Sexual Dysfunction. Image source: Freepik
What Is Sexual Dysfunction?
Sexual dysfunction, also referred to as Erectile 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 driver or response to sexual stimulus.
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.
Sexual dysfunction refers to difficulties in any stage of the sexual response cycle, which comprises desire, arousal, orgasm, and resolution. These issues can manifest as an inability to achieve or maintain an erection, difficulty reaching orgasm, pain during intercourse, or a lack of interest in sexual activity. Sexual dysfunction can be a primary problem or a secondary issue arising from underlying medical, psychological, or relational factors.
A thorough sexual history and assessment of general health and other sexual problems if any are important when assessing sexual dysfunction because it is usually correlated with other psychiatric issues, such as mood disorders, eating and anxiety disorders, and schizophrenia. Assessing performance anxiety, guilt, stress, and worry is integral to the optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the human sexual response cycle proposed by William H. Masters and Virginia E. Johnson, and modified by Helen Singer Kaplan.
Types of Sexual Dysfunction
- Sexual dysfunction can be classified into four categories: sexual desire disorders, arousal disorders, orgasm disorders, and pain disorders. Dysfunction among men and women is studied in the fields of andrology and gynecology respectively.
- “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.”
- Sexual dysfunction often involves a complex interplay of physical and psychological concerns. Plus it can be difficult to separate the concerns into individual categories.
Sexual desire disorders
Sexual desire disorders or decreased libido are characterized by a lack of sexual desire, libido for sexual activity, or sexual fantasies for some time. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may start after a period of normal sexual functioning, or the person may always have had an absence. Or a lesser intensity of sexual desire.
The causes vary considerably but include a decrease in the production of normal estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs), or psychiatric conditions, such as depression and anxiety.
Sexual arousal disorders
Sexual arousal disorders were previously known as frigidity in women and impotence in men. Though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced with several terms describing specific problems that can be broken down into four categories as described by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.
For both men and women, these conditions can manifest themselves as an aversion to and avoidance of sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
There may be physiological origins to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease and the partners’ relationship can also contribute to dysfunction. Additionally, postorgasmic illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation: rapid breathing, paresthesia, palpitations, headaches, aphasia, nausea, itchy eyes, fever, muscle pain and weakness, and fatigue.
From the onset of arousal, symptoms can persist for up to a week in patients.
The cause of this condition is unknown; however, it is believed to be a pathology of either the immune system or the autonomic nervous system. It is defined as a rare disease by the National Institute of Health, but the prevalence is unknown. It is not thought to be psychiatric, but it may present as anxiety relating to coital activities and may be incorrectly diagnosed as such. There is no known cure or treatment.
Erectile dysfunction
Erectile dysfunction (ED), or impotence, is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes of ED, including damage to anatomical structures, psychological causes, medical disease, and drug use. Many of these causes are medically treatable.
Psychological ED can often be treated by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage can be more difficult to treat. One leading physical cause of ED is continual or severe damage taken to the nervierigentes, which can prevent or delay erection. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries.
Erectile Dysfunction And Diseases
Diseases are also common causes of erectile dysfunction. Diseases such as cardiovascular disease, multiple sclerosis, kidney failure, vascular disease, and spinal cord injury can cause erectile dysfunction. Cardiovascular disease can decrease blood flow to penile tissues, making it difficult to develop or maintain an erection.
Due to the shame and embarrassment felt by some with erectile dysfunction, the subject was taboo for a long time and is the focus of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the newsworthiness of stories about it and heavy advertising.
It is estimated that around 30 million men in the United States and 152 million men worldwide have erectile dysfunction. However, social stigma, low health literacy, and social taboos lead to underreporting which makes an accurate prevalence rate hard to determine.
The Latin term impotentiacoeundi describes the inability to insert the penis into the vagina and has been mostly replaced by more precise terms.
ED from vascular disease is seen mainly amongst older individuals who have atherosclerosis. Vascular disease is common in individuals who smoke or have diabetes, peripheral vascular disease, or hypertension.
Drugs And Erectile Dysfunction
Drugs are also a cause of erectile dysfunction. Individuals who take drugs that lower blood pressure, antipsychotics, antidepressants, sedatives, narcotics, antacids, or alcohol can have problems with sexual function and loss of libido.
Hormone deficiency is a relatively rare cause of erectile dysfunction. In individuals with testicular failure, as in Klinefelter syndrome, or those who have had radiation therapy, chemotherapy, or childhood exposure to the mumps virus, the testes may fail to produce testosterone. Other hormonal causes of erectile failure include brain tumors, hyperthyroidism, hypothyroidism, or adrenal gland disorders.
Orgasm disorders
Anorgasmia
Anorgasmia is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it. A common physiological cause of anorgasmia is menopause; one in three women report problems obtaining an orgasm during sexual stimulation following menopause.
Premature ejaculation
Premature ejaculation is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation and poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both.
Premature ejaculation has historically been attributed to psychological causes, but newer theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation.
Post-orgasmic disorders
Post-orgasmic disorders cause symptoms shortly after orgasm or ejaculation. Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation, arousal, or orgasm. In men, POIS causes severe muscle pain throughout the body and other symptoms immediately following ejaculation. These symptoms last for up to a week.
POIS may involve adrenergic symptoms: rapid breathing, paresthesia, palpitations, headaches, aphasia, nausea, itchy eyes, fever, muscle pain and weakness, and fatigue.
The etiology of this condition is unknown; however, it is believed to be a pathology of either the immune system or the autonomic nervous system. It is defined as a rare disease by the NIH, but its prevalence is unknown. It is not thought to be psychiatric, but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment.
Dhat syndrome is another condition that occurs in men: it is a culture-bound syndrome that causes anxious and dysphoric mood after sex. It is distinct from the low-mood and concentration problems (acute aphasia) seen in POIS.
Sexual pain disorders
Sexual pain disorders in women include dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse).
Dyspareunia may be caused by vaginal dryness. Poor lubrication may result from insufficient excitement and stimulation, or hormonal changes caused by menopause, pregnancy, or breastfeeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.
It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse) may play a role. Another female sexual pain disorder is vulvodynia, or vulvar vestibulitis when localized to the Vulval vestibule. In this condition, women experience burning pain during sex, which seems to be related to problems with the skin in the vulvar and vaginal areas. Its cause is unknown.
In men, structural abnormalities of the penis like Peyronie’s disease can make sexual intercourse difficult and/or painful. The disease is characterized by thick fibrous bands in the penis that lead to excessive curvature during erection. It has an incidence estimated at 0.4–3% or more, is most common in men 40–70, and has no certain cause. Risk factors include genetics, minor trauma (potentially during cystoscopy or transurethral resection of the prostate), chronic systemic vascular diseases, smoking, and alcohol consumption.
Priapism is a painful erection that occurs for several hours and occurs in the absence of sexual stimulation. This condition develops when blood is trapped in the penis and is unable to drain. If the condition is not promptly treated, it can lead to severe scarring and permanent loss of erectile function. The disorder is most common in young men and children. Individuals with sickle-cell disease and those who use certain medications can often develop this disorder.
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.
Physical Factors
Chronic illnesses such as diabetes, cardiovascular diseases, and neurological disorders can affect sexual function by impacting blood flow, nerve function, or hormonal balance.
Psychological Factors
Anxiety, depression, stress, low self-esteem, and past traumatic experiences can contribute to sexual dysfunction by affecting one’s mental state and perception of intimacy.
Relationship Issues
Communication problems, unresolved conflicts, and emotional distance within a relationship can lead to sexual difficulties.
Hormonal Imbalances
Fluctuations in hormone levels, such as those occurring during menopause or as a result of thyroid disorders, can impact sexual desire and function.
Medications
Certain medications, including antidepressants, antihypertensives, and some hormonal therapies, can have sexual side effects.
Symptoms of Sexual Dysfunction
The symptoms of sexual dysfunction can vary depending on the specific type of issue. However, common symptoms include:
Diminished Sexual Desire
Reduced interest in sexual activity leads to a lack of initiation or enthusiasm.
Difficulty Achieving or Maintaining an Erection
Inability to achieve or sustain an erection suitable for sexual activity.
Pain During Intercourse
Physical discomfort or pain experienced during sexual intercourse.
Difficulty Reaching Orgasm
Inability to achieve orgasm or delayed orgasm, causing frustration and dissatisfaction.
Anxiety and Emotional Distress
Feelings of anxiety, stress, or emotional distress related to sexual performance or intimacy.
Treatment Options for Sexual Dysfunction
1. Medications
- Erectile dysfunction: Phosphodiesterase type 5 (PDE5) inhibitors like Viagra and Cialis.
- Female sexual dysfunction: Hormone therapy, including estrogen or testosterone supplementation.
- Premature ejaculation: Selective serotonin reuptake inhibitors (SSRIs) and topical anesthetics.
- Delayed ejaculation: Medications addressing underlying causes, such as adjusting antidepressants.
2. Psychotherapy
- Cognitive-behavioral therapy (CBT) and sex therapy can address psychological factors contributing to sexual dysfunction.
3. Lifestyle Changes For Sexual Dysfunction
- Adopting a healthier lifestyle, including regular exercise, balanced nutrition, and stress management, can improve overall sexual health.
4. Couples Counseling
- Relationship-focused therapy can help couples communicate, resolve conflicts, and rebuild intimacy.
5. Hormone Therapy
- Balancing hormonal levels through medications or lifestyle changes may be beneficial for certain cases of sexual dysfunction.
6. Pelvic Floor Therapy For Sexual Dysfunction
- Physical therapy techniques can help address issues like dyspareunia and vaginismus.
7. Surgery For Sexual Dysfunction
- Surgical interventions, such as penile implants for erectile dysfunction or corrective surgery for physical abnormalities, may be considered.
In 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, 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.
Sexual dysfunction is a common and complex issue that can significantly impact an individual’s quality of life and relationships. Understanding the various types, causes, symptoms, and available treatments is crucial for addressing this condition effectively. Seeking professional help from healthcare providers, therapists, or counselors can provide valuable support and guidance in navigating the challenges of sexual dysfunction. By addressing both the physical and psychological aspects of sexual health, individuals and couples can work towards achieving a fulfilling and satisfying sexual life.
