What Is Sexual Dysfunction?

James Myhre & Dennis Sifris, MD
·16 min read

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's sex drive or response to sexual stimulus. Oftentimes, multiple factors are involved.

Sexual dysfunction is also characterized by emotional distress that not only places significant strain on relationships but also on a person's quality of life.

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.

<p>kitzcorner / Getty Images</p>

kitzcorner / Getty Images

For the purpose of this article, "male" refers to people with penises, and "female" refers to people with vaginas, despite the gender or genders they identify with. The terms used in this article reflect the terms used in the referenced source.

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 the Diagnostic 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.

So, rather than classifying sexual dysfunction as being either physiological or psychological, it is categorized in the DSM-5 by the part of the sexual response that is affected, namely libido (sex drive), arousal (sexual excitement), and orgasm (sexual climax). Sexual pain is also a distinct category listed in the DSM-5.

Sexual Desire Disorders

Sexual desire disorders involve a lack of sexual desire, libido, or sexual fantasies. Also known as hypoactive 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:

  • General HSDD (meaning a general lack of sexual desire) or situational HSDD (meaning the lack of sexual desire for a specific partner)

  • Acquired HSDD (meaning a lack of desire after a period of normal sexual functioning) or lifelong HSDD (meaning that a person has always had a lack of sexual desire)

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.

The DSM-5 lists two subtypes of HSDD differentiated by sex, which are:

  • Female sexual interest/arousal disorder (FSIAD): In females, HSDD typically occurs alongside the lack of sexual arousal—meaning that they neither have sexual interest nor respond to sexual stimuli.

  • Male hypoactive sexual desire disorder (MHSDD): In males, HSDD can occur independently of sexual arousal—meaning that they may lack sexual desire but still have the ability or potential to be aroused and get an erection.

Related:Causes of Female Sexual Dysfunction

Sexual Arousal Disorders

Sexual arousal disorders are those that affect a person's ability to respond to sexual stimuli, such as touch or erotic thoughts. Unlike sexual desire, in which emotions can affect the physical response, with sexual arousal there's a lack of a physical response despite your emotions. The symptoms can vary by a person's sex.

In males, the term is used to describe erectile 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:

  • A lack of vaginal lubrication

  • A lack of vaginal dilation (widening)

  • Decreased genital tumescence (swelling)

  • Decreased genital or nipple sensation

Related:How Common Is Erectile Dysfunction?

Orgasm Disorders

Orgasm disorders are those that interfere with the ability to achieve an orgasm with satisfaction or at all. This includes the ability to ejaculate (eject semen from the penis) in males.

Orgasm disorder may occur independently or along with a sexual desire or sexual arousal disorder.

Orgasm disorders include:

  • Anorgasmia (the absence of orgasm in at least 75% of sexual encounters)

  • Delayed ejaculation (ejaculation that requires extended sexual stimulation)

  • Premature ejaculation (ejaculation that occurs before or soon after sexual contact)

  • Anejaculation (the inability to ejaculate)

  • Postcoital dysphoria (feelings of extreme melancholy or anxiety after orgasm, more often affecting females)

  • Postorgasmic illness syndrome (debilitating pain, flu-like, or allergy symptoms immediately following an orgasm, most often affecting males)

Related: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:

  • Dyspareunia (painful intercourse caused by any wide-ranging medical conditions, including vaginal dryness in females and Peyronie's disease in males)

  • Vaginismus (a condition of unknown origin that causes involuntary spasms of vaginal walls during penetrative sex)

  • Vestibulodynia (a chronic pain disorder of unknown origin affecting the opening of the vagina and the inner lips of the vulva during sex)

  • Male dysorgasmia (also known as painful ejaculation, which can be short-lived due to a urinary infection or a persistent chronic condition)

Related: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 the sexual 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, an anxiety disorder can 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 are depression 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:

  • Cardiovascular causes: Hypertension (high blood pressure), heart failure, and coronary artery disease (CAD) are among the heart diseases that can affect blood flow to the genital arteries and reduce the sexual response.

  • Functional causes: These are conditions like Peyronie's disease in males and endometriosis in females that can cause sexual pain. Other functional disorders like an enlarged prostate in males or pelvic floor dysfunction in females can interfere with the physical response.

  • Hormonal causes: In males, hypogonadism (low testosterone) can affect sexual desire, arousal, clarity of thinking, mood, erectile function, and bone density. In females, hormone fluctuations during the menstrual cycle, pregnancy, and menopause can do the same. Thyroid, pituitary, and adrenal diseases also cause hormonal problems that contribute to sexual dysfunction.

  • Neurological causes: Conditions like epilepsy, diabetic neuropathy, multiple sclerosis (MS), Parkinson's disease, and brain or spinal cord injuries can all affect the nerves that regulate the sexual response, including erections in males and vaginal sensitivity and arousal in females.

  • Metabolic causes: Obesity, metabolic syndrome, and dyslipidemia (high cholesterol) can all give rise to sexual dysfunction by affecting hormone levels. They also contribute to the onset of heart disease and type 2 diabetes.

  • Tumors and cancer: Uterine fibroids can cause sexual pain, while noncancerous Leydig cell tumors in the ovaries or testicles can affect sexual function by altering hormone levels. Many types of cancer (including bladder, cervical, colon, prostate, rectal, testicular, and uterine cancer) are characterized by 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 like serotonin and dopamine that regulate moods and sexual desire. Others affect sex hormones like testosterone, estrogen, and progesterone that 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 abuse can also lead to sexual dysfunction by depressing the central nervous system and slowing down nerve signals between the brain and genitals. Illicit drugs like heroin, cocaine, methamphetamine, and ecstasy (MDMA) are also associated with sexual dysfunction.

Diagnosis of Sexual Dysfunction

The diagnosis of sexual dysfunction may involve multiple healthcare providers, including your primary care provider and specialists like a urologist, 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).

A physical exam will be done. It may include a pelvic exam in females or an examination of the penis, testicles, and general muscle tone in males (all of which are influenced by testosterone). A digital rectal exam (DRE) may be used to check for an enlarged prostate.

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) or transvaginal 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 a magnetic 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.

A psychologist or psychiatrist may be recommended if there are no physical causes of your symptoms or if a mood disorder like depression or an anxiety disorder like PTSD is complicating your symptoms.

Treatment of Sexual Dysfunction

The treatment of sexual dysfunction varies by the cause. As with the diagnosis of sexual dysfunction, the treatment may involve multiple providers, including those who treat different aspects of the disease or associated conditions like diabetes and heart disease.

Sexual Desire Disorders

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:

  • Cognitive behavior therapy (CBT): A form of "talk therapy" that challenges beliefs and alters behaviors that contribute to low sexual desire

  • Couples counseling: Used to explore sexual or intimacy problems and teach communication skills in a structured environment

  • Change or adjustment of medications: Including antidepressants or oral contraceptives that can contribute to low libido

Different drug therapies may be used to support these interventions:

  • Testosterone replacement therapy (TRT): Given by injection, patches, pellets, or gels to improve libido and sexual functioning in males

  • Hormone replacement therapy (ERT): Given by pills, patches, gels, or creams to deliver estrogen (with or without progesterone) for improved vaginal moisture and libido

  • Addyi (flibanserin): An oral drug used for the treatment of HSDD in postmenopausal females that works by increasing dopamine (which increases sexual excitement) and lowering serotonin (which decreases sexual excitement)

Related:Can a Testosterone Patch Improve Female Sex Drive?

Sexual Arousal Disorders

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:

  • PDE5 inhibitors: These oral drugs are used as a first-line treatment of ED. They include Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil).

  • Alprostadil: This drug is given either by penile injection (Caverject), penile suppository (Muse), or topical cream (Vitaros). It enables erections by widening blood vessels in the penis. Other types of more potent injections contain alprostadil with other medications (commonly known as Trimix).

  • Penile pumps: Manual or automated devices that draw blood into the penis with a vacuum

  • Penile implants: These devices surgically inserted into the penis can either be inflated or manually bent to enable sexual penetration.

Related:How Erectile Dysfunction Is Treated

Orgasm Disorders

Psychotherapy and lifestyle changes are central to treating orgasm disorders in both males and females. This may involve:

  • Individual or couples counseling: Usually in the form of CBT and sexual education

  • Sensate focus: A progressive, at-home practice involving non-erotic and, later, erotic touch to improve sexual communication

  • Masturbation therapies: Can identify ways to improve orgasms in people with delayed or absent orgasms or to learn how to delay orgasms in people with premature ejaculation

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:

Sexual Pain Disorders

The treatment of dyspareunia (painful intercourse) and other sexual pain disorders can vary by the cause and a person's biological sex.

In females, sexual pain disorders are commonly treated with:

  • Desensitization therapy: Including pelvic floor exercises and vaginal dilators that help relax vaginal muscles by teaching conscious vaginal muscle control

  • Topical vaginal creams: Including estrogen cream and lidocaine numbing cream

  • Osphena (ospemifene): An oral drug typically used in postmenopausal females that can help decrease pain by strengthening vaginal tissues

In males with sexual pain disorders, the following may be prescribed::

  • Flomax (tamsulosin): A drug commonly used to treat enlarged prostate that may also help ease painful ejaculation

  • Testosterone replacement therapy: Sometimes used to treat postorgasmic illness syndrome

When a physical cause cannot be found, sex therapy may 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:

  • Routine exercise: Aerobic and strength training exercises can aid in cardiovascular health, mood, and self-esteem.

  • Healthy diet: A healthy diet can improve metabolic and cardiovascular health.

  • Stress reduction: In addition to routine exercise, explore mindfulness-based practices like yoga, meditation, tai chi, guided imagery, and deep breathing exercises.

  • Quit smoking: Cigarette smoke causes the dilation of blood vessels throughout the body, including those of the genitals. Quitting can also reduce blood pressure and increase stamina.

  • Alcohol and drugs: If you have problems with alcohol or drugs, seek treatment. The Centers for Disease and Prevention (CDC) recommends no more than two drinks per day for males or one drink per day for females.

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 Questions

Is sexual dysfunction genetic?

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.

Is erectile dysfunction inevitable as you age?

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.

Is sexual dysfunction in older women inevitable?

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.