Reviewed by Louise Chang on April 05, 2012

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Michael Perelman, PhD, Sex and Marital Therapist, Co-director, Human Sexuality Program Clinical Assoc. Professor of Psychiatry Reproductive Medicine and Urology, N.Y. Presbyterian Hospital/Weil Cornell Medical Center

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Video Transcript

Michael Perelman, PhD, Sex and Marital Therapist: How do people become sexually dysfunctional? I think it's really a multitude of reasons, and I'd like to take something complex and try and make it simple. And the simple thing is the obvious thing. It's all mental and physical. So some people are predisposed to be very, very sexually responsive and others are not. And that's absolutely no different than what you'd expect in looking at people's height, weight, hair color, skin tone, it all varies on a normal distribution curve, a bell shaped curve. And the same thing is true of sex, whether we're talking about desire, arousal, orgasm, all these different aspects of sexual responsitivity vary in some natural way. In addition to that, then you have life and what happens to you, both physically and mentally. So the simple thing, it's all mental and physical, but the mental aspects can facilitate sex or inhibit it. Your life experiences can facilitate your sexual life or inhibit them, your physical capacity can be predicting a really wonderful sex life for you, you're predisposed to great sex, or you're predisposed towards having lots of problems because your hormonal environment isn't in balance, you have some anatomical deformity, or more typically in our society, what happens is as we age, our veins and arteries get a little clogged so the plumbing doesn't work quite as well, so the manifestations of arousal, erection, lubrication aren't what they used to be, so it's a combination of mental and physical issues, and that is unique for an individual every moment in time. Because it will vary for me, for you, at where we are today verses where we'll be ten years from now, verses where we were 10 years ago. It's different for you as a woman than it might be for me as a man, and yet there's tremendous overlap between the genders. How do we overlap as men and women? We overlap tremendously. One of the things that's going on in my field right now is there is a lot of talk about female sexuality and women's sex lives being much more contextual than men, meaning sort of the obvious thing that we all know is true that somehow the context is more important, the relationship, the circumstances, and to a degree, that's all true, but just like in general, men are taller than women, but there's lots of women who are taller than lots of men, the same thing is true of sex. And if you look at the people who are non-responders, the men who are non-responders to the new erectile drugs, Viagra, Levitra, Cialis, those non-responders are very, very contextual in their sexual scripts, meaning that they respond very, very much the same way a lot of women do. If he's upset with her, the pill may not help. If he's distressed about what's going on at work, the pill may not help. And in this way, the men who don't respond to these pills actually overlap women in general considerably. That doesn't mean they are like women. What that means is that they are responsive to these external stressors in much the same way as many women are. So we're more alike than we are different, but these are overlapping curves.