The Effect of Psychological Conditions on Sexuality: A Review

There is a wide variety of medical pathologies and psychological disturbances that interfere with sexual functioning and enjoyment. It is known that the majority of sexual problems are not caused by medical conditions, and those will be reviewed in this article Bancroft [1].

Depression, a leading problem globally is frequently associated with sexual dysfunction in both genders [2]. Sexual dysfunction, meaning loss of sexual desire, loss of sexual enjoyment, sexual aversion, failure of genital response (erectile dysfunction in men and vaginal dryness or failure of lubrication in women), orgasmic dysfunction, premature ejaculation, vaginismus in women, and dyspareunia or pain during sexual intercourse Atlantis & Sullivan, 2012. Epidemiological studies found that the 12-month prevalence of at least one sexual dysfunction is between 30% and 70% in sexually active men and women in high-income countries [3,4]. People’s depression affects their ability to work and function socially, and interestingly, antidepressants are known to adversely affect sexual function, which may then enhance the very depression that they are attempting to address Serretti [5].

Beck [6], in his research on depression, found that loss of sexual interest was reported by 61% of those experiencing severe depression, compared to 21% of non-depressed [7]. Similarly, Cassidy et al. [8] compared sexual activity of depressed people to that of medically sick non-depressed patients. He found that 63% of depressed patients complained of decreased sexual activity compared to 39% of the non-depressed participants. Reduced libido affected 83% of depressed males, and 53% of depressed females. Woodruff, Murphy et al. [9] found that 23% of men with primary affective disorder reported ED Bancroft, 2009. A research that looked at men and women whose primary problem was low sexual desire who were not depressed at time of assessment. The low sexual desire group had a significantly higher incidence of depressive illness in the past. It was found that the initial episode of depressive disorder coincided with or preceded the onset of loss sexual desire [10].

In the Zurich Cohort Study of men and women in the ages 20 to 35 Angst, 1998 an association between depression, meaning major depressive illness, dysthymia and recurrent brief episodes of depression, and loss of sexual interest was found in both genders, though it was more marked in women. Angst 1998 further reported that in that study, the loss of sexual interest was negatively correlated with generalized anxiety disorder. Figueira, Possidente, Marques, and Hayes 2001 found that people suffering form panic disorder were more likely to encounter sexual problems, particularly sexual aversion, whereas premature ejaculation was the most common sexual problem in men with social phobias. Given the emphasis on performance anxiety of men and women, it is apparent that anxiety disorders will affect sexual performance, pleasure and satisfaction Norton & Jehu 1984. Interesting to note that the association between negative mood and sexuality is not always in the same direction.

Mathew [7] reported that of a group of depressives, while 31% have lost sexual interest, 22% reported increased sexual interest! In Angst 1998 study, 26% of depressed men reported decreased sexual interest while 23% said that their sexual interest increased. Those perplexing results were less evident in women, where only 9% of them reported increased sexual interest, while 35% reported that their sexual interest significantly decreased. An association between depression and sexual appetite is not surprising. And while there is a minority of men and women whose sexual interest increases when they are depressed, most people are interested in sex when they feel good, relaxed, and content [11].

Given the seriousness and the significant influence that this mental illness has, it is surprising that very limited research on its affect on sexuality was carried out [1]. In earlier studies, Schizophrenics showed less decrease in sexual interest than other psychiatric patients Gittleson & Levine 1966. Gittleson & Dawson-Butterworth, 1967. Friedman and Harrison 1984 found that sexual dysfunction was more common, both pre and post the psychotic breakdown, in the women that they studied. Of these women, 60% have never had an orgasm. Psychotic hallucinations of men commonly involve sexual content. Schizophrenics reported that 30% of their hallucinations involved genital change, and 20% involved sex change [1]. In Schizophrenic women the results were very similar Gittleson & Dawson-Butterworth 1967. The continuation of sexual interest in the presence of bizarre sexual ideas, may account for the psychotic sexual behavior or sexual attacks that Schizophrenics are occasionally involved in. Most Schizophrenics do not have sexual relations, but those who do, engage in unprotected sex and thus are at high risk to contract sexually transmitted diseases [1]. Consequently, they may face partner rejection, social isolation, and loneliness.

Counseling can be very helpful to those who suffer from sexual dysfunctions and which the basis for them is not medical. It is now 50 years that issues such as erectile dysfunction, premature ejaculation, orgasmic disfunction, or dyspareunia have been treated utilizing psychological techniques geared to address the underlying causes for those dysfunctions, and to enlist the sexual partner to assist and empower the struggling one.

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