In order to discuss sexuality in terms of “adult psychological difficulties” and “healthy adult sexuality,” it is important to take a cultural and cross-cultural perspective. What is normal and healthy in one society, one class, or one segment of a society is not seen as such in other societies or in all segments of a society.
For example, in Freud’s fin de siecle Vienna, the upper classes had different norms and expectations for men and women. Men were expected to choose wives based on how that wife could help them financially and socially and were free (and expected) to express their sexuality via sexual exploits and affairs with women of varying social classes. Upper-class women, however, were expected to be chaste and not enjoy sexual activity. This suppression of their sexuality, or the guilt they felt if they expressed their sexuality, often resulted in the many neuroses that Freud and his colleagues cited.
Sexuality in other cultures, classes, and time periods have very different definitions of what is “healthy” or “normal”. Modern day western society is an obvious example in which, although there are various cultural approbations, for the most part, men and women are free to express their sexuality.
A theoretical approach to adult psychological health in all areas, including sexuality, can be seen in Abraham Maslow’s Hierarchy of Needs, published in 1943. According to Maslow, there is a pyramid of needs that need to be met in order to proceed to higher levels. First, basic physiological needs must be met, such as food, water, sleep, etc. On the next level is the need for safety and security, followed by the need to feel loved and have a sense of belonging. Following that is the need for respect and self-esteem. When all these needs are met, people are self-actualized in all areas of their lives and are healthy adults who can express their abilities and creativity, including having healthy adult sexual relationships.