Sexual Aversion Disorder Defined

Persistent or recurrent aversion to and avoidance of all or almost all genital sexual contact with a sexual partner, causing marked distress or interpersonal difficulties.

Sexual aversion disorder occurs occasionally in males and much more often in females. Patients report anxiety, fear, or disgust in sexual situations. The disorder may be lifelong (primary) or acquired (secondary), generalized (global) or situational (partner-specific).

Etiology and Diagnosis

If lifelong, aversion to sexual contact, especially to intercourse, may result from sexual trauma, such as incest, sexual abuse, or rape; from a very repressive atmosphere in the family, sometimes enhanced by orthodox and rigid religious training; or from initial attempts at intercourse that resulted in moderate to severe dyspareunia. Even after the dyspareunia disappeared, painful memories may persist. If the disorder is acquired after a period of normal functioning, the cause may be partner-related (situational or interpersonal) or due to trauma or dyspareunia. If aversion produces a phobic response (even panic), less conscious and unrealistic fears of domination or of bodily damage may also be present. Situational sexual aversion may occur in persons who attempt to or are expected to have sexual relations incongruent with their sexual orientation.

Treatment

Treatment is aimed at removing the underlying cause when possible. The choice of behavioral or psychodynamic psychotherapy depends on diagnostic understanding. Marital therapy is indicated if the cause is interpersonal. Panic states can be treated with tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or benzodiazepines.