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Sexuality, Sexual Dysfunction,
Rosemary Basson David A. Baram
Most young men and young women have multiple serial sexual partners but use condoms inconsistently, thereby exposing themselves to sexually transmitted diseases (STDs) and unintended pregnancies.
Sexual response reﬂects the fundamental interplay between the mind and body: psychological, interpersonal, cultural, environmental, and biological (hormonal, vascular, muscular, neurological) factors interact and modulate sexual experience.
Factors that can affect sexual response include mood, relationship duration and quality, age and stage in life, past sexual experiences—wanted, coercive, or abusive—personal psychological factors stemming from relationships in childhood with parental figures, previous losses and traumas, and ways of coping with emotions, current and past illness, and use of medication, alcohol, and illicit drugs.
Physical, emotional, and economic stressors of pregnancy may negatively affect emotional and sexual intimacy.
Sexual value systems, folklore, religious beliefs, physical changes, and medical restrictions inﬂuence sexual attitudes and behavior during pregnancy and postpartum.
Despite the importance of issues relating to sexuality, many women find it difficult to talk to their physicians about sexual concerns, and many physicians are uncomfortable discussing sexual issues with their patients.
Asking about sexual concerns gives physicians an opportunity to educate patients about the risk of STDs, encourage safer sex practices, evaluate the need for contraception, dispel sexual misconceptions, and identify sexual dysfunction.
Many of the sexual problems couples encounter result from a deficit of knowledge or experience, sexual misconceptions, or inability of the couple to communicate about their sexual preferences.
Sexual problems are common. Vaginismus is an involuntary reﬂex precipitated by real or imagined attempts at vaginal entry. Dyspareunia may affect two-thirds of women during their lifetime. Vestibulodynia, the most common type of dyspareunia, has a prevalence of 15%.
Sexual assault of children and adult women has reached epidemic proportions in the United States and is the fastest growing, most frequently committed, and most underreported crime. The terms sexual abuse survivor and assault survivor are preferable to victim.
Childhood sexual abuse has a profound and potentially lifelong effect on the survivor. Although most cases of childhood sexual abuse are not reported by the survivor or her family, it is estimated that as many as one-third of adult women were sexually abused as children.