By Dr Tomislav Meštrović, MD, PhD
The medicalization of sexuality has displaced older beliefs in the noxious influence of guilt, sin, bad habits or evil spells to sexual function in both men and women, but such perspectives still linger to this day. Biomedical reasoning is in fact just one layer that is added to the pile of arguments used to explain sexual dysfunction and dissatisfaction.
Sexual dysfunction in men
In present day societies, it is of utter most importance to maintain an acceptable level of male sexual function. Although a group of sexual dysfunction in men encompasses ejaculation disorders and low libido, erectile dysfunction (defined as the inability to keep an erection) was definitely the biggest problem throughout history until modern times.
In Greek and Roman understanding of sexuality, penetration was a proof of manhood and a prerequisite for a good reputation. Thus, at the same time doctors of the affected provided recipes for restorative agents, while bawdy authors wrote comic stories of men who failed the crucial test.
During the 18th century, philosophes embraced the notion of men and woman inhabiting distinct sexual spheres while attempting to counter, cure and explain male sexual dysfunction. On the other hand, the nineteenth-century culture that insisted on privacy found discussion of such problems distasteful, although this important issue could not be ignored.
Throughout that period, the authors of marriage manuals for middle class popularized the theory of “spermatic economy” in which excesses led to a loss of manly vigor and stamina, which can ultimately result in impotence. The dangers of masturbation, prostitution, spermatorrhea and sexually-transmitted diseases were also highlighted.
There was a shift from moral to psychological explanations of male sexual dysfunction in the early 20th century. The rise of the field of endocrinology in 1920s legitimized the scientific study of the reproductive system in men, and after the World War II impotence was declared a problem for both men and women.
Many historians claim that Viagra (sildenafil) has completely trumped psychoanalysis, sex therapy and even surgery. It was the first oral treatment for erectile dysfunction which was developed at Pfizer Laboratories practically by accident, and approved by the Food and Drug Administration in 1998. The question still remains did the new impotence pills that followed truly revolutionized sexuality.
Sexual dysfunction in women
Although the term “female sexual dysfunction” was a fairly recent introduction to the medical literature, the recognition of this type of problem reaches further back. Even in the 16th century the diagnosis of nymphomania was not uncommon, and significant increase in the number of women with this condition has been observed in the Victorian era.
The intertwined development of sexology and psychiatry at the end of 19th century led to the rise of new theories of sexual dysfunction. Based on Freud’s pronouncements, certain sexual dysfunctions (such as the failure of achieving vaginal orgasm) were regarded as foundations of “frigidity” (most notably in the works of Hitschmann and Bergler).
Marital advice literature that accentuated the significance of sexual pleasure in marriage proliferated in the UK and the United States in the early years of 20th century. Sexual dysfunction in women was seen as technical issue that was a part of a wider social phenomenon, and that has to be resolved by education considering the profound emotional, physical and spiritual differences between women and men.
First edition of the Diagnostic and Statistical Manual of Mental Disorders’ (DSM) in 1952 classified problems such as frigidity to a separate category of “Psychophysiological autonomic and visceral disorders”. Second edition published in 1968 was similar, though it added dyspareunia to the list.
Significant changes were seen only in the third edition of DSM issued in 1980, where a shift from psychoanalytic to biological psychiatry can be observed. In place of separate categories for psychophysiological genitourinary disorders and sexual deviations, an umbrella chapter on psychosexual disorders had been introduced.
On the whole, female sexual dysfunction has been considered a generic or descriptive term (rather than diagnostic) throughout history. Still, treatment was sought as if it was a true monocausal condition, despite the fact that it was constituted of different diagnostic categories. The social aspects of sexuality and the potential for resolving sexual dysfunction have been extensively covered in medical literature of the 20th and 21th century.
- McLaren A. Impotence: A Cultural History. The University of Chicago Press, 2007; xi, pp. 1-25.
- de la Cruz BJ, Hacker J, Kandeel FR. A History of the Penis: Images, Worship, and Practices. In: Kandeel FR, editor. Male Sexual Dysfunction: Pathophysiology and Treatment. Taylor & Francis Group, LLC, 2007; pp. 3-10.
Last Updated: Nov 23, 2015