x.3.2.4.2.1 In toto
The sexual respons in toto (15-35% women between 18-65y)
The first sexual dysfunction to describe is that of the system as a whole: a dysfunctional sexual response. Despite the brain’s interpretation of the stimuli as being sexual in nature, resulting in reflex genital congestion (except where there is a neurovascular genital restriction), there is no subjective feeling of arousal, pleasure or anticipation of reward, and neither is there conscious acknowledgement of the genital response, resulting in the lack of a strengthening genital stimulus. The control of explicit sexual behavior is reduced or absent, and there are few sexual thoughts or fantasies.
A total absence of sexual response hardly ever occurs. Nearly always there is at least one part of the system working. Some patients however may have several co-existing sexual dysfunctions. Arousal disorders are often associated with orgasm disorders, for example. Women with dyspareunia often have an arousal disorder, which may be either cause or effect.
Not everyone with symptoms of a sexual dysfunction will experience any concern or distress, and even those who do may not seek medical attention. Accordingly, there is a discrepancy between the number of patient presentations and the actual prevalence of sexual dysfunctions. The likelihood of a person seeking medical attention depends on factors such as:
- the importance that they or their partner attach to sexuality (or the importance that the partner is believed to attach to sexuality);
- social attitudes: whether the person believes that seeking help for sexual problems is morally acceptable;
- the availability of forms of therapy which the person considers acceptable.