Why It Matters: Sexual Deviations and Dysfunctions

Why learn about sexual deviations and dysfunctions?

A sign at a trans rights rally: "Gender is like that old jumper from my cousin: It was given to me and it doesn't fit."

Sexual deviations and dysfunctions describe differences in gender, sex, and sexual behavior or preferences. In this module, we will learn about sex, gender dysphoria, sexual dysfunctions (which relate to concerns with sexual performance), and sexual deviations (mostly concerned with “abnormal” sexual desires and paraphilias).

Sexologists such as Henry Havelock Ellis and Alfred Kinsey began conducting research in the area of human sexuality during the first half of the 20th century. This work was groundbreaking and controversial in the scientific arena, but it paved the way for research on sex and sexual behavior. In the 1950s, sex therapy was concerned with “controlling sexual expression” and repressing what was then-considered deviant behaviors, such as homosexuality or having sex too often. Now, of course, the DSM-5 does not consider homosexuality a disorder, and we understand the dangers of conversion therapy.

William Masters and Virginia Johnson are credited with revolutionizing sex therapy in the mid-century and began treating sexual dysfunction by using couple therapy and behavioral interventions that focused on being present in the moment, such as sensate focus exercises. Through the following decades, sex therapy became increasingly common and taboos surrounding sex research decreased.

Despite more acceptance surrounding the discussion of sex and sexuality, sexual dysfunction disorders are not commonly discussed and often go undiagnosed. It is suggested that about 43% of women and 31% of men experience some type of sexual dysfunction, including sexual desire disorders, sexual arousal disorders, orgasm disorder, sexual pain disorders, or other sexual disorders.[1]

Sexual behavior and functioning, considered a biological drive, is influenced by a myriad of things, including psychosocial factors such as personal and family experiences, societal and religious influences, personal beliefs and expectations, etc. For this reason, sexual disorders are psychological in nature and described in the DSM-5, as they may have a somatic or psychogenic cause. A clear example is erectile dysfunction, whose causes may include circulatory problems and performance anxiety. Sex therapy often integrates psychotherapeutic techniques and medical ones, such as Viagra (sildenafil) to increase erectile response and Paxil (paroxetine) to treat premature ejaculation. Sex therapists assist those experiencing problems in overcoming their problems, and in so doing, possibly regain an active sex life. The transformative approach to sex therapy aims to understand the psychological, biological, pharmacological, relational, and contextual aspects of sexual problems.

  1. Avasthi, A., Grover, S., & Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91–S115. https://doi.org/10.4103/0019-5545.196977