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The Psychological Letter
June, 1997
A
variety of organic (physical) and functional (psychological) sexual
disorders may arise following injury. The boundary between what is
physical and what is psychological becomes blurred. Importantly, both
factors are usually at work since a patient with physical problems
which compromise sexual performance is also made anxious by that
sexual dysfunction.
The
more common sexual disorders include:
-
Hypoactive
Sexual Desire Disorder,
-
Sexual
Aversion Disorder,
-
Female
Sexual Arousal Disorder,
-
Male
Erectile Disorder,
-
Female
Orgasmic Disorder.
-
Male
Orgasmic Disorder,
-
Premature
Ejaculation,
-
Dyspareunia
and Vaginismus
Sexual
problems commonly complicate the physical recovery process. The
patient, preoccupied with pain and fear, fails to respond to what
should be effective medical care. The patient also fails to tell those
involved in his/her care that sexual problems have arisen. An
unwillingness to discuss sexual dysfunction is almost universal, with
each individual fearing that they are unique in their problem. Men are
likely to acknowledge a problem indirectly, identifying their
relationship as unsatisfactory rather than revealing the more
frightening issue, for example, of erectile failure.
The
marital conflicts which subsequently arise due the combination of
sexual dysfunction and marital tension further complicate resolution
of the symptoms arising from injury. Clinical data suggest that women
are likely to report pain during intercourse as well as generally
diminished sexual interest arising after injury. While this change in
sexual capacity may not be alarming to the patient, her underlying
fears of abandonment or infidelity by a frustrated spouse can be
inordinately frightening.
Fear
of abandonment, importantly, is common among both men and women, and
impacts symptom magnification for many patients. Unable to maintain
the healthy interest of their spouse, physical symptoms may become the
"glue" that the patient uses to maintain the relationship.
The healthy mate learns to assume a caretaker role, for "How can
I leave him/her when they are in this much pain?" And indeed , it
is difficult for a mate to justify leaving an ill spouse, even if the
relationship was unstable prior to illness or injury.
Patients
may, consciously or unconsciously, utilize their physical symptoms to
mask sexual problems, and to concurrently insure that the mate remains
invested in their recovery. Injured individuals frequently gain weight
due to inactivity and increased food intake.
This
increased eating is not solely based upon the side effects of
medication or boredom; food can become an alternate form of
gratification in the absence of sexual activity. Obviously, obesity
can then, in turn, become a complication to the sexual relationship
due to potentially decreased physical appeal. Interestingly, patients
with a general dislike of sexual activity (hypoactive desire or
aversion), at least with their current partner, can effectively use an
injury to justify avoidance of sexual contact.
Sexual
dysfunction can amplify the patient’s perceptions of the severity of
their condition. Thus, while the physical condition may not be
disabling, the psychological impact of the associated sexual
dysfunction can erode the patient’s perceptions of functional
capacity. The sexual disorder, because of its importance, becomes the
single factor by which a patient measures the degree of their
disability or recovery. Men appear to have more difficulty
acknowledging that a sexual disorder has occurred, and more difficulty
accepting that there may be a psychological component to the disorder.
The
consequent delay in seeking care allows the symptoms to become
entrenched and resistant to change. When sexual dysfunction is
suspected, evaluation should occur without delay. Targeted and
appropriate care will shorten the recovery process, increase the
patient’s positive assessment of their recovery, and aid in the goal
of restoration of the pre-injury lifestyle.
DBA
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