# data[].attributes.body
The struggle is real

# data[].attributes.body
https://www.voanews.com/a/sexual-harassment-charges-in-2017/4178023.html.

# data[].attributes.attachment_link.readable_text
Psychological stress among college students has been getting a lot of attention recently, thanks to articles this year in the New York Times, Huffington Post, and Inside Higher Ed. Research on student stress goes back at least half a century, to David Mechanic's 1962 book Students Under Stress, which was on graduate students. Student stress research seems to have really become vigorous in the 1980s, however. One of the first research studies I ever worked on investigated student stress. In 1983, during the fall term of my senior year at UCLA, the professor of my survey-research course, Christine Dunkel-Schetter, had the class conduct a phone survey of stress on campus.

Think about what many college students go through. Leaving the family home, feeling intense pressure to obtain high grades in connection with career aspirations, taking final exams, trying to establish a romantic/ social life, dealing with (often very high) costs of college and possibly working at a job during the school year. What kind of jobs (if any) students can get after college also remains tenuous given the multi-year recession. On top of all that, students in many parts of the U.S. must deal with snow and subfreezing temperatures that, in the words of a colleague who once taught in Buffalo, leave students "really dragging by December."

I ask you: Considering the above, how can college students not be highly stressed out?

Some will argue that college students are in many ways advantaged, compared to those who don't or can't attend a university. Point well taken, but that shouldn't diminish the stress experienced by students.

The New York Times article reports on Fall 2010 national findings from UCLA's Higher Education Research Institute -- based on students' reflections on their senior year of high school -- showing record levels of poor emotional health among incoming first-year undergraduates (UCLA press release). The actual survey questionnaire is available here (when the new page opens, scroll to "Questionnaire" under "The Freshman Survey").

Researchers understandably want to keep their questionnaires as short as possible, to encourage participation. Because the UCLA survey probes many different areas (e.g., politics, values, in addition to school-related matters), the measures of stress and emotional health are limited to isolated items. On a checklist of feelings and behaviors experienced during the past year, for example, appears the item "Felt overwhelmed by all I had to do," to which participants reply "frequently," "occasionally," or "not at all." Elsewhere in the survey, respondents were asked to rate themselves on a set of traits, including "Emotional health," compared to what they would see as the average person their age. Though brief measures may be necessary in some studies, I would recommend a more extensive one, such as the Undergraduate Stress Questionnaire developed by my friend and colleague Chris Crandall.

The Inside Higher Ed article focuses on studies of stress at Columbia University and the University of San Diego, which aimed to identify types of stress that different subgroups of students (e.g., according to field of study, race- ethnicity, sexual orientation, and holding a job while going to school) considered most pernicious. Examples of findings from USD are that "black students are the most stressed out by disrespectful remarks and property damage; campus climate is the only stressor with significantly worse impact for LGBTQ (lesbian, gay, bisexual, transgender and queer) students than heterosexual ones; and students who hold jobs report much higher levels of stress from their families, finances and time management."

In addition to sources and experiences of stress, there is also a great deal of research on how people (including college students) attempt to cope with and manage the stress they're under. One general typology divides coping into two broad categories: problem-focused (attempting to tackle a problem directly at its source, such as asking one's dormitory Resident Assistant for a room change to escape a bothersome roommate) and emotion-focused (attempting to manage one's emotions, e.g., by putting things in perspective, when one cannot or chooses not to address the underlying source of the problem). As an example of stress-coping research, this 2009 article examines male and female college students' strategies for coping with stress.

What can be done about stress? The University of Georgia's University Health Center offers an online resource entitled " Managing Stress: A Guide for College Students." It offers modules on several specific topics, such as sleep, healthy relationships, and time- management. In addition, the University of Illinois's Counseling Center provides several stress-management tips for first-year students. At my university, Texas Tech, the Student Counseling Service has similar resources as at other institutions. Plus, rubberized stress-relief squeeze toys in the shape of the university's Double-T logo are available.

With the help of family, friends, and perhaps campus stress-management resources, many students are able to keep their stress levels relatively under control or even thrive in the college setting. However, for some students, the challenges and frustrations of campus life appear to lead to severe emotional problems. I address this topic in next month's column.

# data[].attributes.attachment_link.description
Psychological stress among college students has been getting a lot of attention recently, thanks to articles this year in the New York Times , Huffington Post , and Inside Higher Ed . Research on student stress goes back at least half a century, to David Mechanic's 1962 book Students Under Stress , which was on graduate students.

# data[].attributes.attachment_link.title
Women's Health Matters - Sexual Expression

# data[].attributes.attachment_link.description
Having healthy relationships is an important part of sexual health. Sexual health is holistic. Physical health and pleasure are important, but so are emotional and social well being. Unhealthy sexual relationships can affect a woman's mental and emotional health and, in the case of violent relationships, put her in physical danger.

# data[].attributes.attachment_link.readable_text
If you or someone you know is considering suicide, please contact the 988 Suicide & Crisis Lifeline at 988 or 1-800-273-TALK (8255), available 24 hours a day, seven days a week. All calls are confidential, and anyone can use this service. (This service was formerly known as The National Suicide Prevention Lifeline.

Common among students, stress can cause adverse mental and physical side effects.

Stress has many identifiable symptoms that can affect academic performance.

Many colleges provide students with online and in-person mental health resources.

If a school doesn't have the resources you need, it can direct you to external services.

Stress is just one of the many hurdles college students face. Short-term stress can help learners raise a grade, polish an essay, or pursue a coveted career opportunity. But long-term stress, if left unaddressed, can have detrimental side effects.

According to the American Institute of Stress, 4 in 5 college students experience frequent stress. Unchecked stress can lead to physical side effects like trouble concentrating, irritability, a lack of energy, appetite changes, a weakened immune system, and trouble sleeping.

In addition to the negative side effects stress brings, more college students than ever report feeling it for extended periods. Although the majority of this stress often stems from coursework, other factors, such as family, friends, and work, can increase stress and contribute to undesirable academic and personal outcomes.

To address this issue, many colleges provide ample resources and opportunities for students to deal with stress positively. Keep reading to learn more about the different types of stress and solutions for managing it.

What Is Stress and How Does It Affect College Students?

Stress is a physical reaction to a person's emotions. Both positive events (e.g., an upcoming wedding) and negative events (e.g., the loss of a loved one) can cause stress.

When you feel an emotion that triggers stress, your adrenal gland releases epinephrine - the hormone responsible for the flight-or-fight response - and then cortisol. In dangerous situations, this response can save your life. Too much cortisol, however, can have a long-term, negative impact on your metabolic rate, memory formation, and blood sugar regulation.

Stress can take one of three forms:

Acute Stress: The most common form of stress, acute stress is the result of day-to-day stressors, such as waking up late, running to class, or receiving a bad grade. Fortunately, most acute stress fades quickly and has little mental or physical impact.

Episodic Acute Stress: As its name suggests, episodic acute stress develops when a student experiences acute stress multiple times over an extended period. Common symptoms include migraines and tension headaches.

Chronic Acute Stress: Chronic acute stress happens when someone can't avoid a long-term stressful situation. For example, students struggling academically in a major course may develop chronic acute stress, which can lead to weight gain, sleep deprivation, and anxiety.

What Are the Symptoms of Stress in College Students?

When people are exposed to stressors or stimuli that provoke stress, they experience an array of physical, emotional, behavioral, and cognitive reactions. As such, two students might experience stress in very different ways.

Below are some of the various ways stress can manifest in people.

Physical Symptoms: Sweating, increased heart rate or blood pressure, vertigo, shortness of breath, muscle tension, headaches, stomachaches, fatigue

Emotional Symptoms: Hostility, irritability, and other mood changes; increased worrying; feelings of helplessness; loneliness

Behavioral Symptoms: Binge or reduced eating, drug or alcohol misuse, decreased sex drive, erratic sleep habits

Cognitive Symptoms: Memory loss, loss of concentration, negative outlook, dissociation (i.e., disconnection from your thoughts, feelings, and identity)

What Are the Causes of Stress in College Students?

College students respond to stressors in different ways, but some situations are almost always stressful. Here are some of the most common stressors for students.

Finances

Many students work while in school to afford high tuition and housing costs. Unfortunately, part-time jobs typically pay just minimum wage. If you're struggling economically, speak to your financial aid office to see whether you qualify for grants, loans, or work-study.

Homesickness and New Levels of Independence

On top of classes, exams, and meeting people, many students have to deal with growing up. Out-of-state students may be living away from their homes for the first time in their lives, which can easily become a source of constant stress.

Living Among Strangers

Students new to campus life often feel isolated, especially if they're in an unfamiliar city or state. Some students are naturally shy and may find it difficult to make friends.

Cohabitating With Roommates

Many students may not be accustomed to sharing a room with someone else, especially if their roommate is someone they hardly know. This situation can compound the normal stress of college life.

Coursework and Exams

Students often feel overwhelmed by the increased workload associated with college-level coursework. This realization can blindside students and contribute to stress and anxiety. In many classes, exams make up a large percentage of students' grades, causing midterms and finals to be more stressful than normal.

Family Turmoil or Loss Back Home

A 2014 NPR study found that the death of a loved one is the second-highest cause of stress amongst U.S. adults. A death in the family can be extremely traumatic for college students, especially if they live away from home and can't afford to take a break from classes.

Work Schedules

According to a 2013 survey by Citibank and Seventeen Magazine, 4 in 5 students work while attending college. The average student works 19 hours a week. Many learners try to find a job that can accommodate the scheduling concerns associated with full-time education.

Social Obligations

In addition to academic pressures, college introduces plenty of social pressures, such as the idea that you must make tons of friends and party every weekend. Peer pressure and societal expectations can exacerbate stress, especially for first-year students.

Romantic Relationships

Romantic relationships take work. When you and your partner face the stresses of college life, the pressure can feel even greater. Additionally, many students may be in the process of questioning their sexuality and/or gender identity, which can impact dating and relationships.

Can College Stress Lead to Other Health Conditions?

Research shows that stress can lead to the development of many mental health conditions, including depression, anxiety, and substance misuse. It can also introduce physical conditions like chronic pain.

Depression

Depression is a complex mental health condition often caused by a combination of biological, psychological, and environmental factors. Floods of stress hormones can make people, including busy college students, more susceptible to depression.

Anxiety

Severe anxiety can signal an anxiety disorder. This condition, which is especially common among college students, is characterized by physical symptoms, such as muscle tension and shaking, as well as by racing thoughts, feelings of impending doom, fear, excess worry, and irritability.

Sleep Disorders

Sleep disturbances and anxiety often come hand in hand. According to the Anxiety and Depression Association of America, sleep problems can cause or exacerbate anxiety, and vice versa.

Substance Misuse

Some students turn to alcohol or drugs to help manage their stress; however, these dangerous coping mechanisms can lead to substance misuse. A 2018 study by the National Institute on Drug Abuse found that 28% of college students had engaged in binge drinking in the two weeks before the survey was conducted.

Chronic Muscle Pain

For some students, stress can lead to ongoing physical conditions such as chronic neck aches, backaches, stomach aches, and headaches. The National Institutes of Health recommends practicing yoga and meditation to relax your body and release muscular tension.

How to Manage Stress in College: 7 Key Tips

Figuring out what situations might cause stress is only half the battle for college students. Fortunately, there are several tricks you can use to help you avoid getting stressed out, reduce how much stress you feel, and improve your ability to cope with and ultimately eliminate stress.

1. Get Enough Sleep

Getting both quality sleep and enough sleep offers a variety of health benefits, including reducing stress and improving your mood. What's more, students who sleep well are less likely to get sick, have better memory recall, and enjoy a clearer mind.

2. Eat Well

Make an effort to eat nutritious meals and avoid eating on the run so you can avoid indigestion. You may also look for foods that are known to combat stress and boost your mood.

3. Exercise Regularly

In addition to keeping your body healthy, regular exercise releases endorphins and improves your overall cognitive abilities. Exercise can even help you fall asleep, thereby reducing stress. Keep in mind that exercise doesn't need to be strenuous - yoga, short walks, and stretching can all lead to immense mental health benefits and help relieve tension.

4. Don't Rely on Stimulants

Drinking coffee and energy drinks to fuel your late-night study sessions will inevitably lead to a crash later on. These stimulants boost cortisol levels in the body, increasing the physical effects of stress.

5. Set Realistic Expectations

Consistently having too much on your plate can lead to a lot of stress. Try to manage your workload by setting realistic expectations and picking a class schedule that gives you plenty of time to study and relax.

Communication with professors is key - if you're swamped with work, you might be able to get an extension on an assignment by simply asking and explaining your situation.

6. Avoid Procrastinating

Procrastination might feel good in the moment, but it often leads to stress. By managing your time wisely, you can avoid spending all night catching up on coursework. Additionally, habitual procrastination may be a sign of ADHD or anxiety.

7. Identify a Stress Outlet

Stress can never be completely avoided; however, finding a healthy way to reduce stress can go a long way toward keeping it from overwhelming you. Common stress outlets include exercise, spending time with friends and family, and getting massages.

You can also try relaxation techniques such as deep abdominal breathing, concentrating on a soothing word (like "peace" or "calm"), doing yoga or tai chi, and visualizing tranquil scenes.

Where Can Students Go for Help With Managing Stress?

Stress can rise to dangerous levels, threatening students' physical, emotional, and mental health. But nobody has to face stress alone. Here are some organizations and resources you can contact to receive treatment and support for managing stress in college.

On-Campus Mental Health Services

Most colleges offer on-campus (and sometimes virtual) mental health services to students. You can usually find out more about a school's services by going online to its official website.

If you need immediate assistance, contact your school's student services. This department can direct you to appropriate resources, such as mental health clinics, online screening, and individual or group counseling. Taking advantage of these services can improve your mental health, allowing you to thrive academically and socially.

Off-Campus Centers and Hotlines

Schools that can't provide appropriate stress management resources will direct students to use an outside service, such as a local counseling or therapy center.

Other external resources include 24/7 hotlines. The 988 Suicide & Crisis Lifeline at 988 or 1-800-273-8255 gives students space to talk with trained professionals about suicide ideation and conditions such as severe stress, depression, and anxiety.

Similarly, The Trevor Project offers many support services, including a 24/7 crisis counseling center and hotline, for LGBTQ+ students experiencing stress and other mental health challenges. For help, text START to 678678.

Once these professionals identify the underlying issue, they connect students with a long-term solution, such as a psychiatrist or substance misuse prevention group.

Frequently Asked Questions About Managing Stress in College
DISCLAIMER: The information provided on this website is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment; instead, all information, content, and materials available on this site are for general informational purposes only. Readers of this website should consult with their physician to obtain advice with respect to any medical condition or treatment.

# data[].attributes.attachment_link.title
The Student's Guide to Managing Stress | BestColleges

# data[].attributes.attachment_link.description
Stress levels in college students may be on the rise, but there are many ways to combat it. Get helpful tips for managing stress in college.

# data[].attributes.attachment_link.readable_text
Nobody doubts that our culture influences our sexuality and sexual expression. Germany seems to be a hotbed of pantyhose fetish Web sites, Japan has raised the schoolgirl uniform to high art, and male parliamentarians getting spanked can sometimes seem as British as high tea at Harrods.

But our cultural influences are not always good for us. That's part of the "moral values" debate we've been having in this country for 20 years or so. The question is, what can we do to keep the culture from harming us? How can we resist the worst bits of it, and embrace the best?

While reading through some research on sex recently, one of the studies I encountered popped out at me. It raised the question "What is the problem with sex?"

Problem?

Sex is one of the most basic and fulfilling things we do. At least it should be. Assuming we're not suffering from biological or health trouble, sex is a problem only when it clashes with the culture we're in.

Sometimes these clashes can be personally dramatic. Last fall, in a psychiatric journal, British researcher and clinician Nilamadhab Kar described the cases of two men suffering from a condition known in the countries of South Asia as koro.

One, Kar wrote, "presented with the complaints of gradual retraction of penis and scrotum into the abdomen. He had frequent panic attacks feeling that the end had come. ... During exacerbations he spent most of his time measuring the penis by a scale and pulling it in order to bring it out of abdomen. He tied a string around it and attached it to a hook above to prevent its shrinkage during night."

Koro, the anxious feeling that your penis is retracting back into your body, is often described as a "culture-bound" psychiatric disorder. Sometimes, episodes of koro come in waves, almost epidemics. Some victims believe that if the penis shrinks far enough into their bodies, they'll die.

Dhat syndrome is another so-called culture-bound disorder. Victims of dhat syndrome come to believe that semen lost during sleep, through masturbation, or by having sex, is literally draining them of life force. They can feel lethargic or weak. Some have great sexual performance anxiety.

Dhat is thought to be culturally bound to the Indian subcontinent and Sri Lanka (you can find a variety of curatives sold there), but the idea of a loss of vigor developing from a loss of semen is very old and not confined to South Asia. Lord Baden-Powell, founder of the Boy Scouts, believed that losing semen through masturbation made boys weak, sickly, pale. It "quickly destroys both health and spirits; he becomes feeble in body and mind and often ends in a lunatic asylum."

From Sri Lanka to the locker room
Whether or not dhat and koro are truly "culture-bound" is open to debate. There have been reports of European men suffering from koro after smoking too much dope, for example, and if my junior high track coach is any indication, the idea behind dhat is just about universal. I can still hear his barked orders telling us that if we masturbated within a couple weeks of a meet, we'd barely be able to lift the shot put.

Don't miss these Health stories

1. More women opting for preventive mastectomy - but should they be?
Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

2. Larry Page's damaged vocal cords: Treatment comes with trade-offs

3. Report questioning salt guidelines riles heart experts

4. CDC: 2012 was deadliest year for West Nile in US

5. What stresses moms most? Themselves, survey says

Still, both phenomena, especially in their pathological form, do seem to be more prevalent in Asian culture. The culture somehow makes men susceptible to them.

But you needn't seek out far away lands to find just how important culture is to sex. Dionne P. Stephens, a psychologist at Florida International University, has examined the subculture of American hip-hop and how it influences the "sexual scripts," or expectations and behavior, of African-American girls. She argues that girls too often wind up being labeled "freak, gold digger, diva and dyke."

"Clearly, the fact that sexuality is so central in African-American women's scripts within their youth culture is particularly problematic," she writes. "Sexuality remains a commodity within this paradigm, where it is projected as the most powerful instrument that adolescent African American women have for negotiating interpersonal relationships and daily discourses in American society. This continuing physical, emotional, and verbal assault from their potential partners, Hip Hop culture, and broader society reinforces the importance of dismantling the frameworks upon which these sexual scripts are supported."

Dismantling a framework is tough, though. Even modern, mature, middle-aged American women (and no doubt men, too) behave to some degree according to culture.

Back in 1994, a giant research project called Study of Women's Health Across the Nation (SWAN) began collecting all sorts of health data on American women. When the researchers crunched the numbers from SWAN, they found that the sex middle-aged women had, and how often they had it, depended, in part, on their ethnic heritage.

"It suggests something about cultural patterns in groups leading to differences," in behaviors and attitudes, Virginia Cain, lead author of the study, says.

For example, Caucasian women were much more likely to masturbate than were African-American, Hispanic, Chinese or Japanese women. Almost half of Hispanic women engaged in oral sex once per week or more, but only 10.5 percent of Chinese women did. Just over 70 percent of African-American women had intercourse once per week or more; 41.5 percent of Japanese women did.

Cracking the mold
It wasn't just differences in the menu of sex acts, but the deeper importance of sex that distinguished ethnic groups. Women also varied in the amount of emotional satisfaction they received from sex, how often they became aroused, even how often they desired it.

Cain doesn't say what any of this means, whether it's good or bad, only that it has meaning. How cultural norms and expectations come about and how they change, she says, needs more research.

But people can and do crack the mold, Cain says. "It is clear that changes can occur; norms in health practices change over the years and they are learned. One way or the other it is entirely possible to break out of them. The challenge is to figure out the best ways to do that."

The question for each of us is to decide for ourselves how much guidance we wish to take from our culture and our backgrounds in the way we live our sexual lives. Making a conscious choice, not simply reciting from a canned "script," can be key to a fulfilling sex life.
Brian Alexander is a California-based writer who covers sex, relationships and health. He is a contributing editor at Glamour and the author of "Rapture: How Biotech Became the New Religion" (Basic Books). Sexploration appears every other Thursday.

# data[].attributes.attachment_link.title
When society gets in the way of sexuality

# data[].attributes.attachment_link.description
Nobody doubts that our culture influences our sexuality and sexual expression. Germany seems to be a hotbed of pantyhose fetish Web sites, Japan has raised the schoolgirl uniform to high art, and male parliamentarians getting spanked can sometimes seem as British as high tea at Harrods.

# data[].attributes.body
The epitome of sexual harassment

# data[].attributes.body
#MeToo Movement

# data[].attributes.attachment_link.title
The #MeToo movement goes planetary nebula

# data[].attributes.attachment_link.readable_text
Sexuality refers to a person's habits and preferences in terms of sexual behavior and desire. There are as many individual expressions of sexuality as there are individual preferences for dress or music. Some people may experience confusion or distress regarding some aspects of their sexual behavior or desired sexual behavior and seek help from a licensed mental health professional.

Sex therapists, counselors who are trained to help people work through any sex-related issues, may be a good choice for individuals who have questions or concerns about their sexuality or sexual activity. With the help of a sex therapist, many individuals are able to enhance or restore their enjoyment of physical intimacy.

Understanding Human Sexuality

The concept of sexuality is complex and personal and usually entails more than just sexual activity. An individual's personal definition of sexuality may include their feelings of attraction toward others, how they choose to be intimate with others, feelings relating to body image, and personal values. Sexuality can be expressed and experienced in a variety of ways, through thoughts, fantasies, behaviors, roles, and relationships. Further, although an individual's sexuality may be influenced by their gender, orientation, and identity, these are distinct concepts. An individual's sex refers to the sex that was assigned at birth based on physical anatomy, while gender identity refers to one's internal knowledge of being male, female, non-binary, or other gender. Sexuality is also different from sexual orientation, which refers only to the type of sexual attraction that a person experiences.

Sexuality can be considered a developmental process, as it typically changes and evolves over the course of one's lifespan. In early childhood, a child often explores their own body and learns about love and intimacy through their relationships with primary caregivers. Children may engage in sexual play during later childhood (between age 4 and 8), often by playing "doctor." During the adolescent stage, an individual experiences puberty and may start experimenting with masturbation and other forms of sexual exploration, becoming sexually active in the teenage or young adult years. In young adulthood, an individual's sexuality continues to develop, and it is common in many cultures for an individual to begin thinking about choosing a long-term partner. The desire for sex may decline during older adulthood, though many people do maintain the desire for sex and other intimate physical contact.

How Does Culture Relate to Sexuality?

An individual's sexuality is likely to be largely influenced by their culture. In fact, some researchers believe sexuality is determined more by one's environment than by genetics, and what is considered "normal" varies greatly by culture, religion, and historical period. Societies have different norms (and in some cases, even different laws) about premarital sex, non- heterosexual relationships, masturbation, monogamy, and sexual desires and practices. Sex therapist Jill Denton explains, "Each of us possesses a unique model of sexuality, formed at least in part by incoming family messages, childhood abuse or neglect, culture, the media, and, of course, religious influences," and sometimes these messages can prevent or disrupt the development of healthy intimacy.

Socialization to the sexual norms of one's culture generally begins at a young age through messages received from parents, the media, sexual education classes, and religious teachings. The prevailing views on sexuality in any society are influenced by religion, philosophy, history, and various other factors. In the United States, for example, religion has had a great impact on sexuality, though in recent years media outlets have increasingly offered a number of varying viewpoints, influencing ideas and beliefs about what is sexually acceptable and what is taboo.

While there is no single culture that views sexuality the "right" way, problems can emerge when an individual's sexuality does not fit into the norms of their culture. For example, an individual who is attracted to others of the same gender may experience shame or guilt if they are part of a culture in which only heterosexual relationships are considered acceptable. In such a case, an individual may become internally conflicted over whether to conform to cultural norms or follow their own wishes and desires in spite of likely stigma or prejudice. This struggle may in turn lead to sexual concerns or difficulty that can often be addressed with the help of a compassionate and affirming therapist.

Issues Linked to Sexuality

Sexual intimacy can be one of the most satisfying and fulfilling experiences, but for some people, sexual activity is devoid of pleasure. Often, sexual issues are a result of negative feelings or traumatic experiences that prevent a person from being able to fully participate during sexual intimacy. Sex therapist Jill Denton explains, "Each of us possesses a unique model of sexuality, formed at least in part by incoming family messages, childhood abuse or neglect, culture, the media, and, of course, religious influences," and sometimes these messages can prevent or disrupt the development of healthy intimacy.

Sexual problems can also surface as a product of another mental health issue, such as depression or anxiety, or they may be derived from physical conditions, such as bowel or urinary problems, chemical imbalances resulting from certain medications, or, for women, changing hormonal levels resulting from menopause or childbirth.

Sexual problems are not uncommon. Estimates of prevalence for adults in the United States range between 30% and 45%, depending on gender and age. Some of the most common concerns reported by those seeking therapy include:

Anxiety about sex

Impotence

Lack of sexual desire

Anxiety or uncertainty about sexual orientation

Conflicting sexual desires between partners

Recovery from sexual abuse or sexual assault

Loneliness

Body image issues

Sexual impulses or compulsions that cause distress

Promiscuity

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ( DSM-5) lists three diagnosable sexual disorders for females and four for males, though these gender-specific categorizations have been criticized. Recent research indicates sexual interest/arousal disorder is not exclusive to individuals designated female at birth, and the addition of a gender-neutral category has also been proposed.

Female sexual disorders

Sexual interest/arousal disorder

Orgasmic disorder

Genitopelvic pain/penetration disorder

Male sexual disorders

The DSM lists a number of paraphilias -sexual preferences for atypical behaviors-as being potentially problematic when specific criteria are met. A paraphilia might qualify as a paraphilic disorder when recurring personal psychological distress is associated with the behavior or when the distress or injury of another non-consenting person or group results from the behavior. Paraphilias that are acted out between consenting adults are not indicative of mental disorders.

Paraphilias listed in the DSM-5 include:

Fantasies associated with these behaviors are not necessarily cause for concern, unless the person experiencing the fantasy finds them distressing. In fact, most of these behaviors can be explored in a healthy, safe way between willing partners; they are considered problematic only when someone is harmed psychologically or physically by the act.

Addressing Sexuality in Therapy

Sexual intimacy is, for many, a highly satisfying and fulfilling experiences. For some individuals, however, sexual activity is void of pleasure, and this state may be temporary or last throughout life. Some people simply have no desire for sex, and this causes them no distress. Others are negatively impacted by issues relating to sex, and sexual energy, or lack thereof, may have a profound effect on their mood, thoughts, and general state of being.

When a person feels their sexual concerns or questions might be deemed inappropriate by partners, family, and friends, they may experience anxiety, frustration, and even shame, feelings that may lead to further distress. When this is the case, therapy may be of benefit, and finding the right therapist can offer a person a safe place to talk about any difficulties, fantasies, fears, memories, or desires regarding sexuality.

Sex therapists, psychotherapists who are specifically trained to help individuals and couples identify the source of sexual distress, deal with sexual issues, and/or reduce or remove emotional barriers in order to enhance sexual experiences, have experience treating issues related to:

Desire and arousal

Performance

Satisfaction

Sexual trauma/abuse

Sex addiction

Pain that occurs during sex

Conflict or confusion over sexual orientation

A wide range of interventions might be used in sex therapy, such as the exploration of sexual fantasies, mindfulness practices to help people become more fully present during sexual activities, education about sex, exploration of negative beliefs that impede sexual satisfaction, and the identification of the range of forms of sexual expression. Whether physical symptoms manifests through the inability to achieve orgasm, maintain arousal, or have sex without pain, a sex therapist is often able to help a person identify the psychological source of the symptom. By treating the whole person, psychologically and physically, sex therapists are able to help many individuals achieve improved sexual experiences.

Case Examples

Sexual anxiety resulting from childhood: Donald, 47, has lately been experiencing feelings of anxiety and depression and has found himself drinking more and more alcohol to soothe these feelings. Hoping to achieve improved well-being and address the root of the feelings, he decides to seek counseling. He tells the therapist that he has never had a serious girlfriend, though he desires one and has had a number of casual relationships that, as he puts it, "fizzled out" when they approached the point of intimacy. The therapist's questions about his romantic desires seem to cause Donald some embarrassment, and when the therapist gently inquires further. Donald reveals tremendous feelings of shame about the sexual feelings he experiences. Over a few sessions with the therapist, Donald is able to address these feelings, which relate to his strict religious background and a disturbing childhood experience of witnessing another boy being molested by a teacher. Donald reported the incident, he tells the therapist, but was never given the opportunity to discuss or work through his feelings about what he'd witnessed. Finally able to do so, Donald eventually overcomes his shame and fear and slowly begins to accept his sexual desires as a normal and healthy part of life. His low mood and feelings of anxiety diminish, and he renews his social life and is able to date with confidence, excitement, and a positive outlook.

Uncovering new sexual attractions: Marcia, 34, is beginning to realize she is attracted to women and wants to talk about these new feelings with a therapist who can help her understand them. She reports she is happily married to a man and has no desire to leave him or seek a divorce but is at various times guilty, excited, confused, anxious, and overwhelmed by the new type of attraction she is experiencing. Telling the therapist she has had a number of fantasies about a woman she works with, Marcia further explains she believes the attraction may be mutual and that she is not sure whether to tell her husband or try to ignore the impulses. Therapy helps Marcia examine her feelings, the possible choices before her, and the best ways of communicating with her husband, whom she decides to tell. In a later session, she reports to the counselor that she had a productive talk with her husband and that he is not judgmental and supports her acting on her attraction as long as honesty and communication remain forefront in their marriage. Though Marcia does not conclude how best to proceed with the woman in her office, or other potential partners, she tells the therapist she thinks her relationship with her husband has become stronger as a result of their conversation, and she expresses a sense of confidence and peace with the realization that her attraction is simply a part of her nature, as well as happiness that she is loved and accepted.

References:

1. Alexander, B. (2006, May 25). When society gets in the way of sexuality. NBC News. Retrieved from http://www.nbcnews.com/id/12970326/ns/health-sexual_health/t/when-society-gets-way-sexuality/#.WG8ZJFMrLIV

2. Boundless. (2016). Human sexuality and culture. Boundless Psychology. Retrieved from https://www.boundless.com/psychology/textbooks/boundless-psychology-textbook/gender-and-sexuality-15/sexuality-415/human-sexuality-and-culture-299-12834

3. Brotto, L. A. (2015). The DSM diagnostic criteria for hypoactive sexual desire disorder in men. Retrieved from http://www.dsm5.org/Research/Documents/Brotto%202010.pdf

4. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

5. Gender dysphoria. (2013). American Psychiatric Association. Retrieved from http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf

6. LGBTQ+ definitions. (2017). Retrieved from http://www.transstudent.org/definitions

7. Paraphilic disorders. (2013). Retrieved from http://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf

8. Rosen, R. C. (2000, June). Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports, 2(3). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11122954

9. Sex therapy for non-sex therapists. (2010). Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/shf-therapy

10. Sexuality through the lifespan. (2016). Retrieved from http://www.islandsexualhealth.org/sexual-identity/lifespan

Last updated: 07-25-2017

# data[].attributes.attachment_link.description
Sexuality refers to a person's habits and preferences in terms of sexual behavior and desire. There are as many individual expressions of sexuality as there are individual preferences for dress or music. Some people may experience confusion or distress regarding some aspects of their sexual behavior or desired sexual behavior and seek help from a licensed mental health professional.