179 Sexual Aversion Disorder (302.79)

DSM-IV-TR criteria

• Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.
• The disturbance causes marked distress or interpersonal difficulty.
• The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction).
• Subtypes: To indicate onset (Lifelong versus Acquired) and Context (Generalized versus Situational)

Associated features

Some individuals faced with severe sexual aversion disorder may experience panic attacks with extreme anxiety, dizziness, nausea, faintness, heart palpitations, and breathing difficulties. There may be noticeable changes in interpersonal relations (such as marriage). Individuals with sexual aversion disorder (SAD) may avoid sexual situations or potential sexual partners by subtle diversion strategies like falling asleep early, traveling, neglecting their appearance, substance abuse, or burying themselves in work, school, or other activities.Sexual aversion disorder is characterized not only by a lack of desire, but also by fear, revulsion, disgust, or similar emotions when the person with the disorder engages in genital contact with a partner. The aversions may take several different forms, it may be related to specific aspects of sexual intercourse, such as the sight of the partner’s genitals, or the smell of his or her body secretions, but it may also include kissing, hugging, and petting as well as intercourse itself.

Child vs. adult presentation

This disorder manifests itself in early adulthood, so there is no information regarding symptom presentation in children.

Gender and cultural differences in presentation

There are few statistics on the number of people with SAD because it is often confused with other disorders. Many people find sex a hard subject to talk about even with a doctor; consequently, the number of people with SAD is greater than the number of people who seek treatment.

Epidemiology

Because SAD is a subcategory of the Hypoactive Sexual Desire Disorders, the prevalence of SAD is currently unknown. The prevalence is higher in women than in men.

Etiology

In women Sexual aversion disorder is normally caused by a traumatic experience of the past, such as rape, incest, molestation, and other forms of sexual abuse. In men the disorder is associated with performance anxiety. Evidence suggests that past sexual trauma and/or relationship issues may be an underlying cause in the development of SAD.

Empirically supported treatments

Sexual aversion disorder is treated most often with the help of a psychiatrist and psychotherapy. If the disorder also concerns a partner or a spouse, marriage counseling is often used. Pharmacotherapy is typically used for patients with sexual aversion disorder only if they are experiencing panic attacks severe enough to cause additional distress not normally for the disorder itself. Behavioral counseling would be of use in finding out and resolving the underlying issue of this conflict.

Prognosis

• When sexual aversion disorder is addressed as a psychological disorder, treatment can be very successful. Psychotherapy to treat the underlying psychological problems can be successful as long as the patient is willing to attend counseling sessions regularly. For sexual aversion disorder that is situational or acquired, psychotherapy for both the patient and his or her partner may help to resolve interpersonal conflicts that may be contributing to the disorder. Panic attacks caused by or associated with the disorder can be treated successfully by medication if the doctor considers this form of treatment necessary.
• If sexual aversion disorder is not diagnosed, discussed, or treated, the result may be infidelity, divorce, or chronic unhappiness in the relationship or marriage.