chapter  20
42 Pages

Sexual Dysfunction From a Relationship Perspective

BySylvie Aubin, Julia R. Heiman

Fundamental to the study of sexuality and its problems is the analysis of two individuals interacting in a very specific context. Sexual dysfunctions are primarily studied from a clinical management perspective. Currently, the assessment and treatment of individuals with sexual dysfunctions are based on a normative five-phase sexual response model of sexual functioning. Problems in sexual functioning are categorized using the phases and defined by physiological and/or psychological symptoms serving as criteria for clinical diagnosis. Relationship components are conceptualized as consequences and listed among the other symptom criteria to meet diagnosis. One shortcoming of the functional, symptom criteria model includes the emphasis on individual versus relationship symptoms and as a result, the paucity of research and theoretical models to explain sexual dysfunctions from the perspective of the couple. Assessment of sexual problems within the couple requires knowledge in the area of human sexual interactions. One must thus be familiar with the process of assessing sexual dysfunctions from an integrative approach, with the various diagnostic tools andmethods, andwith sexual relationship patterns.We offer a three-dimensional system comprised of interacting personal or relationship variables influencing the onset and course of sexual dysfunctions. Variables may predispose, precipitate, or maintain sexual problems and are best understood from a developmental perspective, emphasizing the importance of situating the onset and impact of sexual problems within partners’ histories as individuals and as a couple. Among the influential relationship variables, the dimension of disparity between partners is a systemic construct that is central to most theoretical explanations of sexual dysfunctions and a relevant clinical management issue. Couples with sexual problems may thus present with significant differences between partners as to their recognition and tolerance of sexual symptoms aswell as their cognitive, emotional, and/or sexual relationships. Sexual dysfunctions may, but do not always, significantly impact couples’ quality of life. Consequences are generally observed on both sexual and nonsexual interactions and are associated with diminished frequency and quality of partner-related sexual activities and often

limited couple closeness. Couple closeness, defined in part as nonsexual intimacy is characterized by diminished frequency and quality of affectionate, loving behaviors and bydecreased communication and/ormutual supportive listening abilities. Fortunately, partners’ coping skills and resources serve as importantmediating variables in limiting the consequences of sexual dysfunctions on couple and sexual relationships. The effectiveness of partners’ reactive coping skills may positively alter the course of their sexual difficulties and contribute to the survival of both couple and sexual relationships.