Male and Female Sexual Dysfunction in a Rapidly Changing Cultural Environment: Addressing Gender Equality versus Equivalence in the Bedroom

IntroductionThe socio-sexual climate in Western cultures is changing at an astounding rate. Never before have societal expectations about gender roles shifted so radically, transforming our understanding of what it means to be a sexual man or woman today. We have observed that confusion regarding masculine and feminine roles within long-term committed relationships can represent challenges for the treatment of sexual dysfunction. Despite the relevance to sexual medicine, sexual medicine specialists have largely avoided this controversial topic.AimTo review the current literature relating to heterosexual gender roles and sexual intimacy, to offer perspective and context on this issue, and to propose an approach to the man, woman, or couple based in evolutionary theory that we have found useful in our extensive clinical experiences.MethodsWe reviewed the English-language peer-reviewed literature, primarily from 2000 through 2015, that addressed the impact of heterosexual gender role expression on sexual intimacy in long-term committed relationships.Main Outcome MeasuresMain outcomes include a review of the applicable literature and an assessment of the literature’s relevance for patients and practitioners of sexual medicine. An alternative context for understanding heterosexual gender expression grounded in evolutionary theory is provided, as is a new treatment perspective based on our work as a sex therapist and an urologist.ResultsThe impact of gender expression on sexual experience might be impossible to ascertain fully because it is difficult to quantify in research, independently and especially in combination. Furthermore, existing research is fraught with challenges and inadequacies.ConclusionAlthough we acknowledge and affirm the critical importance of gender equality, modern conceptualizations of gender in the literature ignore pertinent evolutionary adaptations and might be minimally applicable to sexual medicine patients. More research is needed. We propose that equality of genders does not necessarily mean similarity of genders, at least in sexual medicine.