On the etiology of sexual dysfunction.

Lack of consideration of the sexually functional population has led to misconceptions about the causes of both sexual dysfunction and sexual functioning. Although observation of the dysfunctional population appears to indicate that performance anxiety is the first-order cause of dysfunction, it is proposed that in the functional population performance anxiety has the opposite effect, generating automatic functioning rather than dysfunction. The first-order cause of dysfunction is then whatever causes this differential response to performance anxiety, conceivably an inability or unwillingness to bypass pathogenic influences. Thus automatic functioning can mask the effects of all pathogenic influences on sexuality, making these effects appear random, confounding etiological issues and creating the belief that the causes of the sexual dysfunction and sexual disorder cannot be specified.