Sex Disease

Sex involves the body. When the body is diseased, is injured by accident or surgery, or simply ages, there can be profound effects on the sexual life of the individual. Frequently, the clinician and the patient alike overlook the somatic conditions necessary for full sexual functioning and instead give a psychological interpretation of the cause of the dysfunction. Although it may seem obvious, one must listen to the body, its complaints, and its vulnerabilities when attempting to comprehend a sexual disorder and to design a treatment plan.

The body is involved in all sexual expression. Sexual desire arises from the viscera, is expressed through torso and limbs, is perceived through all five senses, and last—and if all goes well—quietly leaves a spent body.

The Romans said, “Post coitum, omne animal triste est” (after sex, every animal is sad). “Sad” may be a poor translation of triste. Perhaps a better translation would be a combination of “spent, relaxed, satiated, and, in some instances, misty.” While there are certainly emotional qualities to postcoital triste, it reminds us also of the somatic nature of sex. Sexual expression is a bodily reality. If something goes afoul with the body, the implications can be profound. For sexual expression to be its somatic fullest, the four horsemen of disease, disability, drugs, and aging must to a certain extent be kept at bay. When any one of them holds sway, the triste of sexual expression may precede rather than follow the act.

The logic of the disease perspective is, strictly speaking, categorical. Its goal is to group conditions into diagnostic categories based on the pathological conditions found in individuals. Ultimately, the disease perspective seeks to state whether a person has—or does not have—a particular disease. Does this person have tuberculosis, yes or no?

To make this determination, the reasoning of the disease perspective follows three stages: (i) it identifies the symptoms; (ii) it links the symptoms to some abnormal body structure or function; and (iii) it determines the underlying cause of the pathological process. McHugh describes these three steps as the conceptual triad that organizes the disease perspective: clinical entity, pathological condition, and etiology.(1) The clinical entity is the cluster of signs and symptoms present in the individual. Identifying clinical entities is the empirical work of observing and noting phenomena. In the mental status examination, for example, attention is given to the manner of dress, speech rate and rhythm, bodily movements, and any other physical quality or behavior.


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