Psychiatry and Sexuality

What is Sexuality?

Sexuality is a term which the public mainly associates with sex. However, sexuality is a term that covers the sexual organs, gender and reproduction and also sexual orientation, attitude, behavior, public values, desire and pleasure. This means that whilst sexuality provides the human with certain biological properties it also has an effect on the person’s behavior, emotions, relationships and choices.

Whist sexuality is a term inherent in all humans, the experience and expression of it can vary from person to person. For this reason there are different orientations and different sexual behaviors. Sex is a process that has particular phases. During this process which is also called the sexual response cycle and consists of 4 phases, physical and emotional changes occur in the person. The cycle starts with sexual excitement, masturbation, sexual intercourse or any other sexually stimulating activity and shows a similar progress in women as in men:

Excitement (arousal) phase: The first stage of the sexual response cycle is excitement. During this phase which can vary between a few minutes to a few hours, men and women experience some physical changes, and arousal starts. In both genders there is an increase in heart rate, breathing rate and a rise in blood pressure. There may be skin flushing, the nipples of the breast harden and blood pressure rises. In women the vagina widens and a lubricating liquid is discharged whilst in men the penis becomes erect.

Plateau phase: In this phase the initial physical changes continue at an increased level. Both gender experience muscle tension in feet, hands and face. Breathing rate, heart rate and blood pressure increases. In women the vaginal discharge increases and the vagina becomes more sensitized. In men, with the increase in blood flow the penis becomes fully erect and the testicles become drawn upward towards the scrotum.

Orgasmic phase: Amongst the 4 phases this is the shortest phase with the highest pleasure level. During this phase blood pressure, heart beat and breathing rate are at their highest level. Involuntary muscle movements start. A sudden and strong sexual tension triggers ejaculation. In women the vagina contracts and there are rhythmic contractions in the uterus. In men the semen is discharged during these rhythmic contractions.

Resolution phase: This is the phase during which the body slowly starts returning to its former normal state. Sexual organs start returning to their normal state, blood flow, blood pressure and breathing rate return to their original rhythms. The body relaxes and a feeling of well-being sets in.

To understand what happens in each phase of the sexual response cycle will help you to understand at which point sexual problems that may be experienced, arise:

In persons with sexual interest/arousal disorder there is lack of interest in sexual activities, in other words there is a reduced libido, with reduced vaginal discharge in women and insufficient or discontinued erection in men. In these persons the physical changes associated with excitement which is the first phase of the sexual response cycle, do not occur as expected.

Men with delayed ejaculation disorder experience a marked delay, infrequency or absence of ejaculation. In men with premature ejaculation disorder involuntary ejaculation occurs approximately 1 minute after entering the vagina. In women with orgasmic dysfunction there is a marked delay, infrequency or absence of orgasm. In all these disorders the orgasm phase does not occur the way it is expected. Furthermore, in premature ejaculation disorder the plateau phase is very short-lived and the person is unable to control the time during which he remains in this phase.

Persons with sexual pain disorder (dyspareunia and vaginismus) experience marked pain in the vulvovagina or pelvis during intercourse, or they have developed a fear of painful intercourse. The pain may have various different reasons but can also be caused by insufficient vaginal widening and insufficient lubricating discharge during the excitement phase.

Up to now we have given brief information on sexuality and sexual disorders. For a healthy sexual life it is important that persons equip themselves with correct information on these matters. When problems are experienced the help of a doctor or psychologist should be sought. However, it should not be expected that every doctor, psychiatrist or psychologist will apply sexual therapy or treatment. This subject requires expertise. However, by providing the patient with certain basic information the patient’s anxiety about performance or sexual disinterest problems can be resolved.