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 (43 percent of women and 31 percent of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and health care provider.

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 the 40-65 year old range and 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

Inability to control the timing of ejaculation (premature or retarded ejaculation)

In women:

Lack of interest in or desire for sex

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 antidepressants 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, and the effects of a past sexual trauma.

How is sexual dysfunction diagnosed?

In most cases the individual recognizes 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. An evaluation of the person’s attitudes regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship problems, medications, alcohol or drug abuse, etc.) will help the clinician understand the underlying cause of the problem and 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) 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). 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 treatable or reversible physical condition. Mild dysfunction that is related to stress, fear or anxiety often can be successfully treated with counseling, education and improved communication between partners.