Sexuality and Mental Health
Chapter 6 Sexuality and Mental Health
Sex is virtually all in the head anyway.
—John Cloud (2010)
Sexuality and mental health have a dynamic, bidirectional relationship, in which changes in one area directly impact the other (Bitzer et al., 2008; Levine, 2009). Because sexuality is such a central part of people’s lives, there are many mental health-related factors and influences on our sexuality, including how we choose to think, feel, and behave sexually. This chapter delves deeper into the intersections between sexuality and mental health. After reading this chapter, readers will be able to do the following:a.Understand common processes involved in sexual decision-makingb.Describe the impacts of mental health disorders and substance abuse and dependence on sexual functioningc.Understand the diagnostic criteria for sexual dysfunctions that clients may experienced.Identify the impact of sexual trauma on sexuality and sexual functioning
Although sex is often portrayed in the American media as spontaneous, passion- and lust-driven, and without much forethought or planning, people actually engage in significant decision-making processes to help them consider their sexual behaviors, attitudes, and activities, including when to have sex and what kind of sex to have. While some of those thoughts, feelings, and behaviors act at an unconscious level, many sexuality-related decisions are made through intentional processes. In this section, we explore the processes through which people make decisions with regard to their sexual activities. These influences are important for counselors to understand because clients’ confidence in their sexual decision-making abilities may impact their overall sense of satisfaction and confidence with regard to their sexual functioning. There is not one decision-making process that everyone uses in deciding whether to engage in sexual behaviors, and if so, in which sexual behaviors they want to engage (Abraham & Sheeran, 1993; Christopher & Cate, 1984; Juhasz, 1975; Oswalt, 2010). Many factors impact people’s decisions about sex, and this section reviews a number of the factors that have been identified in previous research (Oswalt, 2010).
Relational concerns, including the amount of love and connection in a relationship, are an important factor in people’s decisions whether to engage in a particular sexual activity (Browning, Hatfield, Kessler, & Levine, 2000; Christopher & Cate, 1984; Oswalt, 2010). How much people love and like their partners, partners’ feelings toward each other, their level of relational commitment, the length of their relationship, and their thoughts of continued romantic involvement with their partners are all relevant relational concerns and impact decisions about engaging in sexual activities (Christopher & Cate, 1984; Oswalt, 2010).
Social Norms and Pressure
Peer pressure and family expectations also impact sexual decision-making. If peers are engaging in sexual activities, then adolescents may be more likely to engage in those same activities (Romer et al., 1994; Rosenthal, Lewis, & Cohen, 1996). What people think that their peers are doing, especially in adolescence, impacts which sexual activities they are more likely to consider engaging in. Also, family
expectations and history impact sexual decision-making (Paul, Fitzjohn, Herbison, & Dickson, 2000). The impacts of social pressure and norms are most pronounced during adolescence but often continue to young adulthood (Regan & Dreyer, 1999).