Sexual fantasy disorders

Fantasies are a normal and important part of sexuality. They may appear as fleeting images or as elaborate, drawn-out scenes involving a variety of sexual behaviors in different locations. They may involve one's own sexual partners, potential partners, or fantasy figures. The content of these fantasies usually changes over time.

Some people worry that the content of their sexual fantasies is objectionable or abnormal. However, having such fantasies does not mean that they will come true.

Sexual fantasizing is normal and healthy, although a predominance of fantasies involving sexual relations with children or violence against others in adults may be concerning.

• Psychiatric and psychological causes

Severe affective disorders, including depression and bipolar (manic-depressive) disorders, are a very common psychiatric cause of functional sexual dysfunction. For example, a person with depression usually loses interest in sex. Schizophrenia is also often associated with sexual dysfunction. Personality disorders often lead to sexual dysfunction. The same applies to stress-related adjustment disorders.

A person's personal beliefs about what is considered "right" and "should" be done sexually can have a strong influence on sexual responses. For many people, ignorance or misconceptions about their own bodies can lead to sexual dissatisfaction. For example, many women do not know that intercourse without sufficient clitoral stimulation cannot produce orgasm. Penetration alone is not sufficient to produce such stimulation, so many women who are capable of orgasm stimulate themselves or have a partner who can do so. Men who do not know that women need clitoral stimulation begin to doubt their own masculinity because mere penetration alone cannot produce orgasm in the woman with whom they are having intercourse. This doubt can lead to fear and impotence.

Common psychological causes of sexual problems include:

• Depression.
• Unconscious feelings of guilt or fear associated with sexual intercourse.
• Fear of failure, doubt in one's own sexual abilities, or fear that one's partner's sexual expectations will not be met.
• Inhibition caused by socio-cultural factors (all prohibitions and imperatives in the form of “you should” or “you shouldn’t” that are associated with our family, cultural or religious upbringing.
• Sexual trauma (incest, rape, or painful experiences of sexual failure, etc.).
• The role of the "observer" (concentrating on what is happening, instead of experiencing the whole sexual act).
• Tension in the relationship with a partner (when one partner constantly criticizes or humiliates the other; when one or both partners are angry, etc.).
• Mental conflicts (usually an unconscious state of tension that occurs when internal desires, needs and thoughts are in conflict, such as a man who has unprocessed sexual feelings for his mother and therefore loses interest in his wife after the birth of a child, since she has become the embodiment of his motherly image).

Most often, problems arise because the sexual needs of the other remain unshared. Often, the partner knows little or nothing about the sexual fantasies, preferences, inclinations, fears, and sensitivities of the other. Often, a woman expects her partner to know how to make her orgasm without sharing what exactly gives her pleasure. And a man is hesitant to talk about what helps him get an erection. Often, partners are unaware of each other's problems.

Finally, life crises, stress, fatigue, and habitual mood swings can upset the sexual response cycle. For example, mothers of infants may experience a decrease in sexual desire due to fatigue. After a divorce, a man may experience an increase or decrease in sexual activity due to a change in lifestyle. In these cases, fluctuations in sexual activity usually smooth out as the situation stabilizes, energy returns to its previous level, and mood improves. If this does not happen, appropriate treatment should be carried out to prevent sexual dysfunction.