Sexual aversion disorder
Sexual aversion disorder is a disorder characterized by disgust, fear, revulsion, or lack of desire in consensual relationships involving genital contact.
Normal loss of desire
To understand sexual aversion disorder, one should first understand that there are circumstances in which it is normal for people to lose interest in sexual activity. The reader can then compare these situations to the loss of desire associated with serious sexual disorders, including sexual aversion disorder.
There are a number of reasons that people lose interest in sexual intercourse. It is normal to experience a loss of desire during menopause; directly after the birth of a child; before or during menstruation; during recovery from an illness or surgery; and during such major or stressful life changes as death of a loved one, job loss, retirement, or divorce. These are considered normal causes for fluctuations in sexual desire and are generally temporary. Changing roles, such as becoming a parent for the first time or making a career change have also been found to cause loss of desire. Not having enough time for oneself or to be alone with one's partner may also contribute to normal and naturally reversible loss of desire. Loss of privacy resulting from moving a dependent elderly parent into one's home is a common cause of loss of desire in middle-aged couples. Depression, fatigue , or stress also contribute to lessening of sexual interest.
Sexual aversion disorder represents a much stronger dislike of and active avoidance of sexual activity than the normal ups and downs in desire described above. Sexual aversion disorder is characterized not only by a lack of desire, but also by fear, revulsion, disgust, or similar emotions when the person with the disorder engages in genital contact with a partner. The aversion may take a number of different forms; it may be related to specific aspects of sexual intercourse, such as the sight of the partner's genitals or the smell of his or her body secretions, but it may include kissing, hugging, and petting as well as intercourse itself. In some cases the person with sexual aversion disorder avoids any form of sexual contact; others, however, are not upset by kissing and caressing, and are able to proceed normally until genital contact occurs.
There are several subclassifications of sexual aversion disorder. It may be lifelong (always present) or acquired after a traumatic experience; situational (with a specific partner or in a specific set of circumstances) or generalized (occurring with any partner and in all situations). Sexual aversion may be caused by psychological factors or by a combination of physical and psychological factors.
Causes and symptoms
There are a number of causes of sexual aversion disorder. The most common causes are interpersonal problems and traumatic experiences. Interpersonal problems generally cause situation-specific sexual aversion disorder, in which the symptoms occur only with a specific partner or under certain conditions. In such cases, underlying tension or discontent with the relationship is often the cause. Reasons for unhappiness with the relationship may include the discovery of marital infidelity; major disagreements over children, money, and family roles; domestic violence; lack of personal hygiene on the partner's side; or similar problems. Interpersonal problems are often the cause if intercourse was once enjoyed but is no longer desired.
Traumatic experiences have also been found to cause sexual aversion disorder, often of the generalized variety. Some possible traumas include rape, incest, molestation, or other forms of sexual abuse . The patient then associates intercourse with a painful experience or memory, possibly one that he or she is trying to forget. Sexual aversion disorder may also be caused by religious or cultural teachings that associate sexual activity with excessive feelings of guilt.
The symptoms of sexual aversion disorder can range from mild to severe. Mild symptoms include lack of interest and mild disgust. Severe symptoms can include panic attacks with all the symptoms of such an attack, including dizziness, shortness of breath, intense fear, and rapid heartbeat. People suffering from sexual aversion disorder often go out of their way to avoid situations that could end in sexual contact through any means they can think of, including going to bed at different times from the spouse, spending extra time at work, or trying to make themselves less sexually attractive.
Both men and women can experience sexual aversion disorder. It is thought to be more common in women than in men, possibly because women are more likely than men to be victims of rape and other forms of sexual assault. There are relatively few statistics on the number of people with sexual aversion disorder because it is often confused with other disorders, or with the normal fluctuations in desire associated with life stress. Also, many people find sex a difficult subject to discuss even with a physician, so that the number of people who seek help are probably fewer than the number of people with the disorder overall.
A diagnosis of sexual aversion disorder is usually made when the affected person or his or her partner mentions the problem itself or their dissatisfaction with the relationship to their family physician, gynecologist, or psychotherapist. An important first step in diagnosis is a thorough physical examination, preferably of both partners, to rule out physical causes of the disorder in the affected person, and to rule out a sexually transmitted disease, physical deformity, or lack of personal cleanliness in the partner that may contribute to the affected person's avoidance of sex.
According to the mental health professional's Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR ) of the American Psychiatric Association, to meet criteria for a diagnosis of sexual aversion disorder the patient must not only avoid nearly all genital contact with his or her partner, but have strong negative feelings about such contact or its possibility. In addition, the problem must be causing serious difficulties and unhappiness either for the patient or for his or her partner. In addition, there must not be any underlying physical causes, such as certain disorders of the circulatory system, skin diseases, medication side effects, or similar problems that could cause a loss of desire. To be diagnosed with sexual aversion disorder, the affected person does not have to avoid all sexual contact, but must indicate that he or she is actively avoiding genital contact.
Many other sexual disorders have signs and symptoms similar to those of sexual aversion disorder, which complicates the diagnosis. Sexual aversion disorder is often found in conjunction with other sexual disorders; in some cases several diagnoses are appropriate for one patient.
One disorder similar in many aspects to sexual aversion disorder is hypoactive sexual disorder. Many of the signs, such as avoiding sexual contact in a variety of ways, are similar. The primary difference between the two disorders is that a patient with hypoactive sexual disorder is not interested in sex at all and does not have sexual fantasies of any variety. A patient with sexual aversion disorder, by comparison, may have normal sexual fantasies, and even function normally with some partners, although not with a specific partner. Also, a patient with hyposexual disorder will not enjoy or desire any anticipation in sexual activities including kissing and caressing. Some, though not all, people with sexual aversion disorder do enjoy sexual foreplay until the point of genital contact.
Sexual aversion disorder and hypoactive sexual disorder are both considered to be caused mainly by psychological factors and to manifest psychological symptoms. Another disorder that can have some similar symptoms is female sexual arousal disorder (FSAD). FSAD refers to a woman's recurrent inability to achieve or maintain an adequate lubrication-swelling response during sexual activity. Lack of lubrication is a physical problem that may have either physical or psychological causes. Women with FSAD find intercourse uncomfortable or even painful. As a result of the physical discomfort, the woman often will avoid intercourse and sexual activity with her partner that may lead to intercourse. Although FSAD is a disorder with physical symptoms as well as psychological ones, it is easily confused with sexual aversion disorder because it may manifest as a problem of interest or desire.
Sexual aversion disorder is not thought to have any commonplace underlying physiological causes. The usual treatment is a course of psychotherapy for the psychological condition(s) that may be causing the problem. Marriage counseling, or couples counseling , is often appropriate if the disorder concerns a spouse. Medications can be used to treat some symptoms that may be associated with sexual aversion disorder, such as panic attacks, if they are severe enough to be causing additional distress.
When sexual aversion disorder is addressed as a psychological disorder, treatment can be very successful. Psychotherapy to treat the underlying psychological problems can be successful as long as the patient is willing to attend counseling sessions regularly. For sexual aversion disorder that is situational or acquired, psychotherapy for both the patient and his or her partner may help to resolve interpersonal conflicts that may be contributing to the disorder. Panic attacks caused by or associated with the disorder can be treated successfully by medication if the doctor considers this form of treatment necessary.
If sexual aversion disorder is not diagnosed, discussed, or treated, the result may be infidelity, divorce, or chronic unhappiness in the relationship or marriage.
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Tish Davidson, A.M.