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Nichola Haddad, MD






Brigham & Women's Hospital




Nichola Haddad, MD and Carla Rosinski, PhD

Principal Investigator


Psychiatry and Sex: From Pathology to Pleasure


Introduction: Sexual health is vital to the overall state of psychosocial and physical wellbeing in relationship to sexuality, and not merely the absence of dysfunction. Despite psychiatry’s complex relationship with sexuality, we argue that psychiatrists are in a unique position to address sexual health concerns given their focus on both psychosocial and medical well-being. In this study, we examine the current intersection between psychiatry and the field of sexual health.

Methods: A literature review of the topic was performed.

Results: Literature reveals that psychiatrists do not adequately identify or prioritize their patients’ sexual health concerns and report discomfort and lack of competence in this area. In a cross-sectional study of 100 psychiatrists, less than a third reported that they ask over 80% of their patients about sexual health, although half of them suspected sexual problems in 41-80% of patients. Literature shows that psychiatric patients feel uncomfortable bringing up sexual health concerns when psychiatrists do not initiate the topic, despite a clear association between sexual function and psychiatric comorbidities. In a study of patients on SSRIs, only 14% spontaneously reported sexual dysfunction, while 55% reported dysfunction when asked directly by their provider. This discrepancy significantly impacts the sexual functioning of psychiatric patients.

Conclusions: The data reported above in conjunction with psychiatry’s fraught history with sex emphasizes the need for psychiatrists to take the lead in discussing sex with their patients, with cultural humility and attention to the disruption of cultural normativity. Psychiatrists are in a unique position to work with sexual health experts in treating sexual health concerns because 1) their training includes the psychological and medical aspects of health and disease, and 2) they utilize both psychopharmacology and psychotherapy. Psychiatrists must discuss sex and sexuality from a non-pathologizing lens if they want to address the “whole” patient.

Research Context

Psychiatry and sex have been linked since the time of Freud, who emphasized the importance of libido in psychological functioning. However, psychiatry historically viewed sex from a pathologizing perspective rather than emphasizing sexual health or pleasure and continues to stumble with its relationship to sexuality, especially female sexuality. Most adults (94%) believe that sexual pleasure improves quality of life. Psychiatry has a history of targeting individuals—particularly women—as abnormal. More recently, psychiatry has taken the realm of “normal” into its domain when it diverges from social fantasy of normativity. The medicalization of women’s sexual dissatisfaction is seen in the DSM-5 (i.e., female sexual arousal/interest disorder, female orgasmic disorder, genito-pelvic pain/penetration disorder). In a study of 73 women diagnosed with female sexual dysfunction, 98.63% were found to have psychiatric comorbidities. It is vital for psychiatry to redefine its relationship to sexuality.