Swipe om te navigeren naar een ander hoofdstuk
For most people sexuality is an essential aspect of quality of life. Sexuality is a bio-psycho-social phenomenon. All medical, psychological, social and relational events throughout the lifespan may impact sexual functioning and sexual wellbeing. As a result, sexual concerns and sexual dysfunctions are prevalent and often distressing. Usually, patients only present these problems when a health professional proactively enquires about the presence of any sexual difficulties.
According to incentive motivation theories, sexual desire should no longer be regarded as a spontaneous biological drive or ‘libido’ that precedes sexual arousal and that one has or does not have. Rather, desire for sexual activity is the result of competent sexual stimuli that activate the sexual response system, and mediated by the expectation that sex will be rewarding. Biological factors -neurotransmitters and hormones- do not ‘produce’ sexual desire but do determine the sensitivity of the sexual system for sexual stimuli. Based on these changed views, the distinction between arousal and desire has been abandoned in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new diagnosis ‘female sexual interest/arousal disorder’ should not be made if the sexual difficulties are the result of inadequate sexual stimulation. If a sexual problem is situational, a biomedical cause is most unlikely. Dyspareunia, vulvodynia, and vaginismus are common sexual pain problems in women. Because differentiation between these problems is difficult, in DSM-5 these disorders are merged under the heading of ‘genito-pelvic pain/penetration disorder’. In sexual pain problems, penetration without sufficient lubrication and swelling of the clitoral complex, and insufficient relaxation of the pelvic floor are prevalent precipitating and maintaining factors. In primary dyspareunia, generalized pelvic floor overactivity is related to physical or psychological stressors that were present before sexual debut. In secondary dyspareunia and vulvodynia, pelvic floor overactivity is the consequence of repetitive painful experiences.
Whatever the initial precipitating factor(s) of a sexual dysfunction may be, there are always secondary psychological, relational and contextual maintaining factors that should be explored in the diagnostic and therapeutic process. Treatment of sexual disorders is, by definition, multidimensional, taking into account all possible predisposing, precipitating, maintaining and contextual factors. Therapy may include psycho-education, basic counselling, individual and couple psychosexual behavioural therapy, and hormonal and pharmacological treatment.
Log in om toegang te krijgen
Met onderstaand(e) abonnement(en) heeft u direct toegang:
A central aspect of being human throughout life. Sexuality encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors
A state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (WHO 2002)
Consists of all sexual feelings and all sexual behaviour that is experienced as egosyntonic and satisfying and that is not harmful to others
Cultural competence in health care
The ability to provide care to patients with diverse values, beliefs and behaviours in such a way that care is tailored to meet the patient’s individual social, cultural, and linguistic needs
The personal conception of oneself as male or female (or both or neither)
The classification of people as male or female, typically assigned at birth, based on visual external genital anatomy
The sensitivity, receptivity of the sexual system for sexual stimuli. Sexual arousability is mediated by neurotransmitters such as dopamine and by hormones – with testosterone being the most important. These mediators are not the source of sexual desire or arousal but only determine how responsive the sexual system is to sexual stimuli both on a central and a peripheral level
Involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria are unhappy with the gender to which they were assigned, described as being bothered with characteristics of their body (particularly physical changes during puberty) or by the expected roles of the assigned gender
Are unusual sexual interests for atypical objects, situations, fantasies, behaviours, or individuals. DSM-5 no longer categorizes paraphilia as a disorder. The diagnosis ‘paraphilic disorder’ is only made when the atypical sexual interest causes significant distress or results in behaviour that is harmful or in which nonconsenting adults are involved
(or localized provoked vestibulodynia) Characterized by sharp, burning sensations when specific sites in the vulvar vestibule are touched, such as through vaginal penetration, inserting a tampon, wearing tight clothes or bike riding
Sensate focus therapy
A set of specific exercises for couples or for individuals aimed at increasing personal and interpersonal awareness of own and the other’s needs. Each participant is encouraged to focus on one’s own sensual experiences, rather than to see arousal, penetration or orgasm as a goal that should be reached
American Psychiatric Association. DSM-5: Diagnostic and Statistical Manual for Mental Disorders. 5th ed. USA: American Psychiatric Press; 2013. CrossRef
Beckman N, Waern M, Östling S, Sundh V, Skoog I. Determinants of sexual activity in four birth cohorts of 70-year-old Swedish examined 1971–2001. J Sex Med. 2014;11:401–10. CrossRef
Ingham R. ‘We didn’t cover that at school’: Education against pleasure or education for pleasure? Sex Education 2005;5:377–90. CrossRef
Lunsen RHW van, Laan ETM, Brauer M. Sex, pleasure and dyspareunia in liberal Northern Europe. In: Hall K, Graham C, editors. The cultural context of sexual pleasure and problems: Psychotherapy with diverse clients. New York: Routledge; 2012. pp. 356–70.
Meston CM, Buss DM. Why humans have sex. Arch Sex Behav. 2007;36:477–507. CrossRef
Money J. Love and Love Sickness: The Science of Sex, Gender Difference and Pair-bonding. Baltimore, London: John Hopkins University Press; 1980.
Moorst BR van, Lunsen RHW van, Dijken DKE van, Salvatore CM. Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction. Eur J Contracept Reprod Health Care 2012;17:93–105. CrossRef
Postma R, Bicanic I, Vaart H van der, Laan E. Pelvic floor muscle problems mediate sexual problems in young adult rape victims. J Sex Med. 2013;10:1978–87. CrossRef
Rutgers. Sex under the age of 25. Rutgers 2012 retrieved on 06-06-2017 from https://www.rutgers.nl/sites/rutgersnl/files/PDFOnderzoek/Factsheet_Seksonderje25ste_ENG.pdf.
Yang ML, Fullwood E, Goldstein J, Mink JW. Masturbation in infancy and early childhood presenting as a movement disorder: 12 Cases and a Review of the Literature. Pediatrics 2005;116:1427–32. CrossRef
- Sexual health
Dr Rik H. W. van Lunsen
Ellen T. M. Laan
- Bohn Stafleu van Loghum