Sexual dysfunctions are characterized by a significant impairment in a person's ability to respond sexually or to experience sexual pleasure. This can refer to an inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest. An individual may have several sexual dysfunctions at the same time.
Biology, Psychology, and Sexual Function
Several factors can disrupt sexual functioning. Medical conditions such as multiple sclerosis, spinal cord injury or other nerve damage, diabetes, endocrine (hormonal) disorders, and prostatitis can all lead to problems of sexual interest or sexual capacity. Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), may have sexual side effects. Some age-related vascular, nerve-related, and hormonal changes can also adversely affect sexual functioning. It is important to note that when sexual dysfunctions can be primarily attributed to one or more of these biological factors, it should not be diagnosed as a psychiatric disorder, and treatment should target the underlying medical problem. However, in many cases, medical concerns can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a psychiatric diagnosis may be appropriate.
Other psychiatric disorders can adversely affect sexual function. As one example, Major Depressive Disorder may be characterized by decreased interest in all or almost all of one’s usual activities. Sexual interest, therefore, may be diminished. In such cases, a separate diagnosis of a sexual dysfunction is not warranted. However, as was the case with medical conditions, other psychiatric disorders can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
Several psychological issues, even in the absence of a diagnosable psychiatric disorder, can contribute to sexual dysfunction. Negative body image may lead to feelings of anxiety around sexuality, inhibiting desire or capacity. Performance anxiety may similarly lead to problems of sexual function. Stressors, such as work or family concerns, may preoccupy the individual, affecting sexual interest or performance. A history of sexual trauma or other negative historical events may create negative associations with sexuality, thus undermining function. In such cases, a diagnosis of a sexual dysfunction is usually warranted.
Relationship factors can also contribute to problems of sexual functioning. At a purely physical level, often an individual’s sexual concerns stem not from a problem within the individual, but from a lack of appropriate sexual stimulation from his or her partner. At an interpersonal level, some couples suffer from poor sexual communication, have poor understanding of sexuality, have different desires or preferences for sexual activity, or feel negatively about each other. All of these factors have the potential to adversely affect sexual arousal or performance. Such cases should not be diagnosed as a psychiatric disorder. Again, however, relationship problems can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
The etiology of a sexual dysfunction is frequently unclear, and clinical judgment is needed. Often, multiple possible explanations need to be explored, using both medical and psychiatric examination procedures.
Sexuality is a complex process, coordinated by the neurologic, vascular and endocrine systems. Individually, sexuality incorporates family, societal and religious beliefs, and is altered with aging, health status and personal experience. In addition, sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. All of these contribute to an individual’s sexuality in varying degrees at any point in time as well as developing and changing throughout the life cycle. A breakdown in any of these areas may lead to sexual dysfunction.