Theoretical Perspectives Biological Psychological and Social

Not only are there multiple origins for HSDD in men, but the theoretical perspective of the observer regarding sexual issues as a whole make understanding sexual problems like HSDD even more difficult.

One might look first at differing points of view about sexuality in general. Some view sexual difficulties from primarily a biomedical perspective and regard "sex" as "natural." Kolodny et al. wrote: "to define sex as natural means just as an individual cannot be taught to sweat or how to digest food, a man cannot be taught to have an erection, nor can a woman be taught to lubricate vaginally. Because the reflex pathways of sexual functioning are inborn does not mean that they are immune from disruption due to impaired health, cultural conditioning, or interpersonal stress" (30; p. 479) "Some have reworded 'naturally' to mean 'automatically, without purpose or without effort'" (31).

Others look at sexuality and see the absence of intimacy as being crucial to understanding the psychological origins of many sexual difficulties (11,32). One can particularly appreciate (and learn from) the implications of the absence of intimacy for sexual relationships generally, and sexual desire in particular, when considering the plight of those with a serious mental illness who, by the very nature of the disorder, also have substantial intimacy difficulties (33). "The roots of intimacy difficulties are in the patient's past... this ... needs to be thoroughly explored because it may well have included turmoil in his or her family-of-origin, as well as a dearth of love and nurturing connections which are so often a rehearsal for love relationships later in life. Likewise, the patient's past may not have included the experimental love and sexual relationships of adolescence in which so much learning takes place about oneself and others."

Still others look at sexual matters from a "social constructionist" point of veiw. Tiefer wrote that "the primary influences on women's sexuality are the norms of the culture, those internalized by women themselves and those enforced by institutions and enacted by significant others in women's lives" (5; p. 2)

It may well be that these viewpoints do not apply equally to men and women, and that sexuality in men is, for example, more "natural." However, even as the word "natural" is applied to men, it does not explain the contribution to sexual problems of either intimacy issues or cultural variations in sexual behavior.

"During development and growth, there is interaction with the environment that builds up experience and potentiation of 'sexual' stimuli. The social and cultural environment determines sexual expression and the meaning of sexual experience" (31).

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