Sexual+Aversion

Nathan Majors

**Sexual Aversion**
**Sexual Aversion Definition** Sexual aversion is a disorder characterized by disgust, fear, revulsion, or lack of desire in consensual relationships involving genital contact. It is normal to experience a loss of desire during menopause; directly after the birth of a child; before or during menstruation; during recovery from an illness or surgery; and during such major or stressful life changes such as the death of a loved one, job loss, retirement, or divorce. Sexual aversion represents a much stronger dislike of and active avoidance of sexual activity than the normal ups and downs in desire described above. It may be related to specific aspects of sexual intercourse, such as the sight of the partner’s genitals, or the smell of his or her body secretions, but it may include kissing, hugging, and petting as well as intercourse itself (Davidson, 2003). **Sexual Aversion** **Classifications** In some cases the person with sexual aversion disorder avoids any form of sexual contact; others, however, are not upset by kissing and caressing, and are able to proceed normally until genital contact occurs. There are several subclasssifications of sexual aversion disorder, the most common causes being interpersonal problems and traumatic experiences. In sexual aversion disorders stemming from interpersonal problems, underlying tension or discontent with the relationship is often the cause. Reasons for unhappiness with the relationship may include the discovery of marital infidelity; major disagreements over children, money, and family roles; domestic violence; lack of personal hygiene on the partner’s side; or similar problems. Traumatic experiences such as rape, incest, molestation, or other forms of sexual abuse can cause sexual aversion disorder as well, as the person then associates intercourse with a painful experience or memory, possibly one that he or she is trying to forget. Sexual aversion disorder may also be caused by religious or cultural teachings that associate sexual activity with excessive feelings of guilt (“Sexual Aversion”, 2011). **Sexual Aversion Diagnosis** Davidson (2003) expresses that according to the mental health professional’s //Diagnostic and Statistical Manual of Mental Disorders// of the American Psychiatric Association, to meet criteria for a diagnosis of sexual aversion disorder the patient must not only avoid nearly all genital contact with his or her partner, but have strong negative feelings about such contact or its possibility. In addition, the problem must be causing serious difficulties and unhappiness either for the patient or for his or her partner, and there must not be any underlying physical causes, such as certain disorders of the circulatory system, skin diseases, medication side effects, or similar problems that could cause a loss of desire. To be diagnosed with sexual aversion disorder, the affected person does not have to avoid all sexual contact, but must indicate that he or she is actively avoiding sexual contact. **Sexual Aversion Misdiagnosis** Sexual aversion disorder can be both over-diagnosed and under-diagnosed. It is over diagnosed in cases where the patient has other reasons that are interfering with sexuality, such as tiredness, fatigue, other causes of low libido, or other causes of sexual pain. Also possible is inadequate foreplay of poor sexual technique, which signifies that such a person does not have true aversion to sex. The disorder can be under-diagnosed in cases of sexual pain or other apparent psychological problems with sex. Physicians may assume a history of rape or childhood sexual abuse where none exists. When checking for a misdiagnosis of sexual aversion disorder or confirming a diagnosis of sexual aversion, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. These alternate diagnoses of sexual aversion disorder may need to be considered by a doctor as possible alternative diagnoses or candidates for misdiagnosis of sexual aversion disorder. (“Introduction: Sexual Aversion Disorder”, 2010). **Sexual Aversion History** Janata and Kingsberg (2005) state that T.L. Crenshaw was first credited as describing the sexual aversion syndrome. Her description, published in 1985, remains one of two comprehensive manuscripts describing this disorder, joined only by Kaplan’s 1987 book “Sexual Aversion, Sexual Phobia, and Panic Disorder”. Kaplan suggested that sexual aversion is best conceptualized as encompassing a dual diagnosis, sexual anxiety and panic disorder. Kaplan believed that one must treat the underlying panic disorder with medication before addressing the sexual aversion. Despite this early work, sexual aversion disorder is often overlooked in the spectrum of sexual disorders. Although it finally achieved diagnostic status as a sexual disorder in 1984, it is often ignored or pushed to a secondary status within the field of sex therapy. There are rarely any widely used sex therapy handbooks that devote a chapter solely to sexual aversion, and most include some explanation of aversion in the context of understanding hypoactive desire (biological or learned condition in which a patient is avoidant of sexual activity, but may be absent of fear or anxiety response to sexual behavior, which is critical for the aversion diagnosis), the impact of sexual abuse, vaginismus, and dyspareunia (pp.111-112). **Prevalence** Incidence and prevalence of sexual aversion disorder are not known, despite being considered widespread by several overviews. Significantly, more women than men meet the criteria for sexual aversion disorder. Gold and Gold (2003) describe the typical model for the development of aversion in women to be sexual abuse, while the model for men in their view is performance anxiety. Primary sexual aversion is the acquisition of fear, anxiety, or disgust before the development of healthy sexual interactions with a partner, or a lifelong anxiety, fear, or disgust to sexual stimuli. Secondary sexual aversion is the acquisition of fear, anxiety, or disgust after the development of healthy sexual interactions with a partner, or the acquirement of these feelings in response to sexual stimuli. The criteria for sexual aversion disorders overlap with symptoms of panic disorder and hypoactive sexual desire disorder, thus, even experts in treating sexual disorders remain somewhat unclear regarding how and when to diagnose sexual aversion (Janata and Kingsberg, 2005, pp.113-115). **Sexual Aversion Case** Many people struggle with sexual aversion disorder, and many may experience the same feelings as others who believe they have this disorder. For example, a person with sexual aversion may experience feelings similar to the following example, "Im a 24 year old female, and I believe I suffer from sexual aversion disorder. I find the thought of all genital contact quite repulsive, and on occasions in the past when guys tried to touch me below the waist I have become very panicky and upset. It’s not that I have no sexual desire I do…I feel this is really starting to have a negative effect on my life and the ironic thing is, all I really want is to get married and have kids…but I’m so put off by the idea of sex I don’t see how that will ever happen. There is no history of sexual abuse in my past. I haven’t been able to talk about anyone how I feel. I see a psychiatrist every 2 months or so, but have been too embarrassed to broach the subject with her. Is this something that is going to rule my life, or is it something I can get over?” (Counts, 2007). **Sexual Aversion Treatment**  Typical treatment of sexual aversion disorder would involve discovering and resolving underlying conflict or life difficulties. Medications can be used to treat some symptoms that may be associated with sexual aversion disorder, such as panic attacks, if they are severe enough to be causing personal distress. Hormone replacement therapy (including treatment of the underlying disorder), along with psychological treatment that tries to influence the thoughts and feelings about sexual contact are also used. An added treatment of sexual aversion disorder is to educate the patient on male and female anatomy, arousal, and response such as where the blood flows, hormone levels, and sexual composition. States of panic can be treated with tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or benzodiazepines (“Sexual Aversion Disorder”, 2011).

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