A Quick Word on Psychological Sexual Disorders

[Epistemic status: this really speculative piece is not an article on sexual dysfunctions and/or psychology. You’d better go to PubMed for that]

 I.

It’s early in the morning and I’m already drunk. Well, that’s how I start my essays. Especially at the end of International Masturbation Month.

In this article, we’ll examine the problem of the “sexual disorder” in today’s medicine and why it is a problem. As a bonus, we’ll have a really quick overview of the sexual disorders treatment toolbox.

II.

Before we move any further, let me work on my thesis. Firstly, there are 2.1 gazillions of sexual disorders (say, there were 549 paraphilias back in 2009), and not so many people know the difference between a sexual disorder, gender dysphoria, and bipolar (heck, even PTSD can be a sexual disorder and a cause of sexual dysfunction). You get a new sexual disorder by combining a Greek word for something weird with -philia or -ism suffix, like vorarephilia – sexual attraction to eating humans. And don’t forget the rule #34 of the Internet – if something exists, there’s a weird porn featuring it, thus creating a rich background for an official sexual disorder list.

Secondly, let’s consider the causes of sexual disorders. Almost every psychological distress or physical pathology (or another disorder, which creates an infinite cross-disorder loop) can be a cause of multiple sexual disorders. For example, depression can result in low libido, anorgasmia, poor body image, and narcissistic traits, which can result in the Dorian Gray syndrome. Even an oversimplified classification of what can and cannot be a cause of sexual addiction ends up being a solid two hundred pages study. Hence, it’s much easier to use online pornography as a scapegoat — it’s an easy shot, that’s why we have so many articles focusing on the destructive effect of porn and sexualization of women in media.

 III.

So, treatment.

Mainly, there are two groups of treatment available and popular today:

1. Psychotherapy: cognitive behavioral therapy, psychoanalysis, you name it.
2. Pharmacology: antidepressants, selective serotonin reuptake inhibitors (SSRIs), chemical castration by antiandrogens; flibanserin (female sexual arousal disorder (FSAD)), testosterone (short-term treatment of hypoactive sexual desire disorder (HSDD)); Cialis, Viagra, Levitra (male erectile dysfunction (ED), etc.

Bonus: all-time winners — weed (increases sexual stamina, intensifies orgasms), regular masturbation (relieves menstrual cramps, better sleep).

For anything else there is Xanax.

 IV.

Sexual disorders (and many other disorders) are not separate, isolated pathologies. Like many other things about humans, they have multiple cross-effects on many levels of our health, life, and the world around us. Being treated by different medical experts (with little or no understanding of the previous history) makes the situation even more complicated.

V.

DSM-5, one of the biggest psychiatry trendsetters in the world (sorry, in the US), says it “removes artificial distinctions between medical and mental disorders.” That’s great, but after a short meditation, it appears that a number of disorders remained the same, approximately 300 while the lines between groups become even more blurred, and there are even more overlapping cases. Some of the disorders only migrated to different classes or changed the names. This raised serious criticism — “weak methodology,” “lack of empirical evidence,” “junk science,” “subjective judgments and diagnosis” with loud borderline disorder campaigns.

Maybe I’m too optimistic, but it

                 “removes artificial distinctions between medical and mental disorders”

seems like DSM-5 made a little step toward a more holistic view of problems it’s facing. However, plausible deniability is on the horizon. Now it looks like a preposterous semantic veil covering up some dirty mess where doctors cannot agree on what pedophilia is and how to diagnose/treat it, any meaningful discussion is impossible. Everyone for himself, Big Pharma is watching you, and “if we have media coverage on it, then it’s true,” and “new disorder — new drug.” Add in cultural relativity, social anxiety, and political agendas and you’ve got the whole picture of what it’s like when system optimization brings the system closer to a classic Malthusian trap. It seems that it’s the right moment to mention “negative entropy,” but hoping to save this text from #tedtalks attitude, i.e. complete failure, I’ll just stop here.

In other words, “divide et impera.” With “impera” only remotely meaning “cure.”

 VI.

OK, it’s time for super quick summary — nobody really knows what a sexual disorder is because there’s too much contradictory and subjective data, even big scientific institutions are completely devoid of coherent perspective on the issue. And, there’s no end to it. But somehow doctors still manage to treat their patients, which is great and interesting and lies totally beyond this article.