x.3.5.2 Future

As a result of the ageing population, emancipation and increasing prosperity, there is an increasing demand for care that promotes wellbeing, which certainly includes sexological care. Today, more than ever before, people are prepared to seek help in order to achieve ‘marital happiness’. Couples wish/have to stay together longer than ever before, even after the meno/penopause. This means that the demand for sexological care will only increase. In order to meet this need, knowledge of sexual anatomy and the physiology of sexual functions is essential. Until recently, knowledge of sexual function did not appear to have advanced since the ground-breaking work of Masters and Johnson in 1966. This has changed, in particular in recent years. Thanks to psychophysiological research, it has become increasingly clear that genital arousal in women is a poor predictor of the subjective sexual experience. Genital signals alone are therefore not sufficient to conclude that a woman is sexually aroused. Similarly, few or no sexual feelings in a situation do not necessarily point to a dysfunctional genital sexual response. The various sexual disorders are still entirely based on the linear phases in the response cycle as defined by Masters and Johnson. Today, we think more in terms of a circular model whereby sexual impairments in practice often involve dysfunctions in more than one phase. It would therefore seem to be time to review DSM-IV. This will probably be done in 2013.
Advances in neuro-imaging techniques have made it possible to search for answers to the question of whether certain psychological functions involved in sexual arousal originate in specific parts of the brain. This work is being undertaken with commitment and enthusiasm. Partly inspired by the success of male treatment, a veritable quest is under way to develop prosexual drugs for women, at the risk of reducing female dysfunction to a biochemical problem. Research into sexual function in illness and handicap shows that sexual capacity plays a subordinate role, and that sexual wellbeing is determined mainly by intra- and interpersonal factors. Finally, new diagnostic instruments such as the MRI enable us not only, for example, to produce images of coitus, but also to examine in detail the various phases of the sexual response and generate a quantitative record of these changes.