MEDICINE AND SOCIETY Medicine, Sexual Norms, and the Role of the DSM

Sexuality is tricky territory—for individuals, couples, society—and for professionals. Some aspects are harmful, criminal, and stigmatized, while others are central to identity, deeply pleasurable, and bonding. That’s quite a range. It’s hard to make that argument for any other topic in medicine, and it predicts some unusual complexities in dealing with sexual complaints. Physicians listen to people who come with complaints to office or clinic. They help people think more clearly about their complaints by exploring their origins, details, and possible resolutions through history taking, physical exam, and laboratory testing. Something hurts. Something isn’t functioning properly. When it comes to sexuality, tricky elements enter the picture. Despite the avalanche of sexual subjects in the media, when it comes to a one-on-one conversation with a doctor, most patients are tongue-tied and embarrassed about their complaints (“I don’t know what’s the matter”), and many use mysterious euphemisms (“Doc, my nature isn’t right”). People who might actually be bold in bed can feel paralyzed when trying to speak about their sexual habits or problems. Shame and self