Saturday, June 30, 2012

Sexual Dysfunction and Relationships

erectile dysfunction relationship cycle
The Erectile Dysfunction-Relationship Cycle

Erectile and sexual dysfunction in an ongoing relationship usually reflects difficulties between the partners. Relationship problems interfere with sexual feelings and cause or worsen erectile dysfunction.  Any experience that hinders the ability to be intimate, that leads to a feeling of inadequacy or distrust, or that develops a sense of being unloving or unlovable may result in erectile dysfunction.  Successive episodes of impotence are reinforcing. The man becomes increasingly anxious about his next sexual encounter. Erectile dysfunction is worsened by anticipatory anxiety about achieving and maintaining an erection interferes.  Sexual dysfunction interferes with pleasure in sexual contact and reduces ability to respond to sexual stimulation.

Erectile Dysfunction in the relationship cycle

In the early years of the relationship

  • Lack of knowledge - there is a refractory period after sex before you can get the next orgasm. This refractory period increases gradually from a few minutes in teenagers to many days  in the elderly. Misguided enthusiasm after a period of separation causes a one-off problem with erection. This  is transient erectile problem is further reinforced by succeeding anxiety.
  • Lack of privacy - the young couple moves into the parental home and has minimal access to privacy. Sex is a hurried activity with the focus on orgasm. Intimacy is not fostered. Subsequently there is dissatisfaction and a further build-up of anxiety.
  • Stressors - careers with long working hours, night shift work and work from home leaves little time for the emotional intimacy that is requisite for sexual intimacy.

Middle phase

  • Lifestyle changes - a sedentary  life style coupled with an indiscriminate diet result in obesity, a leading risk factor for erectile dysfunction. Excessive alcohol intake, and smoking have a direct impact on sexual functioning.
  • Infidelity - is a major cause of anxiety and erectile dysfunction in the middle phase of the relationship. This  is especially so when the infidelity arises from insecurity - the man or woman attempting to prove continued youthfulness and desirability outside the relationship.

Later years

  • Medical issues - chronic illnesses such as diabetes, and heart disease are commonly associated with erectile dysfunction.

What to do

  • Don't panic - anxiety worsens erectile dysfunction. An occasional problem with  erection is not a reflection on your masculinity, and does not necessarily indicate a long term erectile dysfunction. Don't immediately try  to 'prove' yourself. Give it a days break to be safely out of the refractory period. There  will be  no trouble in the  next sexual encounter.
  • Communicate - reassure your  partner of your continuing sexual interest in her. Communicate openly about  your condition. Involving your  partner improves the outcome of treatments for erectile dysfunction.
  • Quit smoking
  • Lose weight, exercise regularly
  • Get treatment for alcohol or drug problems
  • Work through relationship issues. Consider counseling if unable to work through  problems on your own.
  • Depression, anxiety and stress related mental health issues should be addressed. Don't ignore them.

Whom to see for sexual dysfunction

  • Consult a qualified psychiatrist. He or she  is the only person with the knowledge, training, and experience to deal with the psychological and medical issues that result in sexual dysfunction. The psychiatrist will also address issues in the relationship that are perpetuating the erectile dysfunction.
  • Avoid self-styled sex therapists and sexologists

  1. Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res. 2003 Feb;15(1):63-71.
  2. McCabe M, Althof SE, Assalian P, Chevret-Measson M, Leiblum SR, Simonelli C, Wylie K. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2010 Jan;7(1 Pt 2):327-36.
  3. Metz ME, Epstein N. Assessing the role of relationship conflict in sexual dysfunction. J Sex Marital Ther. 2002 Mar-Apr;28(2):139-64.
  4. Nina Bingham. Research Findings on Sexual Dysfunction, Intimacy and Conflict in Heterosexual Couples. Accessed 30-Jun-2012

Monday, March 21, 2011

Cross-Dressing - Prevention by Parenting?

cross-dressing symbol
Cross-dressing is associated with problems in parenting and may be preventable. Recently a male student in Pune was found dead with a wig and female articles of clothing lying about his room.

Types of cross-dressing

Cross-dressers in society are psychologically indistinguishable from non-cross-dressing men (Brown 1996).
  1. Fetishistic transvestism
  2. Almost three percent of men and 0.4% of women have had at least one episode of transvestic fetishism (sexual arousal from cross-dressing) (langstrom 2005). However, these 'nuclear' transvestites are less likely to venture out dressed in public.
  3. Transvestism
  4. 'Marginal’ transvestites experience non-sexual pleasure from cross-dressing and are more likely to appear in public while cross-dressed. They are probably a separate group and more likely to be homosexual.
  5. Transsexualism
  6. Cross-dressers could also be transsexuals who desire surgical sex reassignment. Cross-dressing in Asians is one of the earliest signs of transexualism (Tsoi 1990).

The cross-dresser's childhood

(RL Schott 1995)
Cross-dressers are usually the eldest male child in their family. Most had a very positive relationship with their mothers and a very negative relationship with their fathers.
As children cross-dressing was furtive and secret - the covert group of cross-dressers. In the overt group (up to 20%), cross-dressing was initiated and openly encouraged - up to school age and sometimes beyond - by a mother, sister, or other female extended family member.
Young boys, in contrast to young girls, must struggle to separate psychologically from their mother in order to establish their own gender identity. Identification as a male, as being of the opposite sex from the mother, requires individuation and separation from her. Disturbances in masculinity (cross-dressing) may be an expression of impairments in this process. The eldest male child may be especially vulnerable for lack of a role model or cushion between himself and the mother.

Cross-dressing facts

(Docter 1997)
  • Usually starts before the age of 10 years.
  • Initially associated with sexual pleasure and orgasm. However, up to 90% of cross-dressers continue to do so for non-orgasmic pleasure.
  • The most commonly used articles are female underclothing and wigs.
  • Considered as an expression of the feminine part of the self, rather than as just the self with different clothes. Cross-dressing is an expression of consciously felt femininity (Levine 1993). Hence the symbol.
  • Cross-dressers prefer complete to partial cross-dressing.
  • Cross-dressers are not bold in their public appearances. About a quarter appear cross-dressed in public and a similar number have ever used the lady's restrooms - the final frontier of femininity. With increasing awareness and activism public appearances by this group of people are increasing.
  • Transvestism in adulthood is associated with guilt. Most cross-dressers get rid of their feminine clothing at some time due to feelings of shame.
  • Most wives are aware of their partners cross-dressing. Up to a quarter of them are completely accepting of the behaviour.

When is cross-dressing normal in children?

    Cross-dressing boys are first brought for psychiatric evaluation by their parents when they are discovered in their mother's underclothes. The sexual outcome of early isolated cross-dressing is not predictable.
  • It is not uncommon for boys to prefer aesthetic activities like dance or singing to football or wrestling. 
  • They occasionally role-play as a girl, play with a doll, or dress up in a girl's or woman's costume.
    Cross-dressing is associated with transvestism and transsexualism when there is
  1. Stated preference for being a girl and for growing up to become a woman
  2. Repeated cross-sex fantasy play
  3. Preference for traditionally female-type activities like knitting and baking
  4. Female peer group

How to deal with a cross-dressing child

Parents bring their cross-dressing child for psychiatric evaluation when they fear he will become homosexual or transsexual. We have already seen that  parenting style affects the child's social, emotional and behavioural development. At this early stage the focus should be on making the child comfortable with himself or herself and to reduce social stigma (Lev 2005).

Integrate the child into his peer group

This is essential to prevent teasing
  • By ages 4-5 boys and girls differ in their manners of walking, running, throwing a ball, and narrating a story. Point out these gestures and mannerisms.

Emphasise a positive father-son experience

Whether the father is distant or the boy is more attuned to his mother - the boy with gender identity disorder typically has a strained relationship with his father.
  • The father must compromise his busy work schedule to build a relationship with his son.
  • Nonathletic activities can be mutually enjoyable.
  • Taking the son to work provides a better image of who father is.
  • Board games, video games, and a shared father-son activity, such as model making and visits to the zoo are helpful.

Convey happiness with the sex of the child

The child may believe that the parents wanted a child of the other sex. Sometimes parents did and conveyed the wish to the child.
  • Parents must convey the message that they wanted a child of the same sex.
  • Convey that they are happy with the sex of their child.

Teach the boy that sex is irreversible

Psychologically children have not achieved gender constancy at ages 4 to 6. They may think that by cross-dressing or changing hair length they change their sex.
  • The anatomical differences between the sexes should be made explicit
  • Point out that superficial changes will not change their sex.

  1. Brown GR, Wise TN, Costa PT Jr, Herbst JH, Fagan PJ, Schmidt CW Jr. Personality characteristics and sexual functioning of 188 cross-dressing men. J Nerv Ment Dis. 1996 May;184(5):265-73.
  2. Richard F Docter and Virginia Prince. Transvestism: A survey of 1032 cross-dressers. Archives of Sexual Behavior; Dec 1997; 26, 6.
  3. Långström N, Zucker KJ. Transvestic fetishism in the general population: prevalence and correlates. J Sex Marital Ther. 2005 Mar-Apr;31(2):87-95.
  4. Arlene Istar Lev. Transgender emergence: therapeutic guidelines for working with gender variant people and their families. Haworth Clinical Practice Press. New York. 2005.
  5. Levine SB. Gender-disturbed males. J Sex Marital Ther. 1993 Summer;19(2):131-41.
  6. Richard L. Schott. The childhood and family dynamics of transvestites. Arch Sex Behav. 1995 Jun;24(3):309-27.
  7. Tsoi WF. Developmental profile of 200 male and 100 female transsexuals in Singapore. Arch Sex Behav. 1990 Dec;19(6):595-605.

Sunday, December 12, 2010

How do I know if my partner is cheating on me - evolution, sexuality and relationships

Last week I gave a talk on Personality and Sexuality. One question that cropped up was - "How do I know if my partner is cheating on me?" By chance the next morning there was a newspaper article attributing uncommitted sex, one-night stands, and acts of infidelity to genetics.

Individuals who have frequent sex with multiple partners are psychologically different from those who have frequent sex with single partner (Simpson & Gangestad, 1991). This sociosexual difference places individuals in two groups
  1. Unrestricted sociosexual types, have a higher number of sexual partners, and one night stands. They have a permissive attitude to casual and uncommitted sex.
  2. Restricted sociosexual types, require greater closeness and commitment before sex with their romantic partner.
 Genetics plays an important role in sociosexuality
Genes evolve to enhance survival of the species. From an evolutionary viewpoint females reproduce with a mate who will invest in their offspring and produce offspring with an advantaged genetic makeup. Female socio-sexual orientation exists because males vary in the quality of their genes.
  • Unrestricted type females benefit from passing the genes of men with greater reproductive success to their own offspring. To induce males to invest in their offspring they frequently engage in pretense and deceit, traits that are strongly associated with unrestricted sociosexuality.
  • Restricted type females benefit from caring males who limit reproductive efforts to the females own offspring.
  • Male sociosexuality evolved through competition. Males who do not succeed with an unrestricted socio-sexual orientation become Restricted.

How do you know your partner's sociosexuality?
Lynda Boothroyd showed that observers were able to identify restricted vs. unrestricted individuals from cues in thier faces. My audience successfully differentiated the Restricted and Unrestricted pairs from the same picture. Test yourself.

What does this mean for a relationship?
  • Restricted socio-sexual personalities are more willing to remain in an unsatisfactory marriage. They are less likely to be drawn out of such a relationship by attractive alternate partners.
  • For Unrestricted individuals long term stability in the relationship depends on the extent to which the partner is highly attractive and possesses high social visibility. Decisions to continue or terminate a relationship depend more on changes in the partners physical attractiveness and social status.

However, personality is not all in the genes. Genes contribute to the biological aspect of personality - temperament. Personality also has an acquired aspect - character. When fully developed, character defines the mature personality.

How do I know if my partner is cheating on me?
To return to the question. Asking the question indicates there are already boundaries being overstepped. It indicates an erosion of trust - a core component in any long-term relationship. That is what needs to be addressed.

Jeffry A Simpson, Steven W Gangestad. Personality and sexuality: empirical relations and an integrative theoretical model. In: Sexuality in close relationships. Kathleen McKinney, Susan Sprecher Editors. Lawrence Erlbaum Associates. New Jersey. 1991:71-92.