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Abstract
Sexual aversion disorder is characterized by the presence of aversion and avoidance of making a genital contact with sexual partners. In the DSM-IV-TR, the characterization of the problem was extended by the inclusion of some of the features of phobias such as anxiety, fear, and disgust; thereby describing it as a phobia. However, the disorder was deleted during transition from DSM-IV-TR to DSM-5, probably due to the presence of scarce studies on the topic. Sexual aversion disorder is commonly found in women as compared to men, and it is commonly found in women in the age range of 15 to 40 years reported more often the symptoms of sexual aversion as compared to women above 40 years of age. Married women have more chances of developing sexual dysfunction as compared to separated or divorced women. This problem can be prevented by making lifestyle changes, exercises, and reducing stressors in life. Some behavioral therapies and pharmacotherapeutic strategies can also be used to control the problem. This paper deals with characterization, prevalence, factors behind the problem, and prevention and treatment strategies for sexual aversion disorder.
Sexual dysfunction in women can be assessed by the presence of four symptoms including absence of sexual interest or sexual aversion, loss of pleasure, dyspareunia, and inability or difficulty of sexual arousal. In these symptoms, sexual aversion is among the most commonly reported problem in women with sexual dysfunctions (Park, Sohn, Seong, & Cho, 2015). However, it is also among the less commonly studied problems in sexual disorders. Sexual aversion disorder is often characterized by an aversion or hatred to making a contact with a sexual partner. It is also characterized by the avoidance of making a genital contact with the partner (Abnavi, Ahmadi, Hamidian, & Ghaffarpour, 2016).
Sexual Aversion Disorder, and Diagnostic and Statistical Manual of Mental Disorders (DSM)
Sexual aversion disorder was initially described in DSM-III-R as an aversion to and avoidance of making genital sexual contact with a sexual partner. This characterization of the disorder was extended in the DSM-IV-TR showing that the issue of making a sexual contact could be related to some of the features of phobias such as anxiety, fear, and disgust. Therefore, DSM-IV-TR strengthened the relation between certain phobias and sexual aversion disorder. According to the criteria, severe sexual aversion was characterized by the presence of extreme level of anxiety or panic as well as avoidance behaviors. There could be a number of different types of stimuli as well as behaviors resulting in aversion and avoidance. Those stimuli and behaviors may range from a specific and/or simple aspect of sex such as genital fluid to other somewhat broader aspects such as touching, kissing, and cuddling (Borg, de Jong, & Elgersma, 2014).
According to DSM-III-R, sexual aversion disorder is not represented by a complete disinterest in sexual activities. A person with sexual aversion disorder may have sexual fantasies and may think of releasing sexual tension. Therefore, it can be said that sexual aversion disorder is different from “decreased sexual desire”, i.e. Hypoactive Sexual Desire Disorder, which is represented by decreased sexual desire, decreased sexual fantasies, and decreased urge to touch for pleasure. Studies also show that sexual aversion often goes hand in hand with sexual arousal problems. People having less interest in sex or/and less easily sexually aroused have more chances of experiencing sexual aversion (Borg et al., 2014).
Although, sexual aversion disorder was described in DSM-III-R and DSM-IV-TR, it was deleted during transition from DSM-IV-TR to DSM-5. One of the reasons for the deletion of sexual aversion disorder from DSM-5 is very little research done on the topic. Few empirical findings on this topic are there in journals. Moreover, no rigorous cross-sectional data is available to give information about the prevalence of sexual aversion disorder in different countries, and no large epidemiological studies are showing the boundaries and/or symptoms of this disorder (Borg et al., 2014).
Sexual Aversion Disorder in Women
In an internet based study about sexual health performed in the Netherlands, it has been found that sexual aversion disorder is not rare in women. There were over 4,000 participants in the study, and more than 30% of the participants reported that they experienced the symptoms of sexual aversion at some point during their lives. About 4% of the participants met the criteria for sexual aversion disorder (Borg et al., 2014).
In another study on Dutch population, it was found that sexual aversion is among the common problems of the population. In the study, researchers considered about 8,000 participants in the age range of 15 to 71 years. The study showed that approximately 4.5% of women regularly experienced the symptoms of sexual aversion as compared to 2.4% of men with such symptoms. If we consider the number of people actually trying to get treatment for sexual aversion, it has been reported by the combined Dutch outpatient clinics for problems related to sex that nearly 3% of women contacting an outpatient clinic showed symptoms of sexual aversion. The study also showed that women in the range of 15 to 40 years reported more often the symptoms of sexual aversion as compared to women above 40 years of age (Borg, de Jong, & Elgersma, 2014).
In a study on Korean women, researchers reported that perimenopausal women (women in the age range of late years of their 40s and early years of 50s) have more chances of developing sexual dysfunction as compared to older women (in the age range of 70 years or more) particularly with regard to the absence of sexual interest (sexual aversion) and dyspareunia. Menopause is considered as the most important cause of sexual dysfunction. However, some studies are also showing body image and/or perceptions of aging are among the important contributors of sexual dysfunction (Park et al., 2015).
Married women also have increased chances of developing sexual dysfunction, i.e. about 2.6 times more chances of developing sexual dysfunction as compared to unmarried women. However, separated or divorced women have lower prevalence of sexual disorder, and this is probably due to the presence of decreased level of distress that is associated with sexual difficulties in married women (Park et al., 2015).
In a study concentrating on people approaching their family doctors or general practitioners for their sexual problems, it has been found that nearly 2 women in 100,000 women, and nearly 0.5 men in 100,000 men showed symptoms of sexual aversion disorder. These numbers are showing that the number of people trying to find treatment for sexual aversion disorder is very low as compared to the number of people trying to find the treatment for other sexual problems such as dyspareunia and erectile dysfunction. Researchers are of opinion that these statistics are in contradiction to certain studies, and this contradiction could be due to the presence of silent sufferers, who are not only avoiding sexual contacts but also avoiding seeking help of sex therapists. Moreover, they do not realize that the symptoms of sexual aversion disorder could be modified and they can be helped (Borg et al., 2014).
Factors associated with sexual aversion disorder in women
Several factors including psychological, biological, and sociocultural factors have been found to be involved in the sexual dysfunction in older people.
Studies are showing different affects of physical health of women on sexual aversion disorder. Some studies are showing that one or more physical illnesses in a woman would not affect the sex life, whereas other studies are showing that disturbances in physical health would significantly affect the sex life. However, it is important to consider that physical illness more strongly affect the sex life of men as compared to women (Park et al., 2015).
Studies show that aging is not the only problem causing sexual disorders in elderly people but several stressors in various areas of life are also involved in the development of such disorders. Particularly, mental health problems as, for example, anxiety and depression have a close association with sexual dysfunctions, and they are more commonly found in elderly women as compared to elderly men. Researchers are of opinion that women having sexual dysfunctions and reporting the loss of pleasure, unmarried status, and experiences of sexual aversion before the age of 50 years have to be checked for the presence of psychiatric disorders (Park et al., 2015).
Some other factors such as more education and living in a rural area could also increase the chances of sexual aversion (Park et al., 2015). In a study, researchers reported that childhood sexual abuse can also increase the chances of the development of sexual aversion disorder (Trickett, Noll, & Putnam, 2011).
In a study, researchers worked on Iranian women to know the effect of males’ opioid dependency (addiction) on the sexual function of wives. They divided the women into two groups; a control group in which those females were considered whose husbands were not addicted, and a case group in which those females were considered whose husbands were addicted. Researchers found that the frequency of sexual aversion disorder and hypoactive sexual desire disorder was significantly higher in females who were considered in the case group as compared to the females in the control group (Abnavi et al., 2016).
Effects of Sexual Aversion Disorder
Patients of sexual aversion disorder can show problems on sexual encounter. They may show anxiety, panic attacks, fearfulness, and certain other physical symptoms such as rapid heartbeat, dizziness, sweating, trembling, nausea, diarrhea, and faintness. Sexual aversion disorder can also result in interpersonal conflicts; thereby, resulting in infidelity, chronic unhappiness in the relationship, and/or divorce.
Prevention and Treatment of Sexual Aversion Disorder in females
One of the most important strategies to prevent the problem of sexual aversion disorder is making changes in lifestyles that could also help in improving overall health. Partners have to set aside some time for intimacy, so that they would come in contact with each other in spite of their busy schedules. Exercise can also help in increasing the mood, improving libido, enhancing stamina, and creating a more positive self-image. Communication has also to be increased to improve a closer emotional connection. Most importantly, stress has to be managed, and in this regard, people have to learn different ways to manage pressures such as financial pressure, work-related pressure, and other stresses commonly encountered in daily life.
Researchers are of opinion that people having sexual aversion disorder have to avoid the situations that would increase the chances of developing sexual aversion disorder related stimuli by increasing the chances of developing a phobia (Borg et al., 2014).
It has been suggested that sexual aversion disorder can be treated by using the same treatment strategies as that of phobia. For example, if someone has a phobia of small animals and insects, and find them intrinsically repulsive or dirty, prolonged physical exposure could help in reducing the disgust-eliciting properties of those insects or animals. In the same way, exposure to physical contact with the partner could help in reducing the sexual aversion disorder in females. Although, there are no controlled and systematic studies on the therapeutic strategies for sexual aversion disorder, it is thought that exposure with response prevention can effectively treat the problem of sexual disgust. In this treatment strategy, it is important to note that avoidance and aversion in sexual aversion disorder could be caused by different reasons such as the presence of strongly held moral beliefs or the presence of negative or traumatic sexual experiences as, for example, incest or/and rape. In the first instance, “exposure” would be of no benefit as it could be difficult to change or challenge the standards developed in the mind of a person. In the second instance, the aversion develops as a result of moving away from traumatic experiences or events; therefore, it can be considered more as Post-Traumatic Stress Disorder rather than sexual aversion disorder (Borg et al., 2014).
General approaches in the treatment of sexual disorder include the facilitation of patient in getting the treatment and educating the patient; identification of medical conditions resulting in a disorder; consideration of the use of medicines and/or other therapeutic substances, and provision of sexual counseling and coaching as well as sex therapy (whenever indicated). Sex therapists and sexuality counselors, usually treat their patients with arousal, desire, satisfaction, and performance issues. They not only counsel patients, who have experienced a sexual abuse or trauma, but also their partners. The counseling is related to sexual orientation issues, sexual pain, fetishes, and/or sexual addictions or compulsions. Sex therapists may offer a variety of therapeutic interventions to help their patients reconnecting emotionally and sexually with their partners (Association of Reproductive Health Professionals, n.d.). These interventions may include anxiety reduction and/or desensitization, cognitive restructuring, communication enhancement, sexual myths, improving sexual intimacy, and homework exercises including behavioral assignments.
According to Association of Reproductive Health Professionals, treatment of this disorder may consist of graduated exposure program consisting of (Association of Reproductive Health Professionals, n.d.):
Behavioral therapy to improve the behavioral responses of females,
Relaxation exercises with graded reintroduction of sexual behavioral responses. These exercises may consist of music therapy, yoga meditation, guided imagery, and/or rhythmic breathing, and
Pharmacotherapy such as the use of selective serotonin reuptake inhibitors or anxiolytics to help and improve behavioral therapy.
Concluding Remarks
Sexual aversion disorder is one of the sexual problems having the symptoms of avoidance and aversion from making sexual contacts. This problem is more commonly found in women as compared to men. Some studies are not only considering it as a sexual dysfunction but also as a kind of phobia as sexual aversion disorder is also related to fear, anxiety and disgust. However, very few studies have specifically worked on sexual aversion disorder.
This disorder requires further studies as the studies about the frequency of this disorder in the population, its clinical interventions, and its differences from phobias are scarce. However, it is clear from studies that the symptoms of sexual aversion disorder are common and it is also related to problems of sexual arousal. This problem can be prevented by making lifestyle changes, exercises, and reducing stressors in life. Moreover, certain behavioral therapies and pharmacotherapeutic strategies including the use of anxiolytics can help in dealing with the problem. However, further research is required from both English as well as non-English countries, and further epidemiological data have to be collected from health agencies and institutions to know the incidences and prevalence of the problem.
References
Abnavi, M. A., Ahmadi, J., Hamidian, S., & Ghaffarpour, S. (2016). Female Sexual Dysfunction Among the Wives of Opioid-Dependent Males in Iran. International journal of high risk behaviors & addiction, 5(1).
Association of Reproductive Health Professionals. (n.d.). Handbook on Female Sexual Health And Wellness. Retrieved from http://www.arhp.org/Publications-and-Resources/Clinical-Practice-Tools/Handbook-On-Female-Sexual-Health-And-Wellness/Treating-Female-Sexual-Dysfuntion
Borg, C., de Jong, P. J., & Elgersma, H. (2014). Sexual Aversion and the DSM-5: An Excluded Disorder with Unabated Relevance as a Trans-diagnostic Symptom. Archives of sexual behavior, 43(7), 1219.
Park, J. E., Sohn, J. H., Seong, S. j., & Cho, M. J. (2015). Prevalence of Sexual Dysfunction and Associations with Psychiatric Disorders Among Women Aged 50 and Older. Journal of Women's Health, 24(6), 515-523.
Trickett, P. K., Noll, J. G., & Putnam, F. W. (2011). The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and Psychopathology, 23(02), 453-476.
