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What is sexual dysfunction?

Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response.

While research suggests that sexual dysfunction is common, it is a topic that many people are hesitant to discuss. Because treatment options are available, it is important to share your concerns with your partner and health care provider.

What affect sexual function?

Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.

What are the types of sexual dysfunction?

Sexual dysfunction generally is classified into four categories:

  • Desire disorders —lack of sexual desire or interest in sex
  • Arousal disorders —inability to become physically aroused or excited during sexual activity
  • Orgasm disorders —delay or absence of orgasm (climax)
  • Pain disorders — pain during intercourse

Who is affected by sexual dysfunction?

Sexual dysfunction can affect any age, although it is more common in those over 40 because it is often related to a decline in health associated with aging.

What are the symptoms of sexual dysfunction?

In men:

  • Inability to achieve or maintain an erection suitable for intercourse (erectile dysfunction)
  • Absent or delayed ejaculation despite adequate sexual stimulation (retarded ejaculation)
  • Inability to control the timing of ejaculation (early or premature ejaculation)

In women:

  • Inability to achieve orgasm
  • Inadequate vaginal lubrication before and during intercourse
  • Inability to relax the vaginal muscles enough to allow intercourse

In men and women:

  • Lack of interest in or desire for sex
  • Inability to become aroused
  • Pain with intercourse

What causes sexual dysfunction?

Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual function.

Psychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image, and the effects of a past sexual trauma.

How is sexual dysfunction diagnosed?

In most cases, the individual recognizes that there is a problem interfering with his or her enjoyment (or the partner’s enjoyment) of a sexual relationship. The clinician likely will begin with a complete history of symptoms and a physical. He or she may order diagnostic tests to rule out any medical problems that may be contributing to the dysfunction, if needed. Typically, lab testing plays a very limited role in the diagnosis of sexual dysfunction.

An evaluation of the person’s attitudes about sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship concerns, medications, alcohol or drug abuse, etc.) will help the clinician understand the underlying cause of the problem, and will help him or her make recommendations for appropriate treatment.

How is sexual dysfunction treated?

Most types of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Other treatment strategies include:

Medication — When a medication is the cause of the dysfunction, a change in the medication may help. Men and women with hormone deficiencies may benefit from hormone shots, pills, or creams. For men, drugs, including sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®, Staxyn®), and avanafil (Stendra®) may help improve sexual function by increasing blood flow to the penis.

Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction (the inability to achieve or maintain an erection). A vacuum device (Eros) is also approved for use in women, but can be costly. Dilators may help women who experience narrowing of the vagina.

Sex therapy — Sex therapists can be very helpful to couples experiencing a sexual problem that cannot be addressed by their primary clinician. Therapists are often good marital counselors, as well. For the couple who wants to begin enjoying their sexual relationship, it is well worth the time and effort to work with a trained professional.

Behavioral treatments — These involve various techniques, including insights into harmful behaviors in the relationship, or techniques such as self-stimulation for treatment of problems with arousal and/or orgasm.

Psychotherapy — Therapy with a trained counselor can help a person address sexual trauma from the past, feelings of anxiety, fear, or guilt, and poor body image, all of which may have an impact on current sexual function.

Education and communication — Education about sex and sexual behaviors and responses may help an individual overcome his or her anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

Can sexual dysfunction be cured?

The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a condition that can be treated or reversed. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

Prevention for sexual dysfunction

Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. One partner should, ideally, be able to communicate desires and preferences to the other partner. People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice. Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.