The Perspectives and Sexual Science

Despite the amount of information abroad about sex, we are only beginning to understand the multifactorial causes of sexual behavior, especially the interaction of biological effects and cultural contexts. Nowhere is this more apparent than in the shift in the causal attributions that have been applied to male sexual arousal in the past twenty-five years. Until the mid-1970s, a combination of the life story and behavior perspectives was used to explain erectile dysfunction in the vast majority of cases. Only those men who had obvious neurological and/or vascular diseases were thought to have “organic” causes of erectile dysfunction. All other men with erectile dysfunction had “performance anxiety” or “spectatoring” (behavior perspective), or the sexual dysfunction was an expression of some unresolved conflict arising earlier in life (life story perspective).

Enter, in the early 1990s, the disease perspective, with its interest in physiological function in sexual arousal. Basic research on nitric oxide’s effect on penile arousal was applied by Pfizer Pharmaceuticals, which produced and marketed sildenafil, Viagra. With the advent of the oral medication in 1998, many speculated that there would no longer be a need for a psychological approach to erectile dysfunction: the pill would solve everything. Erectile dysfunction was to be considered a medical disorder and treated with medical interventions. The disease perspective had nearly replaced the behavior and life story perspectives as the operative perspective on male erectile dysfunction. Female viagra online Australia

Other clinicians did not remain silent about what appeared to them as a reductionistic reliance on the medical/disease perspective. Social constructionism theorists, researchers, and experienced sexual clinicians, writing and speaking largely from the life story perspective, challenged the rise of the medicalization of sexuality (the disease perspective). Their argument was that human sexuality is a far more complex reality than the achievement of reliable erections. They pressed for the inclusion of psychological and relational factors distinct from physiological function when researchers wanted to report on the efficacy of a treatment for sexual disorders. Although these theorists did not intend to employ a four-perspectives methodology, they did in fact work with this method. They took a prevailing perspective and brought other perspectives into dialogue with it.

The four perspectives, each through its relativity to the others, offer checks and balances to the reductionism that may result from the application of a single perspective. There is a constant “but what about . . . ?” refrain that requires the sexual scientist and clinician to consider something they may have overlooked or prematurely dismissed. In all areas of psychiatric thought—but perhaps most in sexual behavior, with its biological, psychological, and cultural components—the four perspectives provide an open-ended dynamic for looking at cases and problems with new questions.