What is Normal Sex? by Bruce W. Cameron, M.S., LPC-S, LSOTP, CAS Southlake, Texas

What's 'normal' sex? Shrinks seek definition:
Controversy erupts over creation of psychiatric rule book's new edition.

This month the American Psychiatric Association announced the names of "working group" members who will guide the development of the new Diagnostic and Statistical Manual of Mental Disorders, or DSM V, the codex of American Psychiatry.

Not surprisingly, given the DSM's colorful history, particularly when it comes to sex, controversy erupted within days of the announcement,
especially over membership of the Sexual and Gender Identity Disorders Working group, which will wrestle with questions such as: Are sadomasochism or pedophilia mental disorders? Are dysfunctions like female hypoactive sexual desire disorder (low sex drive) psychiatric Issues, or hormonal issues? Perhaps the most important question is whether, when it comes to many sexual interests and issues, it's even possible or desirable to create diagnostic criteria.

At least one petition, spearheaded by transgender activists, is being circulated to oppose the appointment of some members to the Sexual and Gender Identity Disorders work group and its chair. Especially advocating the idea that children who are unambiguously male
or female anatomically, but seem confused about their gender identity; can be treated by encouraging gender expression in line with their anatomy.

The APA is doing its best to put science and evidence first, both in who it appoints to working groups and in the process it will use to create the DSM-V (so called because it is the fifth complete version). Each working group will accept input from many experts with varying views, reach a consensus on DSM content, and then put that work group's product before the board of Trustees of the APA and the APA assembly.

All that may be true, on should not expect such reassurances to quell the forces already swirling around the DSM-V as it moves toward a 2012 publication date. Currently, the DSM-IV includes sex-related activities as varied as paraphilias like voyeurism, klismaphilia (erotic
use of enemas) and sadism, and functional disorders like dyspareunia (pain with intercourse), erectile disorders and premature ejaculation.

'A set of scientific hypotheses'

The first DSM was issued in 1952. The idea was to create a more standardized way of talking about psychiatric disorders. The DSM is best viewed as "a language we have chosen to speak, A talking point we mental health professionals have created to communicate as well as we can with each other and with other professions."

But if the DSM is a book of "hypotheses," why the fuss? Does the DSM matter?

Yes. A lot.

The first reason why is prosaic. If you want your insurance to reimburse Your visit to a mental health professional, you are probably going to need a DSM code signifying a diagnosis.
But the more profound reason is that it shapes how doctors, even the rest of rest of society, view sexuality.

"A psychiatric diagnosis is more than shorthand to facilitate communication among professionals or to standardize research parameters. "Psychiatric diagnoses affect child custody decisions, self-esteem, whether individuals are hired or fired, receive security clearances, or have other rights and privileges curtailed. Criminals may find that their sentences are either mitigated or enhanced as a direct result of their diagnoses. The equating of unusual sexual interests with psychiatric diagnoses has been used to justify the oppression of sexual minorities and to serve political agendas.

A review of this area is not only a scientific issue, but also a human rights issue."

A problem for whom?

There is no shortage of opinion on what ought to be changed, deleted or included in the new DSM-V. For instance, should pedophilia be removed? What are the consequences?

This does not mean, as opponents of this idea have suggested, that they somehow approve of sex between adults and children. They would argue that the removal of pedophilia from the DSM would focus attention on the criminal aspect of these acts, and not allow the perpetrators to claim mental illness as a defense or use it to mitigate responsibility for their crimes," they wrote. "Individuals convicted of these crimes should be punished as provided by the laws in the jurisdiction in which the crime occurred."

Most of these suggestions are inherently political, as much as the APA and most psychiatrists would wish to avoid politics. Sex exists as part of the culture, and it cannot be separated from it.

The DSM has reflected cultural shifts through its revisions and new editions. The most famous example is homosexuality. When the first DSM was created in 1952, homosexuality was declared a mental illness. By 1973, and after much heated debate and over objections from religious conservatives, the DSM-II excluded homosexuality as a disorder with the exception of one variant, and that was soon dropped in an interim revision.

"We used to think oral-genital sex was deviant and now we have embraced that. Masturbation was evidence of out-of-control behavior, now we see it as not only normative but to be encouraged."

So if enough people start to do it, or are more public about doing it, does that mean it is no longer a disorder? "I think it probably affects the degree to which people are willing to look at scientific evidence". Statistics drive the bus? If a significant percentage of persons sexually violate children etc..will this normalize this behavior?

This fuzziness is why...starting in the 1980s, the field moved toward adding the notion of "distress" to the DSM.

They did not consider something a disorder unless there is a clearly defined description of this entity and there is clearly some significant dysfunction and distress associated with it.
If you aren't distressed, and everyone is a consenting grown-up, then there probably isn't a disorder. But things won't be that simple for the creators of the new DSM.

"How do you make a criteria that does not pathologize low desire?"

You add the need to be distressed about it. "But then whose distress should be looked at?" she asks, referring to a sexual partner. "You can have hypertension and not feel any distress because there is objective criteria for what is high blood pressure. But there is none of that for sexual diagnoses, even premature ejaculation. What constitutes premature?"

(The International Society of Sexual Medicine made a stab at a definition, saying premature ejaculation is "amale sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.")

This problematic lack of clarity is especially acute for the paraphilias. Does the criteria amount to "If it's mine it's OK, but if it's yours it's kinky? These issues need to be grappled with.

Special Thanks to: Brian Alexander