Psychogenic sexual dysfunctions (sexual neurosis)
Psychogenic sexual dysfunctions include functional psychogenic sexual disorders that have arisen with the direct participation of psychological mechanisms and manifest themselves in qualitative or quantitative disorders in the sexual functions of men and women not associated with organic pathology.
Psychogenic sexual dysfunctions are distinguished by:
1) the leading role in their development of psychotraumatic influences and other negative psychological factors; 2) no obvious connection with organic disorders or diseases; 3) the reversible nature of certain disorders of sexual function.
Psychogenic sexual dysfunctions are the result of a systemic interaction of a number of adverse factors that can lead to some kind of impaired sexual response or decreased libido in men and women. These include various situational factors, traumatic experiences, partnership problems and personal characteristics of the subject.
Situational factors: lack of conditions for complete privacy, the possibility of being caught off guard by the arrival of others (when spouses live with their parents, and then with their children, when trying to commit coitus in a train compartment, inside a car, in the lap of nature, etc.) ); fear of unwanted pregnancy; fear of contracting a venereal disease; the threat of publicity of sexual intercourse during extramarital contacts; poorly expressed desire for intimacy at the moment due to physical fatigue, mental overwork or previous stress; alcohol intoxication, etc.
Traumatic experiences; painful memories of previous sexual failures, including partner’s dissatisfaction with sexual intimacy; anxious fears of their own sexual inferiority and fear of being rejected if it is not possible to “duly” the partner properly; fear of losing an erection or premature ejaculation in men, or anxiety about the possibility of “remaining without an orgasm” in women.
Partnership problems: interpersonal relationships, frequent conflicts, increasing negative emotions, mutual distrust or chilling partners; inadequate behavior of a sexual partner who behaves aggressively, mockingly or demonstrates his coldness and unwillingness of intimacy; differences in sexual preferences and disharmonious sexual interaction between partners.
Personal features: disturbingly-suspicious traits of character; reduced self-esteem, a tendency to conscious self-control during sexual intercourse; unattainable in reality setting the maximum satisfaction from each sexual contact; erroneous beliefs regarding sexuality (due to improper upbringing or own negative experiences of intimate contacts); unconscious hostility to the opposite sex and guilt in connection with sexual pleasure, as well as a deep fear of intimacy and love relationships.
As a rule, several of the above reasons play a role in the development of functional-psychogenic disorders of the sphere in people of both sexes. For example, the most common form of neurotic disorders, leading to sexual dysfunctions, especially erectile dysfunction, is anxious waiting for sexual failure syndrome. This neurotic syndrome is formed in a man after one or more situationally unsuccessful attempts to have sexual intercourse. This is often promoted by suspiciousness, indecision, a tendency to all sorts of fears, as well as other personal characteristics that predispose to the emergence of alarming doubts in their abilities and fears again to be a fiasco. There are also partnership issues that in themselves increase both the probability of failure and its negative consequences. Often women in a mockingly ironic form express their negative attitude to the sexual difficulties of a partner. Therefore, it is not surprising that each subsequent affinity begins to cause a great anxiety in a man, which, due to the release of adrenaline into the bloodstream, which has a vasoconstrictive effect, prevents the genital blood flow from rising to the level necessary for a stable erection. If new breakdowns occur, they more and more fix the man’s attention on their potency, strengthening conscious control over the course of intimate contacts and aggravating the situation. Sexual intercourse loses its inherent sensuality and spontaneity, turning for a man into a kind of examination on the subject of sexual viability. This entails further failures, which only confirm the validity of the obsessive fears of sexual fiasco, closing the “vicious circle” and leading to the emergence of psychogenic erectile dysfunction. Sometimes there is such a strong fear of sexual intimacy that a man, without any coarse organic pathology of the sexual sphere, can avoid any intimate contact for a long time. The presence of the syndrome of anxious expectation of failure, or coitophobia, implies their obligatory neutralization by psychotherapeutic methods, since without this it is difficult to count on a steady recovery of the normal genital reactions of a man.
Neurotic mechanisms of anxious expectation of sexual failure can be found in women with anorgasmia, dyspareunia, sexual aversion, and vaginism. Here, the nature of failure varies (lack of orgasm, pain during intercourse, or others), but almost always there is an expectation from the proximity of negative consequences, sometimes so pronounced that it causes fear and attempts to avoid sexual intercourse by any means. With anorgasmia, for example, there is an increase in conscious control of coitus, which is often combined with attempts to arbitrarily speed up the approximation of the orgasmic discharge. In some cases, this may be due to alarming fears of completely losing control of oneself and looking ridiculous at the time of orgasm; in others, a sense of guilt and shame for the pleasure of sex is subconsciously present; thirdly – the fear of a possible pregnancy, etc. However, at the same time, there is a desire to have an orgasm, putting maximum effort into this. However, any conscious interventions only inhibit the involuntary orgasmic reflex, and over and over again confirming the worst predictions of a woman, lead to the formation of anxious expectation of the next disappointment from intimacy. In some cases, this may contribute to the sexual partner. Many men tend to view female orgasm as a personal victory and evidence of their sexual sophistication. Sometimes they start blaming their partner for not having an orgasm, which causes her to worry before starting a coitus and pushes for ineffective conscious manipulations that only postpone the onset of orgasm and increase anxiety and obsessive thoughts about his absence.
It should be noted that a variety of sexual disorders can have a neurotic nature. Psychogenic sexual dysfunctions include a significant proportion of cases of decreased sexual desire, anorgasmia, vaginism, erection disorders, premature ejaculation, aversion to coitus and lack of satisfaction from it, dyspareunia. Their treatment, as a rule, is of combined (complex) nature, and in the system of corrective measures the leading role belongs to the methods of psychotherapy. The F52 category of ICD-10 includes all sexual dysfunctions (dysfunctions) that are not caused by organic disorders or diseases, that is, predominantly psychogenic etiology.