Table of ContentsView AllTable of ContentsTypesCausesDiagnosisTreatmentCopingFAQs
Table of ContentsView All
View All
Table of Contents
Types
Causes
Diagnosis
Treatment
Coping
FAQs
Sexual dysfunction is the persistent difficulty engaging in sexual activities. It may involve a physical problem that interferes with a person’s ability to engage in any stage of the normal sexual response, from arousal to climax, and/or a psychological issue that diminishes a person’ssex driveor response to sexual stimulus. Oftentimes, multiple factors are involved.
The article describes the different types of sexual dysfunction a person might experience and the underlying causes. It also explains how sexual dysfunction is diagnosed and treated.
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Types of Sexual Dysfunction
“Sexual dysfunction” is a broad term that is open to interpretation. The World Health Organization (WHO) defines it as “a person’s inability to participate in a sexual relationship as they would wish.”
The American Psychiatric Association in theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) takes a more exacting approach, stating that a person must feel extreme distress and interpersonal strain for a minimum of six months before sexual dysfunction is diagnosed.
Sexual dysfunction often involves a complex interplay of physical and psychological concerns, and it can be difficult to separate the concerns into individual categories.
Sexual Desire Disorders
Sexual desire disorders involve a lack of sexual desire, libido, or sexual fantasies. Also known ashypoactive sexual desire disorder (HSDD), the condition can manifest in sexual apathy (indifference) or an outright aversion to sex.
Two sets of features can characterize HSDD, as follows:
As such, a person may be diagnosed as having acquired situational HSDD, lifelong general HSDD, or lifelong situational HSDD, each of which is treated differently.
Sexual desire disorders are diagnosed when symptoms persist for at least six months and cause significant distress.They differ between females and males in underlying causes and features.
Sexual Arousal Disorders
In males, the term is used to describeerectile dysfunction(ED, the inability to achieve or sustain an erection suitable for sex).
In females, the lack of sexual arousal is typically regarded as a facet of FSIAD. manifesting with symptoms such as:
Persistent Genital Arousal Disorder (PGAD): What to Know
Orgasm Disorders
Orgasm disorders are those that interfere with the ability to achieve an orgasm with satisfaction or at all. This includes the ability toejaculate(ejectsemenfrom thepenis) in males.
Orgasm disorder may occur independently or along with a sexual desire or sexual arousal disorder.
Orgasm disorders include:
Are Vaginal Orgasms Real?
Sexual Pain Disorders
Sexual pain disorders are typically physical problems that can make sex too painful to endure or enjoy.With that said, past sexual trauma or emotional abuse can sometimes manifest in pain during sex.
There are several common and uncommon sexual pain disorders experienced in males and females:
Why Do I Get Sex Headaches?
Causes of Sexual Dysfunction
There are many possible causes of sexual dysfunction, from psychological causes like depression and anxiety to physical ones like hormonal changes and chronic illness. Aging can also cause changes in the body that diminish thesexual response, as can certain drugs and alcohol.
Sexual dysfunction often involves multiple factors, some of which perpetuate others. For instance, erectile dysfunction can trigger anxiety, decreasing libido. Similarly, ananxiety disordercan cause erectile dysfunction even if no underlying physical cause exists.
Psychological Causes
Psychological factors associated with sexual dysfunction include those predisposing you to sexual dysfunction (such as past sexual trauma or a restrictive upbringing) and those that precipitate (give rise to) symptoms of sexual dysfunction.
Chief among the precipitating factors aredepression and anxiety, both of which have a cause-and-effect relationship with sexual dysfunction. Depression is known to be independently linked to HSDD and erectile dysfunction.Anxiety is considered a risk factor for erectile dysfunction, premature ejaculation, vaginismus, and vestibulodynia.
Relationship problems and intimacy issues can cause and complicate HSDD, erectile dysfunction, delayed ejaculation, and sexual pain disorders.Guilt, shame, or low-self esteem are also risk factors.
People who experienced past sexual violence or abuse, such as rape or incest, are vulnerable to vaginismus, vestibulodynia, and postcoital dysphoria.Post-traumatic stress disorder (PTSD)is commonly diagnosed in people with FSIAD.
Physical Causes
A wide range of medical conditions can directly or indirectly affect the physical function of the sexual organs and/or the moods that direct the sexual response.
The physical causes can be broadly described in five categories:
How Common Is Sexual Dysfunction?A 2020 analysis involving 4,955 adults reported that 13.3% of males and 17.5% of females met the clinical definition of sexual dysfunction. The most common problems in males were erectile dysfunction (affecting 6.6% of males) and early ejaculation (4.5%). The most common in females were FSIAD (6.9%) and orgasm disorders (5.8%).
How Common Is Sexual Dysfunction?
A 2020 analysis involving 4,955 adults reported that 13.3% of males and 17.5% of females met the clinical definition of sexual dysfunction. The most common problems in males were erectile dysfunction (affecting 6.6% of males) and early ejaculation (4.5%). The most common in females were FSIAD (6.9%) and orgasm disorders (5.8%).
Medications
Certain medications can also cause sexual dysfunction. Some influence the hormones likeserotoninanddopaminethat regulate moods and sexual desire. Others affect sex hormones liketestosterone,estrogen, andprogesteronethat direct the sexual response.
Others still affect blood pressure (reducing blood flow to the genitals) or nerves that regulate arousal and orgasm.
Among the drugs most commonly associated with sexual dysfunction are:
Alcohol and Substance Use Disorders
Diagnosis of Sexual Dysfunction
The diagnosis of sexual dysfunction may involve multiple healthcare providers, including your primary care provider and specialists like aurologist,gynecologist,neurologist,endocrinologist, or psychologist.
The diagnosis typically starts with a review of your medical history, symptoms, current medications, and vital signs (including your blood pressure).
Your healthcare provider will also ask questions to gain insight into any lifestyle, relationship, or emotional issues that may be causing or contributing to your condition. These may include your attitude about sex, current sexual practices, past sexual traumas, alcohol or drug use, etc.
Certain lab tests may provide clues as to the possible causes of your sexual issues, including:
Based on these initial findings, your healthcare provider may order other tests. These may include imaging studies like penile Duplex ultrasound (to check blood flow to the penis) ortransvaginal ultrasound(to check for abnormalities or growths in the female reproductive tract).
You may also be referred to a specialist like a neurologist who may perform amagnetic resonance imaging (MRI)scan to check for abnormalities in the central nervous system. Some studies suggest these may be useful in supporting the diagnosis of FSIAD.
Apsychologist or psychiatristmay be recommended if there are no physical causes of your symptoms or if amood disorderlike depression or ananxiety disorderlike PTSD is complicating your symptoms.
Treatment of Sexual Dysfunction
The treatment of HSDD can vary between sexes, given that the underlying causes and features differ. Even so, there are common approaches used for people of any sex, including:
Different drug therapies may be used to support these interventions:
Can a Testosterone Patch Improve Female Sex Drive?
In females, the treatment of sexual arousal disorders is much the same as for sexual desire disorders, as the two are commonly linked (as FSIAD).
In males with erectile dysfunction (ED), treatment options include:
Psychotherapy and lifestyle changes are central to treating orgasm disorders in both males and females. This may involve:
Different medications may also be prescribed. In addition to testosterone or estrogen replacement, oral or topical drugs may be used to treat specific orgasm disorders:
In females, sexual pain disorders are commonly treated with:
In males with sexual pain disorders, the following may be prescribed::
When a physical cause cannot be found,sex therapymay be explored. Conducted either individually or as a couple, sex therapy can help identify and overcome negative emotional responses to sexual stimulation or intimacy.
For people who have experienced rape, sexual abuse, incest, or sexual violence, intensive psychotherapy may be needed.
Coping With Sexual Dysfunction
While some forms of sexual dysfunction may be temporary and short-lived, they are more often persistent (and sometimes irreversible). Although treatments can help, it may take time for them to work. Moreover, the response to treatment can vary from one person to the next.
As such, it is important to communicate your experiences, feelings, and concerns not only to your healthcare provider but also to your sexual partner. Doing so may be difficult, but it can help reduce stress and any feeling of guilt or embarrassment that can make your condition worse.
If you have problems communicating with your partner, ask your healthcare provider for a referral to a counselor or therapist experienced in relationship issues. Or, join an online support group to connect with people who can share advice, insight, or referrals. You can also bring your partner in with you to speak with your healthcare provider.
There are also lifestyle changes that can help your better cope as you undergo treatment, including:
Summary
Sexual dysfunction is the persistent difficulty engaging in any part of normal sexual activity. It is diagnosed when symptoms are persistent or recurrent for at least six months and are causing you significant distress or relationship problems. The cause may be physical or psychological, or a combination of both.
Types of sexual dysfunction include sexual desire disorders, sexual arousal disorders (like erectile dysfunction), orgasm disorders, and sexual pain disorders. The treatment of these disorders can vary but may involve lifestyle changes, psychotherapy, couples counseling, and medications.
Frequently Asked QuestionsStudies have shown that the risk of erectile dysfunction is higher among male twins than non-twin males, suggesting that genetics may play a part.Genetic factors have also been found to contribute to certain forms of female sexual dysfunction, including sexual arousal disorders.ED is more common as a person ages, but aging does not “cause” ED.Many of the risk factors for ED (like heart disease, high blood pressure, and diabetes) are common in older adults, while behaviors like smoking and alcohol abuse can take their toll on sexual function as a person ages.Learn MoreCauses and Risk Factors of Erectile DysfunctionAging plays a role in sexual dysfunction in older females due to changes in hormones during menopause. With that said, female sexual function can start to decline in the late-20s to late-30s, impacting sexual desire, arousal, and the frequency of orgasms.
Frequently Asked Questions
Studies have shown that the risk of erectile dysfunction is higher among male twins than non-twin males, suggesting that genetics may play a part.Genetic factors have also been found to contribute to certain forms of female sexual dysfunction, including sexual arousal disorders.
ED is more common as a person ages, but aging does not “cause” ED.Many of the risk factors for ED (like heart disease, high blood pressure, and diabetes) are common in older adults, while behaviors like smoking and alcohol abuse can take their toll on sexual function as a person ages.Learn MoreCauses and Risk Factors of Erectile Dysfunction
ED is more common as a person ages, but aging does not “cause” ED.Many of the risk factors for ED (like heart disease, high blood pressure, and diabetes) are common in older adults, while behaviors like smoking and alcohol abuse can take their toll on sexual function as a person ages.
Learn MoreCauses and Risk Factors of Erectile Dysfunction
Aging plays a role in sexual dysfunction in older females due to changes in hormones during menopause. With that said, female sexual function can start to decline in the late-20s to late-30s, impacting sexual desire, arousal, and the frequency of orgasms.
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