Table of Contents
What is Sexual Dysfunction
Sexual Dysfunction – Physical or psychologic circumstances that interfere with sexual interest or sexual activity. Most people experience some degree of sexual dysfunction over the course of their lifetimes. The causes of sexual dysfunction are numerous; most are transient (improve or go away with time). Physical illness, injury, surgery, disability, medication side effects, emotional stress, job pressures, CHILDBIRTH and PARENTING responsibilities, GRIEF, DEPRESSION, and relationship discord are among the most common factors. People who have experienced SEXUAL ASSAULT or rape, in childhood or as adults, may also have difficulty establishing or maintaining healthy sexual relationships. As well, an individual’s attitudes toward and understanding of sex affect the nature and quality of sexual interaction.
Painful SEXUAL INTERCOURSE, called DYSPAREUNIA, is the most common form of physical sexual dysfunction in women. Dyspareunia may result from insufficient vaginal lubrication (which becomes more common after MENOPAUSE), vaginal MUSCLE spasms (VAGINISMUS), INFLAMMATION or irritation of the VAGINA (VAGINITIS) or VULVA (vulvitis), PAIN in the external GENITALIA (VULVODYNIA), UTERINE PROLAPSE, ENDOMETRIOSIS, UTERINE FIBROIDS, or perineal injury (such as perineal tear or EPISIOTOMY repair). Chronic PELVIC INFLAMMATORY DISEASE (PID) may also cause pain during sex. Psychologic or emotional factors may also contribute to dyspareunia.
The most common form of physical sexual dysfunction in men is the inability to achieve or maintain an ERECTION (ERECTILE DYSFUNCTION), which may result from physical or psychologic factors. ATHEROSCLEROSIS (accumulation of plaque deposits in the arteries that narrows the channel for BLOOD flow), DIABETES, peripheral NEUROPATHY (damage to the small nerves that supply the penis), long-term cigarette smoking, and medication side effects are the leading physical causes of erectile dysfunction in men. Men may also experience pain with intercourse as a consequence of URETHRITIS, PEYRONIE’S DISEASE, and inadequate lubrication during penetration.
Excessive ALCOHOL use, ILLICIT DRUG USE, and heavy or long-term cigarette smoking contribute to sexual dysfunction in men and women. Alcohol and many drugs, prescription or “street,” depress LIBIDO. Alcohol affects the health of blood vessels and nerves; long-term alcohol abuse is another cause of erectile dysfunction in men. Cigarette smoking also affects blood flow; NICOTINE is a powerful vasoconstrictor (narrows blood vessels) and the changes in blood oxygen levels that occur when smoking affect the function of cells throughout the body. These effects are most significant for NERVE cells, which require consistent levels of oxygen.
Symptoms and Diagnostic Path
The primary symptom of sexual dysfunction is the reduced ability to engage in or enjoy sexual activity. Men and women may experience difficulty achieving ORGASM (sexual climax); this is more common in women. Psychologic and emotional symptoms of sexual dysfunction in men or women may include diminished libido (sex drive), disinterest in sex, or excessive interest in sex. The diagnostic path begins with a comprehensive medical examination, including PELVIC EXAMINATION for women, and discussion about factors that might be contributing to the symptoms. The doctor may perform additional diagnostic procedures, depending on the findings of the medical examination, such as blood tests (men and women), cultures of vaginal fluids (women) or any discharges (men and women), or pelvic ULTRASOUND (women).
Treatment Options and Outlook
Treatment options depend on the identified causes of the symptoms. Treatment may be as straightforward as changing or stopping a medication that is causing the symptoms or treating an underlying physical condition. Often the symptoms of sexual dysfunction resolve when the factors responsible for them go away, such as when a person changes from a high-pressure job to one that has a lower level of stress. Sometimes simply the process of discussing life circumstances in response to the doctor’s questioning provides a connection between the circumstances and the symptoms that the person had not been able to see.
Sexual dysfunction can be a complex intertwining of physical and psychologic factors that benefits from a combination of treatment for the physical conditions and therapy (counseling) for the psychologic and emotional factors. Relationship or personal therapy may help a person come to insight and understanding about his or her attitudes and expectations about sex.
Risk Factors and Preventive Measures
The key risk factors for sexual dysfunction are physical or psychologic conditions or emotional issues that affect interest in and satisfaction with sexual activity. Appropriate treatment combined with open and compassionate communication can help partners address their concerns and achieve a level of sexual interaction that accommodates each partner’s needs. Though it is not always possible to prevent health and life circumstances from resulting in sexual dysfunction, most causes of sexual dysfunction are treatable.