Sexual dysfunction: what is it, causes, treatments

Although it doesn't get talked about as often, your sexual health is just as important to your well-being as your physical and mental health. 

All of these different aspects of your health are interconnected. So a problem in one area can negatively affect the others as well.

It can be tough to seek help for sexual dysfunction due to social or cultural stigmas, but doing so can improve not just your sex life, but your overall quality of life. 

Having satisfying sex might sound like a simple thing to some people, but it’s actually a complex process that doesn’t always go as planned for many people. The physical and emotional changes that occur as a person becomes sexually aroused are divided into four phases, known as the sexual response cycle. These phases are (Shifren, 2020):

• Desire (libido)

• Arousal (excitement)

• Orgasm

• Resolution 

Everyone can experience these phases, regardless of gender, and they can vary in order, overlap, repeat, or be absent during some or all sexual encounters. You don’t have to experience every phase to feel satisfied. The most important marker of sexual health is if you are happy with your sexual activity (Shifren, 2020).

If you regularly feel dissatisfied with any part of the sexual response cycle, this can be considered sexual dysfunction (Shifren, 2020).

Researchers aren’t sure exactly how many people experience sexual dysfunction since not everyone feels comfortable seeking help from a healthcare provider. Estimates are that one in every eight women have a sexual problem severe enough to cause them distress. Up to 31% of men may experience some sort of sexual dysfunction in their lifetime (Shifren, 2020; Lau, 2005).

There are three major types of sexual dysfunction disorders recognized in women.

Female sexual arousal disorder

This condition is the absence of interest or severely reduced interest in any type of sexual activity. It must last for at least six months, cause significant distress to the woman experiencing it, and not be caused by a medical condition to meet the criteria (Faubion, 2015).

Female orgasmic disorders

The criteria for female orgasmic disorder include a delay or absence of orgasm for at least six months in at least 75% of sexual encounters, causing distress. Causing distress is key because about one-half of women who don’t consistently reach orgasm don’t report being troubled by it (Faubion, 2015).

Genital/pelvic pain during sex

Formerly split into two disorders called vaginismus and dyspareunia, pain during sex is now called genito-pelvic pain/penetration disorder. Its criteria include fear or anxiety about sex, marked tightening or tensing of the abdominal and pelvic muscles, or actual pain with vaginal penetration for at least six months (Faubion, 2015).

Sexual dysfunction in men is a common problem. A meta-analysis of 22 general population surveys in western countries found that 1–15% of men reported lowered libido, 5% noted inability to orgasm, and 35% reported premature ejaculation at some point in their lifetime (Lau, 2005).

Low libido

Like low interest/desire in women, low libido in men is absent or reduced sexual desire that lasts for at least six months. It can be linked to stress, tiredness, relationship issues, or a medical condition.

Erectile dysfunction

Erectile dysfunction (ED), previously called impotence, is failure to achieve or maintain an erection suitable for you to have satisfactory sexual intercourse for at least six months. It's a common condition in men over 40 years old, especially in those with other health conditions (Sooriyamoorthy, 2021).

Premature ejaculation

Premature ejaculation occurs when ejaculation happens sooner than you or your partner would like during sexual activity. It's considered the most common sexual disorder in men. Occasional premature ejaculations should not be concerning, but regular occurrences can interrupt your enjoyment of sexual activity (Crowdis, 2021).

No matter how you identify, there are some common signs of sexual dysfunction that many with the condition share. You may experience any of the following:

• You rarely or never have an interest in having sex.

• You avoid sexual activity with your partner.

• You have trouble getting or staying aroused even when you want sex.

• You can’t have an orgasm.

• You experience pain with sex.

The most important part of diagnosing a sexual function disorder is that it causes you distress. Sexual needs can vary widely. Plenty of people experience little or no sex drive or arousal but are still satisfied with their sex lives. If the level and type of sexual activity you are having aren’t troubling you, then it isn’t considered sexual dysfunction.

Good sexual health depends on complex processes in the body coordinated by your neurological, endocrine, and vascular systems. When one of these systems isn’t functioning optimally, it can affect your self-esteem, body image, interpersonal relationships, and physical health (Mollaioli, 2020).

Some factors that can increase your risk for sexual dysfunction include (Chen, 2019; Basson, 2018):

• Medical conditions, such as diabetes, heart disease, kidney disease, stroke, or cancer

• Lifestyle factors, such as alcohol use, obesity, drug use, or smoking

• Certain medications, such as antidepressants or medicines for high blood pressure

• Mental health problems, such as depression or anxiety

• Hormonal changes, such as low testosterone or those that can happen postpartum or at menopause

• Environmental factors, such as exposure to heavy metals or bisphenol A (BPA) 

It can be challenging to talk about, but you should discuss with your healthcare provider if you’re having trouble with your sex life. 

Your provider’s assessment will most likely include (Sooriyamoorthy, 2021):

• A thorough medical history

• A sexual history

• A physical exam

• A list of medications you take, including supplements

An assessment for sexual dysfunction in men, in particular, should include a workup for heart disease. Sexual problems, especially erectile dysfunction, can often be the first sign of cardiovascular disease (Sooriyamoorthy, 2021).

There are no lab tests required to diagnose sexual dysfunction, but your provider might order some anyway to rule out underlying medical conditions. These might include general labs that you might have done at a regular checkup, such as tests for diabetes or high cholesterol, in addition to estrogen or testosterone levels (Sooriyamoorthy, 2021; Faubion, 2015).

If no apparent physical causes are affecting your sexual function, you might consider meeting with a mental health therapist. They can help you discover if stress, depression, or a history of sexual trauma might be affecting your sex life.

Treatment for sexual dysfunction depends on the type of problem and the underlying causes. You may need to try a combination of several therapies to get the best benefits. Some of the most common treatments are listed below.

Lifestyle modifications

The first step to treating both male and female sexual dysfunction is to change any behaviors that might negatively affect your sexual health. These can include reducing stress, quitting smoking, increasing physical activity, losing weight, and reducing alcohol or drug consumption (Mollaioli, 2020).

Therapy

If you suspect that psychological causes are influencing your sex life, seeing a professional counselor or sex therapist can help. Even if you don’t have a mental health condition, a skilled therapist can help you deal with problems related to sexual dysfunction. These can include reducing performance anxiety, helping you stick with treatment, helping you work on relationship problems, and setting realistic expectations (Sooriyamoorthy, 2021).

Medications

If your sexual problems are being caused or worsened by medication, your provider may be able to make changes to reduce these side effects. Some medications can help you improve your satisfaction with your sex life. First-line medicines for men include sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra).  Medicines aren’t commonly used for women, but two approved by the Food and Drug Administration (FDA) include flibanserin (Addyi) and bremelanotide (Vyleesi) (Basson, 2018; Sooriyamoorthy, 2021).

You don’t have to struggle with sexual dysfunction alone. There are treatments available that can be highly effective at helping you improve your symptoms. It can be tough to get over the potential embarrassment of talking about sex with a healthcare professional, but it can be worth it to feel more satisfied with your sex life.

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Current version

September 26, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.