Sexuality and Psychiatry in the 21st Century

In the 19th and 20th centuries, due to courageous scientific researchers, medicine gradually emerged from total illiteracy about human sexuality. Sir Richard F. Burton, Havelock Ellis, M.D., Sigmund Freud, Robert L. Dickinson, M.D., Alfred C. Kinsey, Sc.D., and William H. Masters, M.D., are but a few who risked much personally and professionally to pursue sexual research. The mysteries and mystique of sexuality gave way to knowledge about the sexual biology and behavior of men, women, children and seniors in health and in illness. The 21st century has brought with it an information age with an abundance and variety of ways in which sexual problems present for solutions.

In this issue we cover a wide range of topics related to sexuality and psychiatry. Some of them are original research resonating with current times. For instance, Melissa Farley, Ph.D., reminds us that we do not need to go to a war zone to find, or prevent, extreme violence. In her article on prostitution and sexual violence she focuses on the plight of women working in the sex industry. This economically disadvantaged, often homeless female population is subjected to a range of abuse, from harassment to battery, rape and torture. Treated like commodities, these women experience devastating outcomes, such as posttraumatic stress disorder, increased risk of suicide, affective and anxiety disorders, substance abuse, sexually transmitted diseases, and traumatic brain injury.

In their article on hypersexuality in children with mania, Barbara Geller, M.D., and Rebecca Tillman, M.S., address a very sensitive and clinically relevant topic: Can an often missed symptom be a cardinal manifestation of prepubertal and early adolescent bipolar disorder? Further, they discuss the issue of validating the diagnosis of mania in children and differentiation from attention-deficit/hyperactivity disorder and other psychopathologies.

Jack Drescher, M.D., focuses on issues relevant for gay, lesbian and bisexual adults, and uncovers from a psychodynamic perspective the struggle homosexual people face while "coming out of the closet." In an attempt to integrate formerly dissociated aspects of the self and fit into their community, these individuals often face homophobia, moral condemnation and antigay violence.

Robert H. Remien, Ph.D., and Jeffrey G. Johnson, Ph.D., in their article on psychiatric disorders and high-risk sexual behavior, highlight the reciprocal relationship between substance abuse, disruptive and personality disorders, and risky sexual behavior. The high rates of sexually transmitted diseases and HIV seen as a result of such behavior are placed in psychosocial context with clear treatment implications.

David L. Rowland, Ph.D., writing about premature ejaculation (PE), underscores the prevalence and broad range of dysfunction associated with PE and provides guidelines for behavioral, psychological and pharmacologic treatment.

Despite such advances in understanding, much remains to be discovered in sexual medicine, which today spans specialties from embryology to pharmacology. Sexual research is still an orphan as far as recognition and funding. It also remains a target for the ignorant to accuse researchers of prurience and oppose their sexual research projects. Child sexual offenders receive lengthy prison sentences, yet there is little scientific understanding or study of their brain function. Should the underlying cause be elucidated using functional magnetic resonance imaging, this may lead to increased protection for society and better treatment of pedophiles.

We are at the frontiers of knowledge. To the ignorant, sex is sex, with no further need to learn and teach. To the wise in society, sexuality can markedly improve the quality of each individual's life. Currently, those with sexual problems struggle to find trained physicians who will assist them. Sexual health remains in the psychiatrist's domain in this millennium and beyond.

Acknowledgement

It is with much appreciation that Psychiatric Times acknowledges Drs. Maletic and Renshaw for their assistance in planning and reviewing the Sex & Sexuality Bonus Edition.