Sexual Pathology

a branch of clinical medicine that studies sexual disturbances in order to determine the scientific bases for their diagnosis, treatment, and prevention. Sexual pathology studies impotence, frigidity, sexual perversion, and infertility, as well as psychophysiological disharmony between a man and woman, which is considered the most important cause of sexual problems.

Sexual pathology, which developed into an independent clinical specialty in the mid-20th century, did so not as an offshoot of another science but as the result of the synthesis of several specialties. Three main views have been expressed on the nature of sexual pathology and its relationship to other medical disciplines. Some researchers regard sexual pathology as a branch of the particular medical specialty they represent, for example, urology. Others maintain that the physiological course of the sex act presupposes many factors, for example, the normal functioning of the endocrine glands, the urogenital apparatus, and the mechanisms of innervation, including those of a complex psychological nature. They believe that sexual pathology lies on the boundary between the various specialties engaged in diagnosing the pathological deviations of these factors. A third group, which includes Soviet and many foreign researchers, recognizes the need for sexual pathology to have its own diagnostic, examinational, and therapeutic methods, which are based on corresponding urologic, gynecologic, endocrinologic, neuropathological, and psychiatric methods. Sexual pathology also utilizes physiological, psychological, and sociological data.

The method of structural analysis of sexual disorders developed by Soviet researchers is based on P. K. Anokhin’s functional-system theory and on ideas concerning the stages and constituents of the sex cycle. It entails a complete clinical examination, during which the urogenital apparatus and the mental state and other elements of neurohumoral regulation are studied as they interact.

In the sexual system, several functional complexes are distinguished: the neurohumoral, psychic, erectile and ejaculatory, and genitosegmental constituents. The neurohumoral constituent, which depends on the activity of deep brain structures and endocrine glands, is responsible for sexual desire and the corresponding excitation of all parts of the nervous system involved in regulating sexual activity. The psychic constituent determines the manifestation of human sexual desire and the conformity of sexual activity with moral and ethical societal standards. An individual’s sexual behavior in specific situations is also determined by the psychic constituent. In males, the anatomic and physiological substrate of the erectile constituent includes the segmental cerebrospinal mechanisms of erection; the substrate of the ejaculatory constituent consists of the complex integration of structural elements, including the prostate and its corresponding brain centers, which assure the secretion of semen. In females, the substrate of the genitosegmental constituent includes the female genitalia and the nerves and nerve plexuses that regulate the activity of the female genitalia.

The structural analysis of sexual disorders makes it possible, on the basis of established criteria for evaluating individual symptoms, to judge the extent of the preservation of the functions of each constituent, to identify the clinical form of the syndrome, and to reveal the focuses of primary affliction, predisposing factors, functional complexes secondarily affected, and possible compensatory measures.

A network of specialized centers and offices was organized in the large cities of the USSR in 1963 to offer free medical advice on sexual problems. The medical facilities are staffed by physicians specializing in sexual pathology, who have received their training mainly from seminars, on-the-job training programs, clinical residencies, and postgraduate research studies. The Moscow Institute of Psychiatry and the Institute for the Advanced Training of Physicians in Kharkov are among the institutes offering training in sexual pathology. There are no specialized periodicals on sexual pathology in the USSR. Foreign publications include the Journal of Reproduction and Fertility (Oxford, since 1960), Medical Aspects of Human Sexuality (New York, since 1967), Andrologie (Berlin, since 1969), and Sexualmedizin (Wiesbaden, since 1972).