ABSTRACT
El artículo describe la psicología dinámica institucional cuyo fundamento es reciente y se ha desarrollado mediante la modificación de esquemas convencionales de abordaje. La propuesta pretende ofrecer una comprensión del fenómeno psíquico y su asociación con los eventos biológicos, así como analizar y entender las reacciones afectivas sin que necesariamente se les ubique en cualquiera de las dos: psíquica o biológica. Se sustenta una teoría de la técnica orientada tanto a las necesidades de la población que se atiende, así como de los objetivos que conforman la misión de la institución, y con ello, las disyuntivas a las que el psicoterapeuta institucional se enfrenta. El reto es la conciliación de objetivos terapéuticos en torno a las necesidades de la población y la misión de la institución. Por último, el artículo propone generar un modelo a manera de matriz que nos oriente en cada situación y para ello, resulta fundamental la investigación que permita comprender el valor simbólico que posee el fenómeno y su evolución.
The article describes the Institutional Dynamic Psychology, whose foundation is recent and has been achieved by modifying approach conventional schemes. The proposal aims to provide an understanding of psychic phenomena and their association with biological events, analyze and understand the emotional reactions without necessarily locate them in any of the two positions. This document sustained a theory of the technique oriented to solved both; the necessities of the attended population, and adjust to the objectives conformed in the mission of the institution, dilemmas that institutional psychotherapist faces and having as a challenge to conciliate both therapeutic objectives of the population attended. Finally, the article suggests a model in form of a matrix that may orient us in each situation but further investigation, including understanding of the symbolic value of the phenomenon and its evolution is necessary.
ABSTRACT
Background At the Department of Psychology of the National Institute of Perinatology Isidro Espinosa de los Reyes (INPerIER) -a medical unit specialized in reproductive problems-, a line of investigation on human sexuality was opened due to the high numbers of patients with some kind of problem in their sexual lives. We have been performing exploratory studies where we have found a high prevalence of sexual disorders, i.e. 52% in women and 38.8% in men, in addition to other comparative studies. These studies revealed that people with disturbances in their sexual life were in a disadvantageous position when considering factors such as self-concept, assertivity, levels of anxiety, marital satisfaction, style of communication and marital communication, when compared to population not showing sexual problems. This brought us to the conclusion that the presentation of one or more sexual disorders is a risk factor that deserves exhaustive studies from the psychological point of view. Our studies, made in groups of men and women showing sexual disorders, lead to the need of studying risk factors related with every sexual disorder. We have a hypothesis that not all disorders show in a similar manner and that it is in the different combination of factors where the specificity to provide elements that can help improve intervention plans lies. Objective The general objective of this work was to identify the frequency, differences, relationships and combinations between the feminine sexual dysfunctions known as sexual pain disorders: dyspareunia and vaginismus, and some intervening variables. These were gender role and self-esteem (psychological factors) and background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems), in order to create a profile of each one of these sexual disorders so that it provides elements for intervention plans. Material and methods This was a non-experimental, transversal, retrospective field study with a correlational-multivariate design and an independent sample divided into three groups with individuals selected by intentional sampling according to pre-established quotas. This work belongs to a wider research study of some risk factors found in male and female sexual dysfunctions, whose original sample consisted of 400 participants; out of this group we selected only participants with dyspareunia and vaginismus and they were compared with the same number of participants who showed no sexual disorder. So, the sample classification remained as follows: Group 1, no sexual dysfunctions; group 2, with dyspareunia, and group 3 with vaginismus. Women participating are frequent attendees of the National Institute of Perinatology (INPerIER) and had to meet all the inclusion criteria. For the allocation into groups and the collection of sexual background data we used the codified clinical history for female sexuality (CCHFS). Measurement of personality factors was performed with the Masculinity and Femininity Inventory (MFI) and with Coppersmith's self-esteem inventory. A questionnaire on sexuality and the other instruments was provided and filled in one single session at the outpatient room. For the analysis of results, we used central tendency measurements to describe controlled socio-demographic factors such as age, civil status and schooling. The statistical analysis consisted on determining the frequency of the presence of sexual dysfunctions within the group of women with sexual dysfunctions, out of which we got the patients presenting dyspareunia and vaginismus for group allocation. Then we made an analysis to compare the groups. The first group was set to be the one with no dysfunctions, the second one with dyspareunia and the third one with vaginismus, in order to get the significative differences and the relationship between groups and personality factors under study (gender role and self-esteem); for these we used the t-Student test and ETA coefficient. For the analysis of sexual background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems) and their relationship with dysfunctions, we used X² and Cramer's V. Factors resulting related were used to perform a discriminant analysis so as to propose explanational profiles; all variables found to be related, psychological factors and sexual background were included in the analysis. Statistical data analysis was made with the software SPSS version 11. Results The description of the samples shows a normal distribution with an average for groups of age and schooling as follows: for group 1, age 31.9±5.32, years in school 10.9±3.17; for group 2, age 32.7±5.54, years in school 10.2±2.8; and for group 3, age 33.7±3.1, years in school, 9.9±2.5. From every statistical analysis variables were isolated and personality factors studied, indicating women with dyspareunia showed a decrease in masculinity features and in their levels of self-esteem, and an increase in submissive features, when compared to women with no sexual dysfunctions. As to the analysis of the results of sexual background, in the dyspaurenia group we found a relationship with conjugal problems, suggesting these variables have a significant intervention in the presence of dyspaurenia during women's adult life. The discriminant analysis launched a factor out of four variables, with 75.9% of the cases correctly classified, demonstrating that women with dyspaurenia within this percentage have related indicators, discriminating variables constituting an explanational approximation. Results of the group of women with vaginismus indicate a decrease in the self-esteem feature and an increase in the submissive features. Analysis of sexual background showed a relation between women with vaginismus and sexual fears, a decrease in sexual information and presence of conjugal problems. Described background data have a significant intervention in these women's adult life. The discriminant analysis launched a factor out of five variables, with 84.1% of the cases correctly classified, demonstrating that women with vaginismus within this percentage have these related indicators, discriminating variables constituting an explanational approximation. Conclusion The isolation of variables with the purpose of detecting the factors related to the presence of the two sexual disorders, dyspareunia and vaginismus, has as its main target to provide indicators of risk that facilitate the creation of intervention plans, in order to avoid making generalizations for the handling of sexual disorders.
Antecedentes En el Departamento de Psicología del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPerIER), se encontró una alta prevalencia de disfunciones sexuales: 52% en las mujeres y 38.8% en los hombres, además de que otros estudios comparativos indican que la población que presentó alteraciones en la vida sexual mostró siempre desventaja en factores como el autoconcepto, la asertividad, la satisfacción marital, el estilo de comunicación y la comunicación marital, en comparación con la población que no presenta problemas sexuales. Por esto es necesario estudiar factores de riesgo relacionados con cada una de las disfunciones sexuales, bajo la hipótesis de que no todas se comportan igual y es en la diferencia de la combinación de factores donde se encuentra la especificidad que puede aportar elementos que mejoren los planes de intervención. Objetivo Identificar la frecuencia, la diferencia, la relación y la combinación entre las disfunciones sexuales femeninas (dispareunia y vaginismo) el papel de género y la autoestima (factores psicológicos), y algunos antecedentes sexuales (experiencia sexual infantil traumática, información sexual, temores a la sexualidad, masturbación y problemas conyugales) para generar un perfil de cada una de estas disfunciones sexuales que aporten elementos para los planes de intervención. Material y método Estudio no experimental, de campo, retrospectivo, transversal, con un diseño correlacional-multivariado de una muestra independiente dividida en tres grupos, seleccionados mediante un muestreo intencional por cuota. Este trabajo forma parte de una investigación más amplia sobre el estudio de algunos factores de riesgo en las disfunciones sexuales femeninas y masculinas, cuya muestra original constó de 400 participantes. De éstos sólo se tomaron las participantes con dispareunia y vaginismo las que se compararon con el mismo número de participantes que no presentaron ninguna disfunción sexual. Las muestras quedaron clasificadas de la siguiente manera: Grupo 1: sin disfunciones sexuales, grupo 2: con dispareunia y grupo 3: con vaginismo. Las participantes asisten al INPerIER y debieron cubrir todos los criterios de inclusión. Para la clasificación de los grupos y de los antecedentes sexuales se utilizó la Historia Clínica Codificada de la Sexualidad Femenina (HCCSF). Se utilizó el Inventario de Masculinidad y Feminidad (IMAFE), y el Inventario de Autoestima de Coopersmith. Él análisis estadístico se realizó con la prueba t de Student, el coeficiente ETA, la X² y una V de Cramer. Finalmente se aplicó un análisis discriminante para proponer los perfiles explicativos. Se trabajó con el paquete estadístico SPSS versión 11. Resultados Se encontró una distribución normal. Los resultados indican que las mujeres con diapareunia presentan una disminución en las características de masculinidad y los niveles de autoestima y un incremento en las características de sumisión, así como relación con problemas conyugales. En el grupo de mujeres con vaginismo hay disminución en la autoestima, incremento en las características de sumisión, relación con temores a la sexualidad, con una pobre información sexual y problemas conyugales. En los demás factores no se encontró relación. Conclusiones El aislar variables para detectar factores relacionados con la presencia de estas dos disfunciones sexuales, tiene como objetivo final descubrir indicadores de riesgo que puedan facilitar los planes de intervención con una mayor especificidad y no hacer generalizaciones de manejo para todas las disfunciones.
ABSTRACT
The systematic study of sexuality is relatively recent if we consider the works of Freud and Kinsey and the studies performed during the first half of the XXth century. The fact of undertaking the sex problem has allowed an even deeper understanding of this phenomenon, by all means complex. Later on, Masters, Johnson and Kolodny created the model of human sexual response and its alterations. Kaplan's works as well as Labrador and Crespo's are directed to conceptualize the etiology of sexual dysfunctions as phenomena evolving from both recent and remote causes, i.e., they can be explained as multi-causal events. At the Department of Psychology of the National Institute of Perinatology (INPerIER), we have detected a high proportion of couples with problems in their sexual lives. The prevalence of sexual dysfunction found was 52% in women and 38.8% in men. Therefore, we decided to initiate a line of investigation on human sexuality, to which this work belongs. The aim was to identify the frequency, difference, relation and combination of three sexual dysfunctions: erectile dysfunction, male orgasmic disorder and precocious ejaculation, as well as some intervening factors that were divided in two types. a) Personality factors, including gender role: prescriptions, norms and expectations according to rules set by the society which are introjected by the individual. When the expression of masculinity and femininity polarizes reaching machisms and submissive behavior, this can result in a negative influence for the development of sexuality. Another personality factor is the level of self-esteem, which greatly determines the conduct of individuals and is defined as the personal judgment of value towards oneself; it is expressed in the form of attitudes of the individual towards himself. b) The existence of some sexual background such as the report of having suffered child traumatic experience of sexual abuse; availability of sex information; presence or absence of sex fears; masturbation during adolescence and absence or presence of conjugal problems. It must be said that the division of intervening factors into types allowed us to propose profiles for the indicators related with the presence of the aforementioned male sexual dysfunctions. These dysfunctions are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Material and methods This was a non-experimental, one-sample, retrospective, transversal, multivariate-correlational field study of independent observations, with samples allocated in two groups. Samples We got non-probabilistic samples from couples of patients recently accepted for service at the institution, according to pre-established quotas. Sample size consisted of 200 men, with 100 men showing no sexual dysfunction (group 1) and 100 men with evidence of sexual dysfunction (group 2). Results of erectile dysfunction, male orgasmic disorder and precocious ejaculation are presented here; they were compared with the same number of participants showing no sexual dysfunction. Participants were limited to individuals who met the following criteria: age range, 22 to 45 years old; elementary school as the minimum schooling; no history of mental illness or chronic disease that could condition the presence of male sexual dysfunctions. Socio-demographic factors controlled in this study included age, civil status and schooling; the classification variable was set to be the presence of male sexual dysfunctions. Instruments For the classification of groups, in order to detect the type of dysfunction present, and for the sake of capturing sexual background data, we used the male version of the questionnaire of sexuality, based on the codified clinical history for female sexuality. For the measurement of gender role, we used the Inventory of Masculinity-Femininity (IMAFE), which measures four orientations: male, female, machismo and submission. For the measurement of self-esteem we used Coopersmith Self-Esteem Inventory, and the validation technique suggested by Lara, Verduzco, Acevedo and Cortés. Participants were approached at the external consultation area at the INPerIER. Instruments described above were applied as well as clinical histories obtained in one single session, individually, once the participant had signed the informed consent letter required by the Committee of Ethics of the INPerIER. Results The most frequent dysfunction detected was precocious ejaculation, which was present in 48 participants. Thirty four men were reported with erectile dysfunction and 15 men showed male orgasmic disorders. In a previous article, we presented the results of hypoactive sexual disorder, the sexual dysfunction more frequently found (55 male participants reported it). In this case we observed that out of 100 participants studied, the overall number of dysfunctions found was 152, including hypoactive sexual disorder, which can be interpreted as one and a half dysfunctions per man. For the sake of establishing the relationship of each sexual dysfunction with personality factors, we estimated the ETA coefficient. In the case of the relation between sexual dysfunctions and sexual background we calculated Cramer's V. Once we established the relations between the personality factors and the background that were used to develop profiles, we performed a discriminant analysis, which included all variables we found related and we came out with the following results: For erectile dysfunction we found a relation with three variables: negative relation with femininity and self-esteem, and positive relation with conjugal problems. In the case of the male orgasmic disorder, we found a relation with five variables: negative relation with femininity and self-esteem, and positive relation with child sexual traumatic experience, masturbation and conjugal problems. In the case of precocious ejaculation, we detected a relation with four variables: negative relation with masculinity, femininity and self-esteem, and positive relation with conjugal problems. The relations that became evident in every dysfunction showed that in this proportion, the discriminant variables provided us with an approximate explanation. Discussion The frequency of sexual dysfunctions can be described as high. The analysis of the results made evident that two factors are always present in these sexual dysfunctions: a tendency to show low self-esteem and the presence of conjugal problems. Alongside the different dimensions of gender roles, there is a decrease of the masculinity features in the case of precocious ejaculation; the reduction of femininity features is found in the three dysfunctions under study. There is a tendency to inhibition of both the sexual expressions and the affective expressions (femininity features), which are found combined in the case of precocious ejaculation, combined as well with a decrease of the masculinity features. When it comes to the sexual background, we observed that the history of child sexual traumatic experience is a risk indicator for the orgasmic disorder, as well as the report of practicing masturbation during adolescence. We can infer from this that this can be due to the type of masturbation limited to a biological discharge and not to the exploration addressed to a self-knowledge of the body. Another indicator present only in the orgasmic disorder is the fear of sexuality. It can be observed that the sexual dysfunction that presents more indicators is the male orgasmic disorder. For what we explained here, it becomes relevant to develop integral intervention plans for the adequate exploration of indicators related to these dysfunctions.
El estudio sistematizado de la sexualidad es relativamente reciente y ha permitido una comprensión más profunda de este fenómeno, por demás complejo. Masters, Johnson y Kolodny generaron el modelo de la respuesta sexual humana y sus alteraciones, o sea, las disfunciones sexuales. Los trabajos de Kaplan y de Labrador y Crespo han conceptualizado la etiología de las disfunciones sexuales como fenómenos que se deben tanto a causas recientes como remotas. En el departamento de Psicología del Instituto Nacional de Perinatología (INPerIER), la prevalencia encontrada de disfunciones sexuales fue, en las mujeres, de 52%, y de 38.8% en los hombres, por lo que se generó una línea de investigación de sexualidad humana de la cual forma parte este estudio que tiene por objetivo identificar la frecuencia, la diferencia, la relación y la combinación entre tres disfunciones sexuales masculinas: el trastorno de la erección, el trastorno del orgasmo y la eyaculación precoz, y algunos factores intervinientes: a) factores de personalidad, como el papel de género y el nivel de autoestima y b) algunos antecedentes sexuales, como son el reporte de haber sufrido una experiencia sexual infantil traumática, el tener o no información sexual, la presencia o no de temores a la sexualidad, masturbación durante la adolescencia y el tener o no problemas conyugales, y así proponer perfiles de los indicadores relacionados con la presencia de estas disfunciones sexuales clasificadas en el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV-TR). Material y método Diseño correlacional-multivariado, de una muestra dividida en dos y de observaciones independientes, fue un estudio no experimental de campo, retrospectivo y transversal. Muestra Se capturó una muestra no probabilística de las parejas de las pacientes recién aceptadas en el INPerIER para su atención mediante un muestreo intencional por cuota. La muestra fue de 200 hombres, 100 sin disfunciones sexuales (grupo 1) y 100 con disfunciones sexuales (grupo 2) de los cuales se presentan los resultados del trastorno de la erección, trastorno orgásmico masculino y eyaculación precoz que se compararon con el mismo número de participantes que no tuvieron ninguna disfunción sexual. Los participantes debieron cubrir con los criterios de inclusión: edad de 22 a 45 años, educación mínima de primaria, sin diagnóstico previo de enfermedad mental o crónica que pudiera condicionar la presencia de disfunciones sexuales. Los factores sociodemográficos controlados fueron: edad, estado civil y escolaridad; la variable de clasificación fue la presencia de estas disfunciones sexuales masculinas. Instrumentos Para detectar el tipo de disfunción y la captura de los antecedentes, se utilizó el Cuestionario de la Sexualidad versión para Hombres. Para la medición del papel de género se utilizó el Inventario de Masculinidad-Feminidad IMAFE. Para medir la autoestima se utilizó el Inventario de Autoestima de Coopersmith, validación mexicana. Resultados La disfunción más frecuente fue la eyaculación precoz, reportada por 48 participantes, 34 reportaron trastorno de la erección y 15 trastorno del orgasmo. Las relaciones se realizaron con el coeficiente ETA y con la V de Cramer, además de un análisis discriminante. Se encontró en trastorno de la erección relación negativa con feminidad y autoestima y positiva con problemas conyugales. En trastorno del orgasmo, relación negativa con feminidad y autoestima y positiva con experiencia sexual infantil traumática, masturbación y problemas conyugales. En eyaculación precoz, relación negativa con masculinidad, feminidad y autoestima y positiva con problemas conyugales.