# Sexual dysfunction

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Difficulty experienced by humans during any stage of normal sexual activity

Medical condition

Sexual dysfunction Other names Sexual malfunction, sexual disorder Specialty Sexology, gynecology, andrology

**Sexual dysfunction** is difficulty experienced by an individual or partners during any stage of normal [sexual activity](/source/Human_sexual_activity), including physical pleasure, [desire](/source/Sexual_desire), preference, [arousal](/source/Sexual_arousal), or [orgasm](/source/Orgasm). The [World Health Organization](/source/World_Health_Organization) defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish".[1] This definition is broad and is subject to many interpretations.[2] A diagnosis of sexual dysfunction under the [DSM-5](/source/DSM-5) requires a person to feel extreme distress and [interpersonal](/source/Interpersonal) strain for a minimum of six months (except for substance- or medication-induced sexual dysfunction). Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life.[3] The term *sexual disorder* may not only refer to physical sexual dysfunction, but to [paraphilias](/source/Paraphilia) as well; this is sometimes termed *disorder of sexual preference*.

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.[4][5][2] Assessing performance anxiety, [guilt](/source/Guilt_(emotion)), [stress](/source/Stress_(biology)), and [worry](/source/Worry) are integral to the optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the [human sexual response cycle](/source/Human_sexual_response_cycle) proposed by [William H. Masters and Virginia E. Johnson](/source/Masters_and_Johnson), and modified by [Helen Singer Kaplan](/source/Helen_Singer_Kaplan).

## Types

Sexual dysfunction can be classified into four categories: [sexual desire disorders](/source/Hypoactive_Sexual_Desire_Disorder), [arousal disorders](/source/Sexual_arousal_disorder), [orgasm disorders](/source/Anorgasmia), and [pain disorders](/source/Pain_disorder). Dysfunction among men and women are studied in the fields of [andrology](/source/Andrology) and [gynecology](/source/Gynaecology) respectively.[6]

### Sexual desire disorders

Main article: [Hypoactive sexual desire disorder](/source/Hypoactive_sexual_desire_disorder)

[Sexual desire](/source/Sexual_desire) disorders or decreased [libido](/source/Libido) are characterized by a lack of [sexual desire](/source/Sexual_desire), [libido](/source/Libido) for [sexual activity](/source/Human_sexual_activity), or [sexual fantasies](/source/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](/source/Estrogen) in women, or [testosterone](/source/Testosterone) in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as [SSRIs](/source/Selective_serotonin_reuptake_inhibitor)), or psychiatric conditions, such as [depression](/source/Depression_(mood)) and [anxiety](/source/Anxiety_disorder). While many causes of low sexual desire are cited, only a few of these have ever been the object of empirical research.[7]

### Sexual arousal disorders

Main article: [Sexual arousal disorder](/source/Sexual_arousal_disorder)

Sexual arousal disorders were previously known as [frigidity](/source/Hypoactive_sexual_desire_disorder) in women and [impotence](/source/Impotence) in men, though these have now been replaced with less judgmental terms. Impotence is now known as [erectile dysfunction](/source/Erectile_dysfunction), and frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by the [American Psychiatric Association's](/source/American_Psychiatric_Association) *[Diagnostic and Statistical Manual of Mental Disorders](/source/Diagnostic_and_Statistical_Manual_of_Mental_Disorders)*: lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.[8]

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](/source/Postorgasmic_illness_syndrome) (POIS) may cause symptoms when aroused, including adrenergic-type presentation: rapid breathing, [paresthesia](/source/Paresthesia), palpitations, headaches, [aphasia](/source/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 autonomic nervous systems. It is defined as a rare disease by the [National Institute of Health](/source/National_Institutes_of_Health), but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and may be incorrectly diagnosed as such. There is no known cure or treatment.[9]

#### Erectile dysfunction

Main article: [Erectile dysfunction](/source/Erectile_dysfunction)

Erectile dysfunction (ED), or impotence, is a sexual dysfunction characterized by the inability to develop or maintain an erection of the [penis](/source/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.

Psychogenic ED is defined as ED primarily due to psychological disease or interpersonal factors. Chronic psychological Psychogenic erectile dysfunction (ED) is characterized by difficulty achieving or maintaining an erection primarily due to psychological or interpersonal factors. Factors such as performance anxiety, relationship distress, or ongoing stress can initially lead to temporary erectile difficulties. If these psychological factors persist over time, they may contribute to physiological changes in vascular and neural pathways, potentially resulting in chronic erectile dysfunction.[10] Psychogenic ED is also strongly associated with depression or low mood, and addressing the underlying psychological or mental health conditions is recommended for effective management.[11]

Medical conditions are also common causes of erectile dysfunction. Diseases such as [cardiovascular disease](/source/Cardiovascular_disease), [multiple sclerosis](/source/Multiple_sclerosis), [kidney failure](/source/Kidney_failure), [vascular disease](/source/Vascular_disease), and [spinal cord](/source/Spinal_cord) injury can cause erectile dysfunction.[12]

It is estimated that around 30 million men in the United States and 152 million men worldwide have erectile dysfunction.[13][14] However, [social stigma](/source/Social_stigma), [low health literacy](/source/Health_literacy), and social [taboos](/source/Taboo) lead to under reporting which makes an accurate prevalence rate hard to determine.

ED from [vascular disease](/source/Vascular_disease) is seen in individuals who have [atherosclerosis](/source/Atherosclerosis). Vascular disease is common in individuals who smoke or have [diabetes](/source/Diabetes_mellitus), [peripheral vascular disease](/source/Peripheral_vascular_disease), or [hypertension](/source/Hypertension). Cardiovascular disease can decrease blood flow to penile tissues, making it difficult to develop or maintain an erection.[15]

Drugs are also a cause of erectile dysfunction. Individuals who take drugs that lower [blood pressure](/source/Blood_pressure), [antipsychotics](/source/Antipsychotic), [antidepressants](/source/Antidepressant), sedatives, narcotics, antacids, or alcohol can have problems with [sexual function](/source/Sexual_function) and loss of libido.[16]

[Hormone](/source/Hormone) deficiency is a relatively rare cause of erectile dysfunction. In individuals with testicular failure, as in [Klinefelter syndrome](/source/Klinefelter_syndrome), or those who have had [radiation therapy](/source/Radiation_therapy), [chemotherapy](/source/Chemotherapy), or childhood exposure to the [mumps virus](/source/Mumps_virus), the testes may fail to produce testosterone. Other hormonal causes of erectile failure include brain tumors, [hyperthyroidism](/source/Hyperthyroidism), [hypothyroidism](/source/Hypothyroidism), or [adrenal gland](/source/Adrenal_gland) disorders.[17]

### Orgasm disorders

#### Anorgasmia

Main article: [Anorgasmia](/source/Anorgasmia)

[Anorgasmia](/source/Anorgasmia) is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters.[18]: 368 The disorder can have physical, psychological, or pharmacological origins. [SSRI](/source/SSRI) antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological cause of anorgasmia is [menopause](#menopause); one in three women report problems obtaining an orgasm during sexual stimulation following menopause.[19]

#### Premature ejaculation

Main article: [Premature ejaculation](/source/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.[20] For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both.[21]

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.[22]

#### Post-orgasmic disorders

Post-orgasmic disorders cause symptoms shortly after [orgasm](/source/Orgasm) or [ejaculation](/source/Ejaculation). [Post-coital tristesse](/source/Post-coital_tristesse) (PCT) is a feeling of [melancholy](/source/Depression_(mood)) and [anxiety](/source/Anxiety) after sexual intercourse that lasts for up to two hours. [Sexual headaches](/source/Sexual_headache) occur in the skull and neck during sexual activity, including [masturbation](/source/Masturbation), arousal or orgasm.

In men, [post orgasmic illness syndrome (POIS)](/source/POIS) causes severe [muscle pain](/source/Myalgia) throughout the body and other symptoms immediately following [ejaculation](/source/Ejaculation). These symptoms last for up to a week.[23][24][25] Some doctors speculate that the frequency of POIS "in the population may be greater than has been reported in the academic literature",[26] and that many with POIS are undiagnosed.[27]

POIS may involve adrenergic symptoms: rapid breathing, [paresthesia](/source/Paresthesia), [palpitations](/source/Palpitations), [headaches](/source/Headache), [aphasia](/source/Aphasia), [nausea](/source/Nausea), itchy eyes, [fever](/source/Fever), [muscle pain](/source/Muscle_pain) and [weakness](/source/Muscle_weakness), and [fatigue](/source/Fatigue).

The etiology of this condition is unknown; however, it is believed to be a pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the NIH, but the prevalence is unknown. It is not thought to be psychiatric in nature, 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.[9]

[Dhat syndrome](/source/Dhat_syndrome) is another condition which occurs in men: it is a [culture-bound syndrome](/source/Culture-bound_syndrome) which causes anxious and [dysphoric](/source/Dysphoria) 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](/source/Dyspareunia) (painful intercourse) and [vaginismus](/source/Vaginismus) (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse).

Dyspareunia may be caused by [vaginal dryness](/source/Vaginal_dryness). Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by [menopause](/source/Menopause), [pregnancy](/source/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](/source/Rape) or [abuse](/source/Domestic_violence)) may play a role. Another female sexual pain disorder is [vulvodynia](/source/Vulvodynia), or [vulvar vestibulitis](/source/Vulvar_vestibulitis) when localized to the [vulval vestibule](/source/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](/source/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 1–20% of men, and is most common in men aged 40–70, although cases have occurred in younger individuals and adolescents.[28][29] Peyronie's disease has no certain cause, but the leading hypothesis is that it arises from dysregulated [wound healing](/source/Wound_healing) in response to [chronic](/source/Chronic_condition) [microtrauma](/source/Microtrauma) of the erect penis. Risk factors include age, genetics, minor trauma (potentially during [cystoscopy](/source/Cystoscopy) or [transurethral resection of the prostate](/source/Transurethral_resection_of_the_prostate)), chronic systemic vascular diseases, [diabetes](/source/Diabetes), smoking, and alcohol consumption.[28]

[Priapism](/source/Priapism) is a painful erection that occurs for several hours and occurs in the absence of [sexual stimulation](/source/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](/source/Sickle-cell_disease) and those who use certain medications can often develop this disorder.[30]

## Causes

There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which include [depression](/source/Clinical_depression), sexual fears or guilt, past sexual trauma, and sexual disorders.[31]

Sexual dysfunction is especially common among people who have [anxiety disorders](/source/Anxiety_disorders).[2][32][33][5] Ordinary anxiety can cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as [panic disorder](/source/Panic_disorder) commonly cause avoidance of intercourse and premature ejaculation.[34] Pain during intercourse is often a comorbidity of anxiety disorders among women.[35]

Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol, [nicotine](/source/Nicotine), [narcotics](/source/Narcotic), stimulants, [antihypertensives](/source/Antihypertensive_drug), [antihistamines](/source/Antihistamine), and some psychotherapeutic drugs.[36] For women, almost any physiological change that affects the reproductive system—[premenstrual syndrome](/source/Premenstrual_syndrome), pregnancy and the postpartum period, and menopause—can have an adverse effect on libido.[36] Back injuries may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in [sexual dysfunction after spinal cord injuries](/source/Sexuality_after_spinal_cord_injury)). Diseases such as [diabetic neuropathy](/source/Diabetic_neuropathy), [multiple sclerosis](/source/Multiple_sclerosis), [tumors](/source/Tumor), and, rarely, tertiary [syphilis](/source/Syphilis) may also impact activity, as can the failure of various organ systems (such as the heart and lungs), [endocrine](/source/Endocrine) disorders ([thyroid](/source/Thyroid), [pituitary](/source/Pituitary), or [adrenal gland](/source/Adrenal_gland) problems), hormonal deficiencies (low [testosterone](/source/Testosterone), other [androgens](/source/Androgen), or [estrogen](/source/Estrogen)), and some [birth defects](/source/Birth_defect).

In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for the male partner, causing poor body image, and it can also be a major source of low desire for these men.[37] In aging women, it is natural for the vagina to [narrow and atrophy](/source/Menopause#Urogenital_atrophy). If a woman does not participate in sexual activity regularly (in particular, activities involving vaginal penetration), she will not be able to immediately accommodate a penis without risking pain or injury if she decides to engage in penetrative intercourse.[37] This can turn into a vicious cycle that often leads to female sexual dysfunction.[37]

According to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become "an illness that needs treatment" instead of viewing it as a natural part of the aging process. Not all cultures seek treatment; for example, a population of men living in Mexico often accept ED as a normal part of their maturing sexuality.[38]

### With SSRI medication

Sexual problems are common with SSRIs,[39] which can cause [anorgasmia](/source/Anorgasmia), [erectile dysfunction](/source/Erectile_dysfunction), diminished [libido](/source/Libido), genital numbness, and [sexual anhedonia](/source/Sexual_anhedonia) (pleasureless orgasm).[40] Poor sexual function is also one of the most common reasons people stop the medication.[41] In some cases, symptoms of sexual dysfunction may persist after discontinuation of SSRIs.[40][42][43]: 14[44][45] This combination of symptoms is sometimes referred to as [post-SSRI sexual dysfunction](/source/Selective_serotonin_reuptake_inhibitor#Sexual_dysfunction).[46][47]

### Pelvic floor dysfunction

Main article: [Pelvic floor dysfunction](/source/Pelvic_floor_dysfunction)

Pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men, and is treatable by [pelvic floor physical therapy](/source/Pelvic_floor_physical_therapy), a type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas.[48][49][50][51][52]

### Female sexual dysfunction

Several theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include: the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis:

- Self-perception theory: people make attributions about their own attitudes, feelings, and behaviours by relying on their observations of external behaviours and the circumstances in which those behaviours occur[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

- Overjustification hypothesis: when an external reward is given to a person for performing an intrinsically rewarding activity, the person's intrinsic interest will decrease[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

- Insufficient justification: based on the classic [cognitive dissonance](/source/Cognitive_dissonance) theory (inconsistency between two cognitions or between a cognition and a behavior will create discomfort), this theory states that people will alter one of the cognitions or behaviours to restore consistency and reduce distress[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

The prevalence of sexual dysfunction in women is not well known due to a paucity of epidemiological studies, inconsistent criteria for sexual dysfunction across different studies and incomplete recruitment, with studies often excluding women who were without a partner or who were sexually inactive. However, based on incomplete population based studies from the United States, Europe and Australia, unspecified arousal dysfunction (in which a woman is unable to achieve desirable genital or non-genital sexual arousal despite adequate stimulation and desire) was present in 3-9% of women aged 18–44, 5-7.5% aged 45–64 and 3-6% in women older than 65.[53] Anorgasmia with distress (in which women were unable to achieve an orgasm) was present in 7-8% of women younger than 40, 5-7% aged 40–64 and 3-6% of those older than 65.[53] Poor sexual self image leading to distress was seen in 13.4% of women younger than 40 in an Australian population based study.[53]

The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity.[37] Several factors influence a women's perception of her sexual life. These can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion.[37] Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study found that African American women are the most optimistic about menopausal life; Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic.[37]

Since these women have sexual problems, their sexual lives with their partners can become a burden without pleasure, and may eventually lose complete interest in sexual activity. Some of the women found it hard to be aroused mentally, while others had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners, the environment where sex occurs being uncomfortable, or an inability to concentrate on the sexual activity due to a bad mood or burdens from work. Other factors include physical discomfort or difficulty in achieving arousal, which could be caused by aging or changes in the body's condition.[54]

[Sexual assault](/source/Sexual_assault) has been associated with excessive menstrual bleeding, genital burning, and painful intercourse (attributable to disease, injury, or otherwise), medically unexplained dysmenorrhea, menstrual irregularity, and lack of sexual pleasure.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] Physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms. Multiple assaults, assaults accomplished by persuasion, spousal assault, and completed intercourse were most strongly related to sexual symptoms.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] Assault was occasionally associated more strongly with reproductive symptoms among women with lower income or less education, possibly because of economic stress or differences in assault circumstances. Associations with unexplained menstrual irregularity were strongest among African American women; ethnic differences in reported circumstances of assault appeared to account for these differences. Assault was associated with sexual indifference only among Latinas.[55]

### Menopause

The most prevalent of female sexual dysfunctions that have been linked to menopause include lack of desire and libido; these are predominantly associated with hormonal physiology. Specifically, the decline in serum estrogens causes these changes in sexual functioning. Androgen depletion may also play a role, but current knowledge about this is less clear. The hormonal changes that take place during the menopausal transition have been suggested to affect women's sexual response through several mechanisms, some more conclusive than others.

### Aging in women

Whether or not aging directly affects women's sexual functioning during menopause is controversial. However, many studies have demonstrated that aging has a powerful impact on sexual function and dysfunction in women, specifically in the areas of desire, sexual interest, and frequency of orgasm.[3][37][56] The primary predictor of sexual response throughout menopause is prior sexual functioning,[3] which means that it is important to understand how the physiological changes in men and women can affect sexual desire.[37] Despite the apparent negative impact that menopause can have on sexuality and sexual functioning, sexual confidence and well-being can improve with age and menopausal status.[3]

Testosterone, along with its metabolite [dihydrotestosterone](/source/Dihydrotestosterone), is important to normal sexual function in men and women. Dihydrotestosterone is the most prevalent androgen in both men and women.[37] Testosterone levels in women at age 60 are on average about half of what they were before the women were 40. Although this decline is gradual for most women, those who have undergone [bilateral oophorectomy](/source/Bilateral_oophorectomy) experience a sudden drop in testosterone levels, as the ovaries produce 40% of the body's circulating testosterone.[37]

Sexual desire has been related to three separate components: drive, beliefs and values, and motivation.[37] Particularly in postmenopausal women, drive fades and is no longer the initial step in a woman's sexual response.[37]

## Diagnosis

### List of disorders

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#### DSM

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following sexual dysfunctions:

- Hypoactive sexual desire disorder (see also [asexuality](/source/Asexuality), which is not classified as a disorder)

- Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse)[57][58]

- [Female sexual arousal disorder](/source/Female_sexual_arousal_disorder) (failure of normal lubricating arousal response)[59]

- Male erectile disorder

- Female orgasmic disorder (see anorgasmia)[60]

- Male orgasmic disorder (see anorgasmia)[61]

- Premature ejaculation

- Dyspareunia

- Vaginismus

Additional DSM sexual disorders that are not sexual dysfunctions include:

- Paraphilias

- [PTSD](/source/PTSD) due to [genital mutilation](/source/Genital_mutilation) or [childhood sexual abuse](/source/Childhood_sexual_abuse)

#### Other sexual problems

- Sexual dissatisfaction (non-specific)

- Lack of sexual desire

- Anorgasmia

- Impotence

- [Sexually transmitted infections](/source/Sexually_transmitted_infection)

- Delay or absence of [ejaculation](/source/Ejaculation), despite adequate stimulation

- Inability to control timing of ejaculation

- Inability to relax vaginal muscles enough to allow [intercourse](/source/Sexual_intercourse)

- Inadequate vaginal lubrication preceding and during intercourse

- Burning pain on the vulva or in the vagina with contact to those areas

- Unhappiness or confusion related to [sexual orientation](/source/Sexual_orientation)

- [Transsexual](/source/Transsexual) and [transgender](/source/Transgender) people may have sexual problems before or after [surgery](/source/Sex_reassignment_surgery).

- [Persistent sexual arousal syndrome](/source/Persistent_sexual_arousal_syndrome)

- [Sexual addiction](/source/Sexual_addiction)

- [Hypersexuality](/source/Hypersexuality)

- All forms of [female genital cutting](/source/Female_genital_cutting)

- Post-orgasmic diseases, such as Dhat syndrome, PCT, POIS, and sexual headaches.

- [Hard flaccid syndrome](/source/Hard_flaccid_syndrome)[62]

## Treatment

### Males

Several decades ago, the medical community believed most sexual dysfunction cases were related to psychological issues. Although this may be true for a portion of men, the vast majority of cases have now been identified to have a physical cause or a correlation.[63] If the sexual dysfunction is deemed to have a psychological component or cause, [psychotherapy](/source/Psychotherapy) can help. Situational anxiety arises from an earlier bad incident or lack of experience, and often leads to development of fear towards sexual activity and avoidance which enters a cycle of increased anxiety and [desensitization](/source/Desensitization_(medicine)) of the penis. In some cases, erectile dysfunction may be due to marital disharmony. Marriage [counseling](/source/Relationship_counseling) sessions are recommended in this situation.

Lifestyle changes such as discontinuing [tobacco smoking](/source/Tobacco_smoking) or substance use can also treat some types of ED.[64] Several oral medications like [Viagra](/source/Sildenafil), [Cialis](/source/Tadalafil), and [Levitra](/source/Vardenafil) have become available to alleviate ED and have become first line therapy. These medications provide an easy, safe, and effective treatment solution for approximately 60% of men. In the rest, the medications may not work because of wrong diagnosis or [chronic](/source/Chronic_(medicine)) history.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

Another type of medication that is effective in roughly 85% of men is called intracavernous pharmacotherapy, which involves injecting a vasodilator drug directly into the penis to stimulate an erection.[65] This method has an increased risk of priapism if used in conjunction with other treatments, and localized pain.[21]

[Premature ejaculations](/source/Premature_ejaculation) are treated by behavioural techniques Squeeze technique and Stop Start Technique. In Squeeze technique the area between head and shaft of penis is pressed using index finger and thumb just before ejaculation. In Stop Start Technique the male partner stops having sexual intercourse just before ejaculation and waits for the sense of ejaculation to pass away. Both Techniques are repeated many times.[66]

When conservative therapies fail, are an unsatisfactory treatment option, or are contraindicated for use, the insertion of a [penile implant](/source/Penile_implant) may be selected by the patient. Technological advances have made the insertion of a penile implant a safe option for the treatment of ED, which provides the highest patient and partner satisfaction rates of all available ED treatment options.[67]

Pelvic floor physical therapy has been shown to be a valid treatment for men with sexual problems and pelvic pain.[68]

The 2020 guidelines from the [American College of Physicians](/source/American_College_of_Physicians) support the discussion of [testosterone](/source/Testosterone_(medication)) treatment in adult men with age-related [low levels of testosterone](/source/Low_T) who have sexual dysfunction. They recommend yearly evaluation regarding possible improvement and, if none, to discontinue testosterone; intramuscular treatments should be considered rather than transdermal treatments due to costs and since the effectiveness and harm of either method is similar. Testosterone treatment for reasons other than possible improvement of sexual dysfunction may not be recommended.[69][70]

### Females

In 2015, [flibanserin](/source/Flibanserin) was approved in the US to treat decreased sexual desire in women. While it is effective for some women, it has been criticized for its limited efficacy, and has many warnings and contraindications that limit its use.[71] Flibanserin was found to increase pleasurable sexual experiences by 0.5 events per month in trials. Possible side effects include dizziness, drowsiness, nausea and fatigue.[53] Flibanserin should not be taken with alcohol.[53] [Bremelanotide](/source/Bremelanotide) has been shown to modestly increase sexual desire in women, but it has not shown evidence of increasing the number of satisfactory sexual experiences per month. Possible side effects include nausea, flushing and headaches.[53] Women experiencing pain with intercourse are often prescribed pain relievers or desensitizing agents; others are prescribed [vaginal lubricants](/source/Personal_lubricant). Many women with sexual dysfunction are also referred to a [counselor](/source/Mental_health_counselor) or [sex therapist](/source/Sex_therapy).[72] Counselling for female sexual dysfunction, including [sexual counselling](/source/Sex_therapy), [cognitive behavioral therapy](/source/Cognitive_behavioral_therapy), body awareness counselling, and [couples counselling](/source/Couples_counselling) have been found to be helpful.[53]

Estrogen replacement therapy, outside of the indicated use for menopausal symptoms, is not recommended for the treatment of sexual dysfunction in women.[53]

#### Menopause

Estrogens are responsible for the maintenance of collagen, elastic fibers, and vasculature of the urogenital tract, all of which are important in maintaining vaginal structure and functional integrity; they are also important for maintaining vaginal pH and moisture levels, both of which help to keep the tissues lubricated and protected.[3] Prolonged estrogen deficiency leads to atrophy, fibrosis, and reduced blood flow to the urogenital tract, which cause menopausal symptoms such as vaginal dryness and pain related to sexual activity and/or intercourse.[3] Women experiencing vaginal dryness who cannot use commercial lubricants may be able to use coconut oil as an alternative.[73]

Androgen therapy for hypoactive sexual desire disorder has a small benefit but its safety is not known.[74] It is not approved as a treatment in the United States.[74] It is more commonly used among women who have had an oophorectomy or are in a postmenopausal state. However, like most treatments, this is also controversial. One study found that after a 24-week trial, women taking androgens had higher scores of sexual desire compared to a placebo group.[3] As with all pharmacological drugs, there are side effects in using androgens, which include [hirsutism](/source/Hirsutism), acne, [polycythaemia](/source/Polycythemia), increased high-density lipoproteins, cardiovascular risks, and [endometrial hyperplasia](/source/Endometrial_hyperplasia).[3] Alternative treatments include topical estrogen creams and gels that can be applied to the vulva or vagina area to treat vaginal dryness and atrophy.[3]

## Research

This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2021) (Learn how and when to remove this message)

See also: [List of investigational sexual dysfunction drugs](/source/List_of_investigational_sexual_dysfunction_drugs)

In modern times, clinical study of sexual problems is usually dated back no earlier than 1970 when [Masters and Johnson's](/source/William_Masters_and_Virginia_Johnson) *[Human Sexual Inadequacy](/source/Human_Sexual_Inadequacy)* was published. It was the result of over a decade of work at the Reproductive Biology Research Foundation in St. Louis, involving 790 cases. The work grew from Masters and Johnson's earlier *[Human Sexual Response](/source/Human_Sexual_Response_(book))* (1966).

Prior to Masters and Johnson, the clinical approach to sexual problems was largely derived from [Sigmund Freud](/source/Sigmund_Freud). It was held to be [psychopathology](/source/Psychopathology) and approached with a certain pessimism regarding the chance of help or improvement. Sexual problems were merely symptoms of a deeper malaise, and the diagnostic approach was from the psychopathological viewpoint. There was little distinction between difficulties in function and variations nor between perversion and problems. Despite work by psychotherapists such as Balint sexual difficulties were crudely split into frigidity or impotence, terms which acquired negative connotations in popular culture.

*Human Sexual Inadequacy* moved thinking from psychopathology to learning; psychopathological problems would only be considered if a problem did not respond to educative treatment. Treatment was directed at couples, whereas before partners would be seen individually. Masters and Johnson believed that sex was a joint act, and that sexual communication was the key issue to sexual problems, not the specifics of an individual problem. They also proposed [co-therapy](/source/Co-therapy), with a pair of therapists to match the clients, arguing that a lone male therapist could not fully comprehend female difficulties.

The basic Masters and Johnson treatment program was an intensive two-week program to develop efficient sexual communication. The program is couple-based and therapist-led, and began with discussion and sensate focus between the couple to develop shared experiences. From the experiences, specific difficulties could be determined and approached with a specific therapy. In a limited number of male-only cases (41) Masters and Johnson developed the use of a female surrogate, which was abandoned over the ethical, legal, and other problems it raised.

In defining the range of sexual problems, Masters and Johnson defined a boundary between dysfunction and deviations. Dysfunctions were transitory and experienced by most people, and included male primary or secondary impotence, premature ejaculation, and [ejaculatory incompetence](/source/Ejaculatory_incompetence); female primary [orgasmic dysfunction](/source/Orgasmic_dysfunction) and situational orgasmic dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson, [sexual arousal](/source/Sexual_arousal) and [climax](/source/Orgasm) are a normal physiological process of every functionally intact adult, but they can be inhibited despite being autonomic responses. Masters and Johnson's treatment program for dysfunction was 81.1% successful.

Despite Masters and Johnson's work, sexual therapy in the US was overrun by enthusiastic rather than systematic approaches, blurring the space between "enrichment" and therapy.

## See also

- [Human sexuality portal](https://en.wikipedia.org/wiki/Portal:Human_sexuality)

- [Agony aunt](/source/Agony_aunt)

- [Dapoxetine](/source/Dapoxetine)

- [Orgastic impotence](/source/Orgastic_impotence)

- [Premature ejaculation](/source/Premature_ejaculation)

- [Sex and drugs](/source/Sex_and_drugs)

- [Sex after pregnancy](/source/Sex_after_pregnancy)

- [Sexless marriage](/source/Sexless_marriage)

- [Sexual arousal disorder](/source/Sexual_arousal_disorder)

- [Dapoxetine](/source/Dapoxetine)

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## External links

- Media related to [Sexual disorders](https://commons.wikimedia.org/wiki/Category:Sexual_disorders) at Wikimedia Commons

- [NIH site on sexual problems](https://web.archive.org/web/20131018092257/http://www.nlm.nih.gov/medlineplus/ency/article/001951.htm) (archived 18 October 2013)

Classification D ICD-10: F52 ICD-9-CM: 302.7 MeSH: D020018

v t e Human sexual activity Human sexuality Physiology and biology Clitoral erection Erogenous zones Insemination Intersex Libido Nocturnal emission Orgasm Female and male ejaculation Pelvic thrust Penile erection Pre-ejaculate Pregnancy Sexual arousal Sexual response cycle Sexual stimulation Vaginal lubrication Activities Anal sex Bareback BDSM Conventional sex Creampie Edging Erotic sexual denial Facial Fisting Footjob Forced orgasm Frot Gang bang Group sex Mammary intercourse Manual sex Anal fingering Fingering Handjob Masturbation Mechanics of sex Nipple stimulation Non-penetrative sex Oral sex 69 Anilingus Cunnilingus Fellatio Irrumatio Pompoir Quickie Sexercise Sex positions Sexual intercourse Foreplay Sexual penetration Sumata Swinging Tribadism Urethral intercourse Urolagnia Virtual sex Cybersex Erotic talk Wet T-shirt contest Behaviour Attraction Fetishism Foot fetishism Paraphilia Sexual fantasy Health and education Birth control Condom Male contraceptive Obesity and sexuality Safe sex Sex education Sex therapy (PLISSIT model) Sexology Sexual dysfunction Compulsive sexual behaviour disorder Erectile dysfunction Hypersexuality Hyposexuality Sexual medicine Sexual surrogate Sexually transmitted infection Identity and diversity Gender binary Gender identity Men who have sex with men Sexual identity Sexual orientation Women who have sex with women Law Age of consent Criminal transmission of HIV Child sexual abuse Incest Indecent exposure Obscenity Sexual abuse Cybersex trafficking Rape Sex trafficking Sexual assault Sexual harassment Sexual misconduct Sexual slavery Sexual violence Revenge pornography History Feminist sex wars History of erotic depictions Sexual revolution Relationships and society Anarchism and love/sex Coital imperative Extramarital sex Family planning Flirting Free love Orgasm imperative Orgasm gap Premarital sex Promiscuity Romance Sex-positive movement Sexual abstinence Sexual addiction Sexual capital Sexual ethics Sexual objectification Sexual repression Sexual slang By country Ancient Rome China India Japan Philippines South Korea United States Sex industry Adult video games Erotica Pornography Film actor Prostitution Sacred Survival sex Red-light district Sex museum Sex shop Sex tourism Child Female Sex worker Sex toy Doll Strip club Webcam model Religion and sexuality Buddhism and Hinduism Tantric sex Christianity and sexual orientation Christian demonology Clerical celibacy Buddhist monasticism Catholic Church Hindu monasticism Jain monasticism Daoism Islam Judaism LGBTQ people LGBTQ-affirming religions Mormonism Sacred prostitution Ancient Greece Thelema Sex magic Human sexuality portal

v t e Human sexuality Index Outline Physiology and biology Adolescent sexuality Child sexuality Human female sexuality Human male sexuality Intersex Sex differences Differentiation Physiology Mechanics of sexuality Sexual response cycle Anatomy Anus Breasts Clitoris Erogenous zones Genitourinary system Nipples Penis Rectum Reproductive system Male Female Throat Vagina Events Clitoral erection Insemination Libido Nocturnal emission Orgasm Female and male ejaculation Pelvic thrust Penile erection Pre-ejaculate Pregnancy Sexual arousal Sexual stimulation Semen Vaginal lubrication Health Birth control Sexual dysfunction Compulsive sexual behaviour disorder Erectile dysfunction Hypersexuality Hyposexuality Disorders of sex development Obesity and sexuality Safe sex Sexual addiction Sexuality and disability Sexually transmitted infection Research Biological Birth order Handedness Neuroscientific Prenatal hormones Demographical Environmental Reproductive medicine Andrology Gynaecology Urology Sex education Sex therapy (PLISSIT model) Sexual medicine Sexecology Specific research Kinsey scale Klein Sexual Orientation Grid Split attraction model Masters and Johnson Society Identity and diversity Asexuality Gray asexuality Demisexuality Bisexuality Pansexuality Heterosexuality Homosexuality Men who have sex with men Women who have sex with women LGBTQ Sexual orientation Relationship phenomena Casual relationship Casual sex Celibacy Love shyness Celibacy syndrome Herbivore men Committed relationship Conventional sex Fictosexuality Flirting Free love Foreplay Friends with benefits relationships Group sex Marriage One-night stand Promiscuity Female Romance Romantic orientation Aromanticism Polyamory Sex life Sexual abstinence Sexual orientation Sexual partner Sexual repression Single person Swinging Sexual dynamics Hypergamy Physical attractiveness Sexual activity Sexual attraction Sexual capital Sexual communication Sexual consent Sexual desire Sexual ethics Sexual frustration Sociosexuality See also Abortion-rights movement Age of consent Decriminalization of sex work LGBTQ rights by country or territory Public sex Reproductive rights Right to privacy Sex and drugs Sex worker movements Sex workers' rights Sex-positive movement Sex-positive feminism Sexual and reproductive health and rights Sexual jealousy Sexual norm Sexual revolution Sexual script theory Sexual surrogate Stanley v. Georgia Human sexuality portal

v t e Mental disorders (Classification) Adult personality and behavior Sexual Ego-dystonic sexual orientation Paraphilia Fetishism Voyeurism Sexual anhedonia Sexual anorexia Sexual maturation disorder Sexual relationship disorder Compulsive sexual behaviour disorder Other Factitious disorder Munchausen syndrome Fear of intimacy Gender dysphoria Intermittent explosive disorder Dermatillomania Kleptomania Pyromania Trichotillomania Personality disorder Childhood and learning Emotional and behavioral ADHD Conduct disorder ODD Emotional and behavioral disorders Separation anxiety disorder Movement disorders Stereotypic Social functioning DAD RAD Selective mutism Speech Cluttering Stuttering Tic disorder Tourette syndrome Intellectual disability X-linked intellectual disability Lujan–Fryns syndrome Psychological development (developmental disabilities) Pervasive Specific Mood (affective) Bipolar Bipolar I Bipolar II Bipolar NOS Cyclothymia Depression Atypical depression Dysthymia Major depressive disorder Melancholic depression Seasonal affective disorder Mania Neurological and symptomatic Autism spectrum Autism Asperger syndrome High-functioning autism PDD-NOS Savant syndrome Dementia AIDS dementia complex Alzheimer's disease Creutzfeldt–Jakob disease Frontotemporal dementia Huntington's disease Mild cognitive impairment Parkinson's disease Pick's disease Sundowning Vascular dementia Wandering Other Delirium Organic brain syndrome Post-concussion syndrome Neurotic, stress-related and somatoform Adjustment Adjustment disorder with depressed mood Anxiety Phobia Agoraphobia Childhood phobia Social anxiety Social phobia Anthropophobia Specific social phobia Specific phobia Claustrophobia Other Generalized anxiety disorder OCD Panic attack Panic disorder Paranoia Stress Acute stress reaction PTSD Dissociative Depersonalization-derealization disorder Dissociative identity disorder Dissociative amnesia Dissociative fugue Dissociative disorder not otherwise specified Other specified dissociative disorder Somatic symptom Body dysmorphic disorder Conversion disorder Ganser syndrome Globus pharyngeus Psychogenic non-epileptic seizures False pregnancy Hypochondriasis Mass psychogenic illness Nosophobia Psychogenic pain Physiological and physical behavior Eating Anorexia nervosa Bulimia nervosa Binge eating disorder Avoidant/restrictive food intake disorder Pica Rumination syndrome Other specified feeding or eating disorder Nonorganic sleep Hypersomnia Insomnia Parasomnia Night terror Nightmare REM sleep behavior disorder Postnatal Postpartum depression Postpartum psychosis Sexual desire Hypersexuality Hypoactive sexual desire disorder Psychoactive substances, substance abuse and substance-related Drug overdose Hallucinogen persisting perception disorder Intoxication Physical dependence Rebound effect Stimulant psychosis Substance dependence Substance-induced psychosis Withdrawal Schizophrenia, schizotypal and delusional Delusional Delusional disorder Folie à deux Psychosis and schizophrenia-like Brief reactive psychosis Schizoaffective disorder Schizophreniform disorder Schizophrenia Childhood schizophrenia Disorganized (hebephrenic) schizophrenia Pseudoneurotic schizophrenia Simple-type schizophrenia Other Catatonia Symptoms and uncategorized Impulse-control disorder Klüver–Bucy syndrome Psychomotor agitation Stereotypy Caregiver burden Category

v t e Post-orgasmic diseases Illnesses Dhat syndrome Honeymoon rhinitis Post-coital tristesse (PCT) Postorgasmic illness syndrome (POIS) Sexual headache Specialties Andrology Allergy Endocrinology Gynaecology Psychiatry General Orgasm Ejaculation La petite mort

v t e Male diseases of the pelvis and genitals Internal Testicular Orchitis Hydrocele testis Testicular cancer Testicular torsion Male infertility Aspermia Asthenozoospermia Azoospermia Hyperspermia Hypospermia Oligospermia Necrospermia Teratospermia Ectopic testis Epididymis Epididymitis Spermatocele Hematocele Prostate Prostatitis Acute prostatitis Chronic bacterial prostatitis Chronic prostatitis/chronic pelvic pain syndrome Asymptomatic inflammatory prostatitis Benign prostatic hyperplasia Prostate cancer Seminal vesicle Seminal vesiculitis External Penis Balanoposthitis / Balanitis Balanitis plasmacellularis Pseudoepitheliomatous keratotic and micaceous balanitis Phimosis Paraphimosis Priapism Sexual dysfunction Erectile dysfunction Spontaneous orgasm Peyronie's disease Penile cancer Penile fracture Balanitis xerotica obliterans Persistent genital arousal disorder Scrotum Fournier gangrene Varicocele Pneumoscrotum Other Hematospermia Men's health Postorgasmic illness syndrome Retrograde ejaculation

v t e Sexual and reproductive health Rights Reproductive justice Compulsory sterilization Contraceptive security Abortion-rights movements Genital integrity Circumcision controversy Intersex human rights Education Sex education Genetic counseling Pre-conception counseling Planning Childfreeness/childlessness Birth spacing Parenting adoption foster care Sperm theft Contraception Hormonal contraception Male contraception Safe sex Condom Intrauterine device Sterilization Assisted reproduction In vitro fertilization ICSI Gamete Cryopreservation Egg Sperm Sperm bank fertility fraud Health Men's Women's vulvovaginal Research self-report sexual risk behaviors Pregnancy Maternal health Obstetrics Unintended pregnancy childbirth Abortion Options counseling Pregnancy from rape Pregnant patients' rights Prenatal care Teenage pregnancy Precocious puberty and pregnancy Identity Gender identity Sexual orientation Intersex Transgender Genital modification Medicine Andrology Genitourinary medicine Gynaecology Obstetrics and gynaecology Reproductive endocrinology and infertility Sexual medicine Transgender health care Disorders Disorders of sex development Infertility Reproductive system disease Sexual dysfunction Sexually transmitted infections clinic Gender dysphoria By country China India Iran Ireland Pakistan Philippines Singapore United Kingdom teen United States teen pregnancy birth control History Birth control movement in the United States History of condoms Social hygiene movement Timeline of reproductive rights legislation Policy One-child policy Two-child policy Three-child policy Abortion law

Authority control databases International GND National United States France BnF data Czech Republic Israel Other Yale LUX

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Adapted from the Wikipedia article [Sexual dysfunction](https://en.wikipedia.org/wiki/Sexual_dysfunction) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Sexual_dysfunction?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.