Dr. Wendy After Dark

Dr. Wendy After Dark

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Are Sexual Disorders Always Pathological?

Legs of couple lying under white duvet relaxing in bed

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Dr. Peggy Kleinplatz, a professor in the faculty of medicine at the University of Ottawa.

Kleinplatz, trained as a clinical psychologist and sex therapist, has spent many years untangling the many reasons for sexual dissatisfaction. In 2018, she authored a review of the history of the treatment of female dysfunctions in the Annual Review of Clinical Psychology, examining the controversial ways in which women’s sexuality, in particular, has been viewed and treated over the decades and what might be the best way forward. She is the director of the Optimal Sexual Experiences research team at the University of Ottawa; in 2020, she coauthored the book Magnificent Sex: Lessons from Extraordinary Lovers, inspired by findings from her long-term study of couples.

-Is high Sex Drive a disorder? 1950’s, American Psychiatric Association listed problems of having too much desire. In women, this was called nymphomania; for men is satyriasis. The diagnosis of nymphomania in a woman was fairly serious. A possible treatment for it in the 1950s was electroconvulsive therapy or a frontal lobotomy. Men who had lots and lots of sex, and lots and lots of sexual desire, were generally not given a diagnosis and instead perceived as normal.

- Then the sexual revolution of the 1960’s and 70’s. The birth control pill. - 1980’s And all of a sudden, the idea that “too much” was pathological disappeared. In 1980, the DSM-III got rid of the diagnosis of too much desire and replaced them with the diagnosis of too little desire.

- There was a gender bias. In 1987, they called it “hypoactive sexual desire disorder” for both men and women when low desire causes distress. - 2013: They decided to have erectile dysfunction and hypoactive sexual desire disorder, separate for men. But for women, they said to collapse them to “female sexual interest/arousal disorder.” Still strange. One is psychological. One is physiological.

- Why is there no medical treatment for female sexual desire? Our sexuality is bio, psycho, social. - Why were these lumped together in women? Desire, means the frequency of wanting sex or having sexual fantasies; arousal, means the physiological and psychological response to sexual stimuli.

- “Low-sex desire might simply be good judgment. “It’s rational to have a low desire for undesirable sex.” - Dr. Peggy Kleinplatz

- I think it’s the obligation of clinicians to tease things apart. If you were to walk into your physician’s office and say, “I have a stomachache,” it’s the physician’s job to figure out if you ate something that gave you food poisoning or if you’ve got an ulcer or if you’ve got some kind of cancer in your abdomen, right? So I think that when it comes to sexual problems, it’s equally important for the onus to be on the clinician to tease out whether it’s a problem related to arousal or desire, regardless of whether your patient is male, female, trans, non-binary, etcetera.

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