Sexual Dysfunction

Sexual dysfunction is a common problem that can affect anyone at any age, preventing you from feeling pleasure or satisfaction from sexual activity. While many people find it difficult to talk about, this condition is highly treatable, and understanding its causes and solutions can help you and your partner enjoy a healthier, more fulfilling sex life.

Table of contents

• What Is Sexual Dysfunction?
• How Common Is This Condition?
• Main Types of Sexual Dysfunction
• Signs and Symptoms
• What Causes Sexual Dysfunction?
• How Is Sexual Dysfunction Diagnosed?
• Treatment Options
• When to See a Healthcare Provider

What Is Sexual Dysfunction?

Sexual dysfunction is any problem that prevents you or your partner from experiencing satisfaction from sexual activity. Being unable to enjoy or not wanting to engage in sexual activities may be a sign of sexual dysfunction^[1]. This condition is different from asexuality, which is when someone naturally has little or no interest in sexual activity^[2].

Sexual dysfunction can happen at any point during the sexual response cycle, which is how your body responds to sexual stimulation. This cycle includes four stages: excitement (desiring sex and becoming aroused), plateau (the phase just before orgasm when heart rate and breathing intensify), orgasm (a sudden release of sexual tension and pleasure), and resolution (the calming down period after orgasm)^[1].

A sexual problem is not considered a disorder unless it happens regularly, lasts for at least six months in most cases, and causes significant distress or strain in your relationship with your partner^[2][3]. It’s normal not to be in the mood sometimes or to experience occasional difficulties. These should not be considered a disorder unless they happen regularly and significantly affect your sexual life^[2].

How Common Is This Condition?

Sexual dysfunction is very common and affects many people at different points in their lives. Research suggests that sexual dysfunction affects between 30% and 40% of people at some point in their lives, although it’s more common in people over 40^[1]. Studies estimate that up to 43% of women and 31% of men report some degree of sexual dysfunction^[1][4].

Despite how common sexual problems are, many people don’t like talking about them. They may feel embarrassed or ashamed, which means the actual numbers might be even higher^[1]. However, because treatment options are available and effective, it’s important to share your concerns with your partner and healthcare provider^[1].

Main Types of Sexual Dysfunction

Healthcare providers classify sexual dysfunction into four main categories or types^[1][4]:

Desire disorders involve a lack of sexual desire or interest in sex. This most common type of female sexual dysfunction means you have little or no interest in sexual activity, including masturbation. This may mean you have no interest in any type of sexual activity or no sexual thoughts or fantasies^[1][3].

Arousal disorders mean you’re emotionally in the mood for sex, but your body doesn’t respond. This is an inability to become physically aroused or excited during sexual activity. You may feel a desire for sex, but your body doesn’t respond. In people with a penis, this could mean you can’t get or maintain an erection, a condition called erectile dysfunction^[1][2].

Orgasm disorders involve a delay or absence of orgasm (climax). This means you’re emotionally in the mood and your body responds, but you have difficulty reaching orgasm or cannot reach orgasm at all. You may feel desire and arousal but be unable to orgasm, which can leave you frustrated^[1][2].

Pain disorders involve pain during intercourse, which makes you not want to have sex. This can include actual pain, fear or anxiety about pain, or marked tightening of the vaginal or pelvic muscles during attempts at sexual activity^[1][2].

Signs and Symptoms

Some types of sexual dysfunction affect males more than females, and some types affect females more than males^[1].

In males, common symptoms include^[1][2]:

• Inability to achieve or maintain an erection firm enough for intercourse (erectile dysfunction)
• Absent or delayed ejaculation despite enough sexual stimulation
• Inability to control the timing of ejaculation (premature ejaculation, which is ejaculation that happens before or immediately after penetration)

In females, common symptoms include^[1][2]:

• Inability to achieve orgasm
• Vaginal dryness before and during intercourse
• Inability to relax vaginal muscles enough to allow for intercourse
• Pain during intercourse

Sexual dysfunction symptoms that can affect anyone include^[1]:

• Lack of interest in or desire for sex (low libido, or sex drive)
• Inability to become aroused
• Pain with intercourse
• Changes caused by certain health conditions, treatments, or medications

What Causes Sexual Dysfunction?

Sexual dysfunction is a problem that can result from physical issues, psychological issues, or a combination of both. The causes are often complex and involve biological, psychological, relational, and sociocultural factors^[1][5].

Physical Causes

Physical causes of sexual dysfunction can include^[1][4][5]:

• Chronic conditions such as kidney or liver failure
• Diabetes
• Heart and vascular diseases
• High blood pressure
• Neurological disorders like multiple sclerosis or nerve damage
• Hormonal imbalances, including low estrogen or low testosterone
• Cancer and cancer treatments
• Thyroid disorders
• Obesity and inactive lifestyle
• Insomnia (difficulty sleeping)

For women specifically, certain gynecological problems can cause sexual dysfunction, such as endometriosis, interstitial cystitis, menopause, pelvic pain from uterine fibroids, vaginal dryness, and pelvic floor dysfunction including muscle spasms^[4].

For men specifically, urology conditions can lead to sexual dysfunction, including blood flow problems, ejaculation problems, injury to the penis, nerve disorders, and Peyronie’s disease^[4].

Certain medications can also cause sexual dysfunction. These include^[1][4]:

• Antihistamines
• Blood pressure medicines
• Antidepressants
• Alcohol
• Cigarettes and tobacco
• Illicit drugs such as cocaine and heroin

Psychological and Emotional Causes

Sexual dysfunction can result from psychological or emotional issues such as^[4][5]:

• Mood disorders, including anxiety or depression
• Past sexual abuse or trauma
• Relationship problems or conflicts between partners
• Stress from work or everyday life
• Guilt or fear related to sex
• Body image issues
• Religious or cultural factors
• Performance anxiety

A person’s feelings and emotional state play a major role in sexual function. Feeling relaxed, confident, and aroused is essential for sexual activity. Sexual response involves not just the body but also the mind, and emotional factors play a significant role in sexual satisfaction^[1].

How Is Sexual Dysfunction Diagnosed?

If you’re experiencing sexual problems, it’s important to see a healthcare provider. A thorough evaluation is the first step in diagnosing sexual dysfunction. Your healthcare provider will conduct a comprehensive assessment that includes^[4][3]:

• A physical exam
• Review of your personal and family medical history
• Discussion of your symptoms
• Discussion of your sexual and medical history
• Questions about any medications or supplements you may be taking
• Questions about your current and past relationships

For women, the healthcare provider may perform a pelvic exam to check for physical changes that can affect sexual enjoyment, such as thinning of genital tissues, scarring, or sources of pain^[3].

Your provider might recommend additional tests, such as^[4]:

• Blood tests to check for underlying conditions that could be causing sexual dysfunction, such as diabetes, hormonal imbalances, or thyroid problems
• Pelvic exam or pelvic ultrasound for women to assess any physical issues or identify anatomical problems

If psychological issues seem to be the main cause of the problem, your provider may offer a referral to a counselor or therapist^[3]. It’s important to be open and honest with your healthcare provider about what you’re experiencing, even if you feel awkward. Healthcare providers have seen and heard it all, and they’re there to help, not judge^[8].

Treatment Options

Treatment for sexual dysfunction depends on the cause. Because the problem is often multifactorial, a comprehensive approach that addresses biological, psychological, and relational factors usually works best^[4][5].

Treating Physical Causes

If your sexual dysfunction has a physical cause, your healthcare provider may suggest^[3][4]:

• Treating any underlying medical conditions
• Adjusting or changing medications that may be causing side effects
• Hormone therapy if hormonal issues are the cause
• Medications to improve sexual function

For women with vaginal dryness related to menopause, local vaginal estrogen therapy is recommended and preferred over systemic estrogen therapy when vaginal dryness is the primary concern^[13]. Testosterone therapy, with or without estrogen, has been shown to be effective for short-term treatment of low sexual desire in women who have gone through natural or surgical menopause^[13].

For men with erectile dysfunction, medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) may be prescribed^[5]. Another form of therapy involves injecting a medication into the penis to induce an erection^[5].

For sexual dysfunction caused by antidepressants, your provider may suggest adding another medication, such as bupropion, which has been shown to improve sexual side effects in women^[13].

Treating Psychological Causes

Psychotherapy or sex therapy is useful for managing the psychological, relational, and sociocultural factors affecting sexual function^[13]. Your healthcare provider can help with many of these issues by providing education and validating your sexual health concerns^[13].

Treatment approaches may include^[3][4]:

• Open communication with your partner about your needs and desires
• Counseling to address relationship problems, anxiety, depression, or past trauma
• Cognitive behavioral therapy, which has been shown to effectively treat low sexual desire
• Mindfulness-based interventions, which have been shown to help with low desire, arousal problems, and difficulty reaching orgasm
• Education about sexual function and techniques
• Stress management strategies

Lifestyle Changes

Many lifestyle changes can help improve sexual function^[4][5]:

• Regular exercise and physical activity
• Eating a healthy diet rich in fruits, vegetables, whole grains, and fish
• Maintaining a healthy weight
• Getting enough sleep
• Quitting smoking
• Reducing or eliminating alcohol consumption
• Managing stress
• Avoiding illicit drugs

For men specifically, walking just 30 minutes a day has been linked with a 41% drop in risk for erectile dysfunction^[18]. Losing weight can also help fight erectile dysfunction, as obesity raises risks for vascular disease and diabetes, two major causes of erectile dysfunction^[18].

When to See a Healthcare Provider

If sexual problems are ongoing and causing distress, or if they affect your relationship or worry you, make an appointment with a healthcare provider^[3]. You should seek help when difficulties happen regularly and cause anxiety, sadness, or strain in your relationship for a minimum of six months^[2].

It’s also important to see a healthcare provider if you suspect a physical cause for your sexual problems. In some cases, sexual dysfunction can be the first sign of other health issues, including heart disease^[1]. Erectile dysfunction has been found to be the first hint of cardiovascular disease in up to 30% of men who see their doctors about this problem^[18].

Remember that sexual problems are highly treatable. While there’s no magic solution promising a quick and easy cure, there are many ways to address sexual difficulties^[5]. Most often, a combination of treatments works best^[3]. The first step is to talk openly with your healthcare provider about what you’re experiencing.