved. Recently, Fagan suggested a systematic way in which clinician organize the mass of information about sex. We discuss it in more details for two reasons it distinctly establishes that human sexuality, as other 6 Segraves and Balon areas, requires a more compound and advanced descriptive system, and it exemplifies one of probably many potential approaches.

Fagan suggests using the system of four perspectives, or four different ways to view a clinical case, which was originally developed by McHugh and Slavney (48) for all psychiatric disorders. He believes that these four perspectives are a more complex way of viewing clinical information and then communicating that information to clinicians, colleagues, and the individual with the clinical problem or disorder.

These four perspectives are:

1. The disease perspective
2. The dimension perspective
3. The behavior perspective
4. The life story perspective

The disease perspective is categorical, the patient either has or does not have the disease. As Fagan points out, this is the foundation of the medical model, but not the full story. This view turns to physiology, anatomy, and medicine to learn about patients sexual issue.

The dimension perspective focusing on measurement (dimensional gradation and quantification). Cases of the objects of measurements are intelligence quotient, behavioral patterns, mood, or personality traits.

The behaviour position focussing on the behavior of an individual who is goal directed, or teleological. Fagan explains that the behaviour position is to cognitive-behavioral clinician what the disease perspective is to physician.

Lastly, the life story perspective is what most people connect with psychotherapy. It relies on the narrative told by the patient to give some meaning and focusing to their life.

Fagan underlines that no single perspective is, in itself, more valuable than any other, and each perspective can contribute to the conceptualisation. His proposal assists, in part, to handle several issues. First, human sexuality is much more compound than just reaching reliable erection and, as noted, the medical diagnosis does not include psychological, relational, and other factors. Second, not all sexually disordered behaviour has a psychiatric diagnosis. Third, sexual diagnosis is an alternate and developing concept. Fourth, sexual diagnosis does not involve causality.

Fagan suggests that one should choose the primary perspective that best fits the patient and then integrate the other perspectives into the conceptualisation and treatment to make use of the complementary contributions they may provide. He as well emphasises that perspectives are conjunctive and not disjunctive.

Fagan feels that utilising the four perspectives is more accommodating in delineating sexual problems and conceptualising their handling. Many will probably find this proposal too composite or not compound sufficient, overly inclusive or not inclusive enough, not practical enough or too practical. Nevertheless, we feel that it is an fascinating and thoughtful proposal, which may further stimulate and help the argument about the diagnostic issues in the area of sexual dysfunctions.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Products company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of http://www.maleenhancementgroup.com This article may be freely distributed if this resource box stays attached.

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