18th and 19th centuries The tradition of representing illness as a punishment for sin has existed in Western culture since at least the
Age of Enlightenment in the 18th century. In the 19th century this concept of illness as punishment for sin was medicalised into associating so-called perverted sexual traits and behaviors, such as masturbation, with increased morbidity. This was described by a symptom called
spermatorrhoea invented by
William Acton in 1857, at the time used as a medical justification of
celibacy. The first major publication articulating a broad medicalisation of sexuality was the first edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-1). Published in 1952, it reframed behaviors previously viewed as immoral, such as masturbation, low sexual desire and
homosexuality, as treatable; faults of character or morality were instead described as illnesses. Some treatments described in the DSM-1 included commitment to asylums, hormonal treatments,
circumcision and
castration. A cornerstone in the development of psychiatry, the DSM was highly influential and motivated significant
eugenic research in a search for
naturalistic, biological causes of sexually deviant behaviors, such as the so-called
gay gene. Although referring to the same symptoms, impotence was considered to have
psychogenic causes, whereas erectile dysfunction was considered to have organic causes.
Viagra Academic consensus is that the main pharmaceutical product contributing to medicalisation of sexuality was
sildenafil sold by
Pfizer under the
trade name Viagra approved in 1998, the first phosphodiesterase-5 inhibitor (
see phosphodiesterase inhibitor) which became an instant bestseller for treating
erectile dysfunction and largely replaced
selective serotonin reuptake inhibitor (SSRI) treatments for sexual disorders. The economic success of Viagra motivated research for similar products. Public funding for sex research was decreasing during the 1990s and 2000s when corporate funding shifted the focus from nonmedical
sexology and
sex therapy research, to clinical trials and emphasising the concept of sexual dysfunction under a simplified
epidemiological model. One prominent publication in 1999 purported that "female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30% to 50% of women", believed by a later 2012 publication to be the first complete articulation of FSD as a disorder. Behavioral treatments for sex offenders around the 1990s onward have included
aversion therapy, satiation therapy (intended to reduce arousal through overexposure to deviant fantasies) and
cognitive behavioral therapy. Biomedical treatments included hormone suppressants such as
medroxyprogesterone acetate (MPA) normally used for birth control, and
leuprorelin, normally used as a cancer treatment. The term
homosexuality was first used in a medical context in 1869 by
Hungarian doctor
Karl Maria Kertbeny, who argued against the harsh laws and punishments against sodomy in the
Prussian legal code. He argued that it was inappropriate to treat homosexuality as a crime because, in his view, it was
congenital (i.e. innate) rather than acquired; this is considered the first description of homosexuality as a medicalised disorder. Kraft-Ebbing argued that homosexuality and other "sexual abnormalities" were innate, and therefore should be treated therapeutically rather than punitively.
Sigmund Freud however described homosexuality as a natural sexual variation, and considered
homoeroticism as part of a "normal" sexual development. In the 1940s, Freud's followers including
Edmund Bergler,
Irving Bieber, and
Charles W. Socarides took another approach, re-establishing homosexuality as a psychiatric disorder with negative caricatures such as "megalomaniacal, with free floating malice, unreliability and superciliousness". Up until the 1970s, psychiatrists who disclosed they were homosexual were at risk of losing their job and having their
medical license revoked. Fryer stated, "I am a homosexual. I am a psychiatrist", and then explained issues with the APA's medicalisation of homosexuality. – and Fryer's speech has been cited as a key factor in persuading the psychiatric community to reach this decision. Though the term "homosexuality" was removed from the DSM, the underlying condition was still pathologized. To appease both gay activists and advocates of homosexuality remaining a diagnosis, a disorder known as "
sexual orientation disturbance" was introduced in a reprint of the DSM-2 to replace it. In 1980, the DSM-3 replaced SOD with "
ego-dystonic sexual orientation" and reclassified it under a new category of "psychosexual disorders". The 1987 DSM-3-R omitted any direct substitution for homosexuality, replacing EDH with "sexual disorder not otherwise specified" which was defined by "marked distress about one's sexual orientation". This was later removed in the DSM-5 in 2013 without replacement.
Sexuality of transgender people Beginning in the 1950s, clinicians and researchers developed a variety of classifications of transsexualism. These were variously based on sexual orientation, age of onset, and fetishism. Beginning with
Harry Benjamin in the 1960s, transfeminine individuals' sexuality was medicalised and viewed as pathological, to the extent that the sexuality of transsexual individuals was considered a central factor in diagnosis. Initially, these classifications generally divided transgender women into two groups: "homosexual transsexuals" if sexually attracted to men and "heterosexual fetishistic transvestites" if sexually attracted to women. In 1982,
Kurt Freund further expanded this research based on sexual attraction. In the 1980s and 1990s,
Ray Blanchard proposed a
psychological typology of
gender dysphoria,
transsexualism, and
fetishistic transvestism in a series of academic papers, and coined the term
autogynephilia as part of the typology. These studies have been criticized as bad science for failing to sufficiently
operationalize their definitions and as unfalsifiable. They have also been criticized for lacking reproducibility, and for a lack of a control group of cisgender women, while supporters of the typology denied these allegations.
Gender identity disorder (GID) and
gender identity disorder of childhood (GIDC) were introduced in the DSM-3 in 1980. At the time during the internal drafting process, there was criticism from feminist members of the APA, who claimed that research on people assigned male at birth (AMAB) was inapplicable to those assigned female at birth (AFAB). In response to the critiques, different standards were established between AMAB and AFAB children, with AFAB children being excluded from being diagnosed with GIDC if they transitioned for the "perceived advantages" of being male. However, absent from the discussion was prior research indicating a relationship between
gender nonconformity and homosexuality. Later investigation by Jem Tosh has shown that GIDC was based on research which worked under the assumption that treating gender nonconformity in feminine AMAB children would prevent them from becoming homosexuals as adults. This was desirable, as adult homosexuality was seen as more difficult to change. This bias in research has been argued to reinforce a narrow, medicalised model of sexuality on transgender people focussed on individual sex acts unrepresentative of the population being studied. and , medicalisation continues to be a dominant factor surrounding HIV. Chemoprevention, also known as chemoprophylaxis, is the use of medication to prevent a disease an individual does not have. , chemoprevention remains a controversial for HIV prevention.
Intersex people Medical surgery to normalise intersex bodies within a
gender binary has been conducted since at least the 19th century, and has been influenced by both medicalisation of homosexuality and transsexuality. Intersex people have also been routinely used as subjects for psychological experimentation to study sexuality since the mid-20th century. == Criticism ==