Use & Meaning

Problems with regard to the use or meaning of sex, including relevance and importance of sexuality, are not often part of medical practice. If someone does not consider sex to be important, he or she will not regard sexual dysfunction as problematic. It is then only necessary to address any concerns that the partner may have. Some people regard sexuality as irrelevant, and this ‘indifference’ creates a problem within the partner relationship. We then see the ‘be spontaneous’ paradox: one partner believes that they must engage in sex solely for the benefit of the other. This is not so much a sexual problem as a relationship problem. In the epidemiological sense it is a difficult situation; on the one hand, relationship problems do not fall under the heading of sexual problems (to be addressed by medical practitioners), while at the same time sexual problems can often be the manifestation of underlying relationship problems. If the relationship itself is poor, will efforts to restore satisfactory sexual relationships improve matters, or will they have the opposite effect? Although not included in the statistics, it seems likely that the vast majority of requests for sex therapeutic assistance relate not to a lack of opportunity or capacity, but rather to ways of putting such opportunity into practice.
We use the all-embracing term ‘sexual problems’ which refers primarily to the evaluative aspect of sexual functioning. There is a ‘problem’ if there is too great a discrepancy between the person’s expectations and his or her actual perception of sexual activity. In the more general sense, we also apply terms such as ‘sexual satisfaction’ (Fig. 39.4) and ‘the quality of sexual life’. As noted above, relatively few sexual problems are due to any physical cause or lack of capacity. A number of books and self-help guides written for the general public are available, to which patients whose problems do not have a medical cause can usefully be referred. (Van de Wiel, 2002)