View source for Sexual dysfunction

{{Short description|Difficulty experienced by humans during any stage of normal sexual activity}}
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'''Sexual dysfunction''' is difficulty experienced by an individual or partners during any stage of normal [[Human sexual activity|sexual activity]], including physical pleasure, [[Sexual desire|desire]], preference, [[sexual arousal|arousal]], or [[orgasm]]. The [[World Health Organization]] defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish".<ref>{{cite book | publisher = World Health Organization (WHO). | title = International Statistical Classification of Diseases and Related Health Problems | edition = 10th (ICD-10) | location = Geneva, Switzerland | date = 2010 }}</ref> This definition is broad and is subject to many interpretations.<ref name="Lo_2020">{{cite journal | vauthors = Lo YC, Chen HH, Huang SS | title = Panic Disorder Correlates With the Risk for Sexual Dysfunction | journal = Journal of Psychiatric Practice | volume = 26 | issue = 3 | pages = 185–200 | date = May 2020 | pmid = 32421290 | doi = 10.1097/PRA.0000000000000460 | s2cid = 218643956 }}</ref> A diagnosis of sexual dysfunction under the [[DSM-5]] requires a person to feel extreme distress and [[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.<ref name="eden">{{cite journal | vauthors = Eden KJ, Wylie KR | title = Quality of sexual life and menopause | journal = Women's Health | volume = 5 | issue = 4 | pages = 385–396 | date = July 2009 | pmid = 19586430 | doi = 10.2217/whe.09.24 | doi-access = free }}</ref> The term ''sexual disorder'' may not only refer to physical sexual dysfunction, but to [[paraphilia]]s 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.<ref name="pmid26003261">{{cite book | vauthors = Waldinger MD | title = Neurology of Sexual and Bladder Disorders | chapter = Psychiatric disorders and sexual dysfunction | series = Handbook of Clinical Neurology | volume = 130 | pages = 469–89 | date = 2015 | pmid = 26003261 | doi = 10.1016/B978-0-444-63247-0.00027-4 | isbn = 978-0-444-63247-0 }}</ref><ref name="Norton_1984">{{cite journal | vauthors = Norton GR, Jehu D | title = The role of anxiety in sexual dysfunctions: a review | journal = Archives of Sexual Behavior | volume = 13 | issue = 2 | pages = 165–83 | date = April 1984 | pmid = 6145405 | doi = 10.1007/BF01542150 | s2cid = 19396561 | url = }}</ref><ref name="Lo_2020"/> Assessing performance anxiety, [[guilt (emotion)|guilt]], [[Stress (biology)|stress]], and [[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]] proposed by [[Masters and Johnson|William H. Masters and Virginia E. Johnson]], and modified by [[Helen Singer Kaplan]].
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==Types==
Sexual dysfunction can be classified into four categories: [[Hypoactive Sexual Desire Disorder|sexual desire disorders]], [[sexual arousal disorder|arousal disorders]], [[Anorgasmia|orgasm disorders]], and [[pain disorder]]s. Dysfunction among men and women are studied in the fields of [[andrology]] and [[gynaecology|gynecology]] respectively.<ref>{{cite book | vauthors = van Andel T, de Boer H, Towns A | chapter = Gynaecological, andrological and urological problems: an ethnopharmacological perspective. | veditors = Heinrich M, Jäger AK | title = Ethnopharmacology | date = September 2015 | volume = 18 | pages = 199–212 | doi = 10.1002/9781118930717.ch18  | isbn = 978-1-118-93071-7 }}</ref>

===Sexual desire disorders===
{{Main|Hypoactive sexual desire disorder}}
[[Sexual desire]] disorders or decreased [[libido]] are characterized by a lack of [[sexual desire]], [[libido]] for [[Human sexual activity|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 [[selective serotonin reuptake inhibitor|SSRIs]]), or psychiatric conditions, such as [[Depression (mood)|depression]] and [[Anxiety disorder|anxiety]]. While many causes of low sexual desire are cited, only a few of these have ever been the object of empirical research.<ref>{{cite book | vauthors = Maurice W | date = 2007 | chapter = Sexual Desire Disorders in Men. | veditors = [[Sandra Leiblum|Leiblum S]] | title = Principles and Practice of Sex Therapy | edition = 4th | publisher = The Guilford Press | location = New York }}</ref>

===Sexual arousal disorders===
{{main|Sexual arousal disorder}}
Sexual arousal disorders were previously known as [[Hypoactive sexual desire disorder|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 a number of terms describing specific problems that can be broken down into four categories as described by the [[American Psychiatric Association|American Psychiatric Association's]] ''[[Diagnostic and Statistical Manual of Mental Disorders]]'': lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.<ref>{{cite journal | vauthors = Hartley H | year = 2006 | title = The 'pinking' of Viagra culture: Drug industry efforts to create and repackage sex drugs for women | doi = 10.1177/1363460706065058 | journal = Sexualities | volume = 9 | issue = 3| page = 365 | s2cid = 143113254 }}</ref>

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 autonomic nervous systems. It is defined as a rare disease by the [[National Institutes of Health|National Institute 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.<ref name="rarediseases.info.nih.gov">{{Cite web | url=https://rarediseases.info.nih.gov/diseases/10809/postorgasmic-illness-syndrome | title=Postorgasmic illness syndrome | work = Genetic and Rare Diseases Information Center (GARD) – an NCATS Program}}</ref>

====Erectile dysfunction====
{{Main|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.

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.<ref>{{cite web |title=How Psychogenic ED Can Turn into Physiological ED |url=https://www.rishabhbhola.com/post/how-psychogenic-ed-can-turn-into-physiological-ed |publisher=Rishabh Bhola |date=2025-10-08 |access-date=2025-10-08}}</ref> 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.<ref name="Rosen 2001">{{cite journal |last1=Rosen |first1=Raymond C. |title=Psychogenic Erectile Dysfunction |journal=Urologic Clinics of North America |date=May 2001 |volume=28 |issue=2 |pages=269–278 |doi=10.1016/S0094-0143(05)70137-3}}</ref>

Medical conditions 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.<ref>{{cite book [[Susan Nolen-Hoeksema|Nolen-Hoeksema S]] | date = 2013 | chapter = Sexual Dysfunctions. | title = Abnormal Psychology | publisher = McGraw Hill Education }}</ref>

It is estimated that around 30 million men in the United States and 152 million men worldwide have erectile dysfunction.<ref>{{cite journal | vauthors = ((NIH Consensus Development Panel on Impotence)) | year = 1993 | title = Impotence | journal = [[Journal of the American Medical Association]] | volume = 270 | pages = 83–90 | doi=10.1001/jama.270.1.83}}</ref><ref>{{cite journal | vauthors = Ayta IA, McKinlay JB, Krane RJ | title = The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences | journal = BJU International | volume = 84 | issue = 1 | pages = 50–56 | date = July 1999 | pmid = 10444124 | doi = 10.1046/j.1464-410x.1999.00142.x | s2cid = 35772517 }}</ref> However, [[social stigma]], [[Health literacy|low health literacy]], and social [[taboo]]s lead to under reporting which makes an accurate prevalence rate hard to determine.

ED from [[vascular disease]] is seen in individuals who have [[atherosclerosis]]. Vascular disease is common in individuals who smoke or have [[diabetes mellitus|diabetes]], [[peripheral vascular disease]], or [[hypertension]]. Cardiovascular disease can decrease blood flow to penile tissues, making it difficult to develop or maintain an erection.<ref name="Billups 2005">{{cite journal |last1=Billups |first1=K L |title=Erectile dysfunction as an early sign of cardiovascular disease |journal=International Journal of Impotence Research |date=1 December 2005 |volume=17 |issue=S1 |pages=S19–S24 |doi=10.1038/sj.ijir.3901425 |pmid=16391539 }}</ref>

Drugs are also a cause of erectile dysfunction. Individuals who take drugs that lower [[blood pressure]], [[antipsychotic]]s, [[antidepressant]]s, sedatives, narcotics, antacids, or alcohol can have problems with [[sexual function]] and loss of libido.<ref>{{cite journal | vauthors = Gupta AK, Chaudhry M, Elewski B | title = Tinea corporis, tinea cruris, tinea nigra, and piedra | journal = Dermatologic Clinics | volume = 21 | issue = 3 | pages = 395–400, v | date = July 2003 | pmid = 12956194 | doi = 10.1016/S0733-8635(03)00031-7 }}</ref>

[[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.<ref>[http://www.askmen.com/dating/love_tip_300/381_love_tip.html Strange sexual disorders] Ask Men. Retrieved on February 18, 2010</ref>

===Orgasm disorders===

==== Anorgasmia ====
{{Main|Anorgasmia}}
[[Anorgasmia]] is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters.<ref name="Nolen">{{cite book| vauthors = Nolen-Hoeksema S |title=Abnormal Psychology|date=2014|publisher=McGraw-Hill|isbn=978-1-259-06072-4|location=New York|pages=|author-link=Susan Nolen-Hoeksema}}</ref>{{rp|368}} The disorder can have physical, psychological, or pharmacological origins. [[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.<ref>{{cite book [[Susan Nolen-Hoeksema|Nolen-Hoeksema S]] | date = 2013 | edition = 6th | chapter = Sexual Dysfunctions. | title = Abnormal Psychology | publisher = McGraw Hill Education | page = 368 }}</ref>

====Premature ejaculation====
{{Main|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.<ref name="pmid9638953">{{cite journal | vauthors = Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G | title = Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system | journal = Behavioural Brain Research | volume = 92 | issue = 2 | pages = 111–8 | date = May 1998 | pmid = 9638953 | doi = 10.1016/s0166-4328(97)00183-6 | s2cid = 23494410 }}</ref> 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.<ref name="Diaz">{{cite journal | vauthors = Diaz VA, Close JD | title = Male sexual dysfunction | journal = Primary Care | volume = 37 | issue = 3 | pages = 473–489 | date = September 2010 | pmid = 20705194 | doi = 10.1016/j.pop.2010.04.002 | publisher = [[Elsevier]] }}</ref>

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.<ref name="pmid15215881">{{cite journal | vauthors = Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T | title = Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors | journal = International Journal of Impotence Research | volume = 17 | issue = 1 | pages = 39–57 | date = 2005 | pmid = 15215881 | doi = 10.1038/sj.ijir.3901250 | s2cid = 13187709 | doi-access = free }}</ref>

====Post-orgasmic disorders====
Post-orgasmic disorders cause symptoms shortly after [[orgasm]] or [[ejaculation]]. [[Post-coital tristesse]] (PCT) is a feeling of [[depression (mood)|melancholy]] and [[anxiety]] after sexual intercourse that lasts for up to two hours. [[Sexual headache]]s occur in the skull and neck during sexual activity, including [[masturbation]], arousal or orgasm.

In men, [[POIS|post orgasmic illness syndrome (POIS)]] causes severe [[myalgia|muscle pain]] throughout the body and other symptoms immediately following [[ejaculation]]. These symptoms last for up to a week.<ref name="Balon2005">{{cite book | title=Handbook of Sexual Dysfunction | publisher=Taylor & Francis |veditors=Balon R, Segraves RT | year=2005 | isbn=978-0-8247-5826-4}}</ref><ref name="Wylie2015">{{cite book | url=https://books.google.com/books?id=oH64CAAAQBAJ&q=Post-orgasmic+illness+syndrome&pg=PA75 | title=ABC of Sexual Health | publisher=John Wiley & Sons | year=2015 | page=75 | isbn=978-1-118-66556-5 | veditors = Wylie KR }}</ref><ref name="GARD">{{cite encyclopedia | title=Postorgasmic illness syndrome | encyclopedia=Genetic and Rare Diseases Information Center (GARD) | publisher=[[National Institutes of Health]] | access-date=30 July 2015 | year=2015 | url=https://rarediseases.info.nih.gov/gard/10809/postorgasmic-illness-syndrome/resources/1 | archive-date=5 March 2016 | archive-url=https://web.archive.org/web/20160305193016/https://rarediseases.info.nih.gov/gard/10809/postorgasmic-illness-syndrome/resources/1 }}</ref> Some doctors speculate that the frequency of POIS "in the population may be greater than has been reported in the academic literature",<ref name="Ashby2010">{{cite journal | vauthors = Ashby J, Goldmeier D | title = Postorgasm illness syndrome--a spectrum of illnesses | journal = The Journal of Sexual Medicine | volume = 7 | issue = 5 | pages = 1976–1981 | date = May 2010 | pmid = 20214722 | doi = 10.1111/j.1743-6109.2010.01707.x }}</ref> and that many with POIS are undiagnosed.<ref name="McMahon2014">{{cite journal | url=https://www.statusplus.net/issm/saopaulo2014/presentations/082.pdf | title=Post-Orgasmic Illness Syndrome | author=McMahon CG | journal=16th World Meeting on Sexual Medicine | date=October 2014 | access-date=2015-08-24 | archive-date=2016-03-04 | archive-url=https://web.archive.org/web/20160304110554/https://www.statusplus.net/issm/saopaulo2014/presentations/082.pdf }}</ref>

POIS may involve adrenergic symptoms: rapid breathing, [[paresthesia]], [[palpitations]], [[headache]]s, [[aphasia]], [[nausea]], itchy eyes, [[fever]], [[muscle pain]] and [[Muscle weakness|weakness]], and [[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.<ref name="rarediseases.info.nih.gov" />

[[Dhat syndrome]] is another condition which occurs in men: it is a [[culture-bound syndrome]] which causes anxious and [[dysphoria|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 from 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 [[Domestic violence|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 1–20% of men, and is most common in men aged 40–70, although cases have occurred in younger individuals and adolescents.<ref name=":0">{{Citation |last1=Sandean |first1=Darren P. |title=Peyronie Disease |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK560628/ |access-date=2025-10-11 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32809463 |last2=Leslie |first2=Stephen W. |last3=Lotfollahzadeh |first3=Saran}}</ref><ref>{{Cite web |title=Penile Curvature (Peyronie's Disease) - NIDDK |url=https://www.niddk.nih.gov/health-information/urologic-diseases/penile-curvature-peyronies-disease |access-date=2025-10-11 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref> Peyronie's disease has no certain cause, but the leading hypothesis is that it arises from dysregulated [[wound healing]] in response to [[Chronic condition|chronic]] [[microtrauma]] of the erect penis. Risk factors include age, genetics, minor trauma (potentially during [[cystoscopy]] or [[transurethral resection of the prostate]]), chronic systemic vascular diseases, [[diabetes]], smoking, and alcohol consumption.<ref name=":0" />

[[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.<ref>[http://emedicine.medscape.com/article/777603-overview Priapism in Emergency Medicine], [[eMedicine]]. Retrieved on 2010-02-18</ref>

== 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 [[clinical depression|depression]], sexual fears or guilt, past sexual trauma, and sexual disorders.<ref name="Michetti_et_al_2006">{{cite journal | vauthors = Michetti PM, Rossi R, Bonanno D, Tiesi A, Simonelli C | title = Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED) | journal = International Journal of Impotence Research | volume = 18 | issue = 2 | pages = 170–174 | year = 2005 | pmid = 16151475 | doi = 10.1038/sj.ijir.3901386 | doi-access = free }}</ref>

Sexual dysfunction is especially common among people who have [[anxiety disorders]].<ref name="Lo_2020"/><ref name="pmid3170497">{{cite journal | vauthors = Kaplan HS | title = Anxiety and sexual dysfunction | journal = The Journal of Clinical Psychiatry | volume = 49 Suppl | issue = | pages = 21–5 | date = October 1988 | pmid = 3170497 | doi = | url = }}</ref><ref name="pmid5789606">{{cite journal | vauthors = Cooper AJ | title = A clinical study of "coital anxiety" in male potency disorders | journal = Journal of Psychosomatic Research | volume = 13 | issue = 2 | pages = 143–7 | date = June 1969 | pmid = 5789606 | doi = 10.1016/0022-3999(69)90055-5 }}</ref><ref name="Norton_1984"/> Ordinary anxiety can cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as [[panic disorder]] commonly cause avoidance of intercourse and premature ejaculation.<ref>{{Cite web | url=http://www.astrokapoor.com/ask/premature-ejaculation-treatment@60.html |title = Premature Ejaculation Treatment in Ayurveda &#124; Cure Premature Ejaculation|date = 2018-09-06}}</ref> Pain during intercourse is often a comorbidity of anxiety disorders among women.<ref name="Coretti">{{Cite journal|vauthors=Coretti G, Baldi I|title=The Relationship Between Anxiety Disorders and Sexual Dysfunction |journal=Psychiatric Times |volume=24 |issue=9 |date=August 1, 2007|url=http://www.psychiatrictimes.com/anxiety/article/10168/54881}}</ref>

Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol, [[nicotine]], [[narcotic]]s, stimulants, [[antihypertensive drug|antihypertensives]], [[antihistamine]]s, and some psychotherapeutic drugs.<ref name="Saks">{{Cite journal|author=Saks BR|title=Common issues in female sexual dysfunction |journal=Psychiatric Times |volume=25 |issue=5 |date=April 15, 2008 |url=http://www.psychiatrictimes.com/sexual-issues/article/10168/1153918}}</ref> For women, almost any physiological change that affects the reproductive system—[[premenstrual syndrome]], pregnancy and the postpartum period, and menopause—can have an adverse effect on libido.<ref name="Saks"/> Back injuries may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in [[sexuality after spinal cord injury|sexual dysfunction after spinal cord injuries]]). Diseases such as [[diabetic neuropathy]], [[multiple sclerosis]], [[tumor]]s, and, rarely, tertiary [[syphilis]] may also impact activity, as can the failure of various organ systems (such as the heart and lungs), [[endocrine]] disorders ([[thyroid]], [[pituitary]], or [[adrenal gland]] problems), hormonal deficiencies (low [[testosterone]], other [[androgen]]s, or [[estrogen]]), and some [[birth defect]]s.

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.<ref name="king" /> In aging women, it is natural for the vagina to [[Menopause#Urogenital atrophy|narrow and 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.<ref name="king" /> This can turn into a vicious cycle that often leads to female sexual dysfunction.<ref name="king" />

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.<ref>{{cite journal | vauthors = Wentzell E | title = Aging respectably by rejecting medicalization: Mexican men's reasons for not using erectile dysfunction drugs | journal = Medical Anthropology Quarterly | volume = 27 | issue = 1 | pages = 3–22 | date = March 2013 | pmid = 23674320 | doi = 10.1111/maq.12013 }}</ref>

=== With SSRI medication ===

Sexual problems are common with SSRIs,<ref>{{cite journal | vauthors = Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K | title = Strategies for managing sexual dysfunction induced by antidepressant medication | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 5 | article-number = CD003382 | date = May 2013 | pmid = 23728643 | doi = 10.1002/14651858.CD003382.pub3 | doi-access = free | pmc = 12052305 }}</ref> which can cause [[anorgasmia]], [[erectile dysfunction]], diminished [[libido]], genital numbness, and [[sexual anhedonia]] (pleasureless orgasm).<ref name="Bahrick">{{cite journal| vauthors = Bahrick AS |year=2008|title=Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence|url=https://benthamopen.com/ABSTRACT/TOPSYJ-1-42|journal=The Open Psychology Journal|volume=1|pages=42–50|doi=10.2174/1874350100801010042|doi-access=free}}</ref>  Poor sexual function is also one of the most common reasons people stop the medication.<ref>{{cite journal | vauthors = Kennedy SH, Rizvi S | title = Sexual dysfunction, depression, and the impact of antidepressants | journal = Journal of Clinical Psychopharmacology | volume = 29 | issue = 2 | pages = 157–164 | date = April 2009 | pmid = 19512977 | doi = 10.1097/jcp.0b013e31819c76e9 | s2cid = 739831 }}</ref> In some cases, symptoms of sexual dysfunction may persist after discontinuation of SSRIs.<ref name="Bahrick" /><ref>{{Cite book|title=Neurology of Sexual and Bladder Disorders|vauthors=Waldinger MD|year=2015|isbn=978-0-444-63247-0|series=Handbook of Clinical Neurology|volume=130|pages=479–83|chapter=Psychiatric disorders and sexual dysfunction|doi=10.1016/B978-0-444-63247-0.00027-4|pmid=26003261}}</ref><ref name="Prozac_Insert">{{cite web|url=http://pi.lilly.com/us/prozac.pdf|title=Prozac Highlights of Prescribing Information|date=24 March 2017|publisher=Eli Lilly and Company}}</ref>{{rp|14}}<ref name=":3">{{cite journal | vauthors = Reisman Y | title = Sexual Consequences of Post-SSRI Syndrome | journal = Sexual Medicine Reviews | volume = 5 | issue = 4 | pages = 429–433 | date = October 2017 | pmid = 28642048 | doi = 10.1016/j.sxmr.2017.05.002 | quote = Initial SSRI registration studies found that such side effects were reported by fewer than 10% of patients.  When doctors specifically asked about treatment-emergent sexual difficulties, some found that they were present in up to 70% of patients. }}</ref><ref name="DSM5">{{cite book | author=American Psychiatric Association|year=2013|title=Diagnostic and Statistical Manual of Mental Disorders | edition = 5th |location=Arlington|publisher=American Psychiatric Publishing|page=449|isbn=978-0-89042-555-8 }}</ref> This combination of symptoms is sometimes referred to as [[Selective serotonin reuptake inhibitor#Sexual dysfunction|post-SSRI sexual dysfunction]].<ref name=":4">{{cite journal | vauthors = Healy D | title = Post-SSRI sexual dysfunction & other enduring sexual dysfunctions | journal = Epidemiology and Psychiatric Sciences | volume = 29 | article-number = e55 | date = September 2019 | pmid = 31543091 | pmc = 8061302 | doi = 10.1017/S2045796019000519 | quote = Close to 100% of takers of a selective serotonin reuptake inhibitor (SSRI) have a degree of genital sensory change within 30 min of taking. | doi-access = free }}</ref><ref name=":2">{{Cite journal| vauthors = Bahrick AS |date=2006|title=Post SSRI sexual dysfunction|url=https://www.researchgate.net/publication/236587031|journal=American Society for the Advancement of Pharmacotherapy|volume=Tablet 7.3|pages=2–3}}</ref>

=== Pelvic floor dysfunction ===
{{Main|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]], a type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas.<ref name="malepelvicfloor.com">{{Cite web|title=Male Pelvic Floor: Advanced Massage and Bodywork|url=http://malepelvicfloor.com/sd.html}}</ref><ref>{{Cite web|date=2015-02-23|title=Pelvic Floor Dysfunction, Perineum Pain, Sore Pelvis|url=http://www.pelvicpainhelp.com/pelvic-floor-dysfunction/}}</ref><ref>{{Cite web|title=Sexual Dysfunction &#124; Beyond Basics Physical Therapy &#124; New York City, Manhattan|url=http://www.beyondbasicsphysicaltherapy.com/sexual-dysfunction|access-date=2016-08-31|archive-date=2018-04-14|archive-url=https://web.archive.org/web/20180414014503/http://www.beyondbasicsphysicaltherapy.com/sexual-dysfunction}}</ref><ref>{{cite journal | vauthors = Handa VL, Cundiff G, Chang HH, Helzlsouer KJ | title = Female sexual function and pelvic floor disorders | journal = Obstetrics and Gynecology | volume = 111 | issue = 5 | pages = 1045–1052 | date = May 2008 | pmid = 18448734 | pmc = 2746737 | doi = 10.1097/AOG.0b013e31816bbe85 }}</ref><ref name="ReferenceA">{{cite journal | vauthors = Rosenbaum TY, Owens A | title = The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME) | journal = The Journal of Sexual Medicine | volume = 5 | issue = 3 | pages = 513–523 | date = March 2008 | pmid = 18304280 | doi = 10.1111/j.1743-6109.2007.00761.x }}</ref>

===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|date=September 2024}}
*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|date=September 2024}}
*Insufficient justification: based on the classic [[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|date=September 2024}}

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.<ref name="Davis 2024">{{cite journal |last1=Davis |first1=Susan R. |title=Sexual Dysfunction in Women |journal=New England Journal of Medicine |date=22 August 2024 |volume=391 |issue=8 |pages=736–745 |doi=10.1056/NEJMcp2313307|pmid=39167808 }}</ref> 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.<ref name="Davis 2024" /> Poor sexual self image leading to distress was seen in 13.4% of women younger than 40 in an Australian population based study.<ref name="Davis 2024" />

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.<ref name="king" /> 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.<ref name="king" /> 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.<ref name="king" />

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.<ref>{{Cite web | url=http://www.merckmanuals.com/home/womens_health_issues/sexual_dysfunction_in_women/overview_of_sexual_dysfunction_in_women.html | title=Overview of Sexual Dysfunction in Women - Women's Health Issues}}</ref>

[[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|date=September 2024}} 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|date=September 2024}} 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.<ref>{{Cite web|title=Saint Louis University Libraries {{!}} Saint Louis University|url=https://login.ezp.slu.edu/login?qurl=https://pubmed.ncbi.nlm.nih.gov%2f12296010%2f|access-date=2020-12-17|website=login.ezp.slu.edu}}</ref>

===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.<ref name="eden"/><ref name="king" /><ref>{{cite journal | vauthors = Laumann EO, Paik A, Rosen RC | title = Sexual dysfunction in the United States: prevalence and predictors | journal = JAMA | volume = 281 | issue = 6 | pages = 537–544 | date = February 1999 | pmid = 10022110 | doi = 10.1001/jama.281.6.537 | doi-access = free }}</ref> The primary predictor of sexual response throughout menopause is prior sexual functioning,<ref name="eden" /> which means that it is important to understand how the physiological changes in men and women can affect sexual desire.<ref name="king" /> 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.<ref name="eden" />

Testosterone, along with its metabolite [[dihydrotestosterone]], is important to normal sexual function in men and women. Dihydrotestosterone is the most prevalent androgen in both men and women.<ref name="king">{{cite journal | vauthors = Kingsberg SA | title = The impact of aging on sexual function in women and their partners | journal = Archives of Sexual Behavior | volume = 31 | issue = 5 | pages = 431–437 | date = October 2002 | pmid = 12238611 | doi = 10.1023/A:1019844209233 | s2cid = 7762943 }}</ref> 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]] experience a sudden drop in testosterone levels, as the ovaries produce 40% of the body's circulating testosterone.<ref name="king" />

Sexual desire has been related to three separate components: drive, beliefs and values, and motivation.<ref name="king" /> Particularly in postmenopausal women, drive fades and is no longer the initial step in a woman's sexual response.<ref name="king" />

==Diagnosis==
===List of disorders===
{{Unreferenced section|date=May 2021}}

====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]], which is not classified as a disorder)
* Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse)<ref>{{Cite web|title=Sexual Aversion Disorder|url=https://labs.la.utexas.edu/mestonlab/sexual-aversion-disorder/|access-date=2021-10-22|website=labs.la.utexas.edu}}</ref><ref>{{cite journal | vauthors = Crenshaw TL | title = The sexual aversion syndrome | journal = Journal of Sex & Marital Therapy | volume = 11 | issue = 4 | pages = 285–292 | date = 1985 | pmid = 4078910 | doi = 10.1080/00926238508405454 }}</ref>
* [[Female sexual arousal disorder]] (failure of normal lubricating arousal response)<ref>{{Cite web|title=Female Sexual Interest/Arousal Disorders|url=https://labs.la.utexas.edu/mestonlab/female-sexual-interestarousal-disorders/|access-date=2021-10-22|website=labs.la.utexas.edu}}</ref>
* Male erectile disorder
* Female orgasmic disorder (see anorgasmia)<ref>{{cite book | vauthors = Rellini AH, Clifton J | title = Sexual Dysfunction: Beyond the Brain-Body Connection | chapter = Female orgasmic disorder | volume = 31 | pages = 35–56 | date = 2011 | pmid = 22005203 | doi = 10.1159/000328807 | isbn = 978-3-8055-9825-5 | series = Advances in Psychosomatic Medicine | s2cid = 207708545 }}</ref>
* Male orgasmic disorder (see anorgasmia)<ref>{{Cite web|title=Ejaculatory and Orgasmic Disorders | work = UCSF Department of Urology|url=https://urology.ucsf.edu/patient-care/adult-non-cancer/male-sexual-and-reproductive-health/ejaculatory-orgasmic-disorders|access-date=2021-10-22 }}</ref>
* Premature ejaculation
* Dyspareunia
* Vaginismus

Additional DSM sexual disorders that are not sexual dysfunctions include:
* Paraphilias
* [[PTSD]] due to [[genital mutilation]] or [[childhood sexual abuse]]

====Other sexual problems====
* Sexual dissatisfaction (non-specific)
* Lack of sexual desire
* Anorgasmia
* Impotence
* [[Sexually transmitted infection]]s
* Delay or absence of [[ejaculation]], despite adequate stimulation
* Inability to control timing of ejaculation
* Inability to relax vaginal muscles enough to allow [[Sexual intercourse|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]]
* [[Transsexual]] and [[transgender]] people may have sexual problems before or after [[sex reassignment surgery|surgery]].
* [[Persistent sexual arousal syndrome]]
* [[Sexual addiction]]
* [[Hypersexuality]]
* All forms of [[female genital cutting]]
* Post-orgasmic diseases, such as Dhat syndrome, PCT, POIS, and sexual headaches.
* [[Hard flaccid syndrome]]<ref>{{Cite journal |last1=Gryzinski |first1=Gustavo |last2=Hammad |first2=Muhammed Moukhtar |last3=Alzweri |first3=Laith |last4=Azad |first4=Babak |last5=Barham |first5=David |last6=Lumbiganon |first6=Supanut |last7=Serefoglu |first7=Ege Can |last8=Yafi |first8=Faysal |date=2024-06-19 |title=Hard-Flaccid syndrome: a survey of sexual medicine practitioners' knowledge and experience |journal=International Journal of Impotence Research |volume=37 |issue=6 |language=en |pages=446–447 |doi=10.1038/s41443-024-00917-3 |issn=1476-5489|doi-access=free |pmid=38898174 |pmc=12185328 }}</ref>

==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.<ref>{{cite journal | vauthors = Jarow JP, Nana-Sinkam P, Sabbagh M, Eskew A | title = Outcome analysis of goal directed therapy for impotence | journal = The Journal of Urology | volume = 155 | issue = 5 | pages = 1609–1612 | date = May 1996 | pmid = 8627834 | doi = 10.1016/s0022-5347(01)66142-1 }}</ref> If the sexual dysfunction is deemed to have a psychological component or cause, [[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 (medicine)|desensitization]] of the penis. In some cases, erectile dysfunction may be due to marital disharmony. Marriage [[Relationship counseling|counseling]] sessions are recommended in this situation.

Lifestyle changes such as discontinuing [[tobacco smoking]] or substance use can also treat some types of ED.<ref>Merck Sharpe & Dohme. [http://www.merck.com/pubs/mmanual_ha/sec3/ch59/ch59a.html "Male genital and sexual disorders"] 2010-02-18.</ref> Several oral medications like [[Sildenafil|Viagra]], [[Tadalafil|Cialis]], and [[Vardenafil|Levitra]] 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 (medicine)|chronic]] history.{{Citation needed|date=September 2021}}

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.<ref>{{cite journal | vauthors = Rodríguez Vela L, Moncada Iribarren I, Gonzalvo Ibarra A, Sáenz de Tejada y Gorman I | title = [Treatment of erectile dysfunction using intracavernous pharmacotherapy] | journal = Actas Urologicas Espanolas | volume = 22 | issue = 4 | pages = 291–319 | date = April 1998 | pmid = 9658642 | author4 = Sáenz de Tejada y Gorman I }}</ref> This method has an increased risk of priapism if used in conjunction with other treatments, and localized pain.<ref name=Diaz />

[[Premature ejaculation]]s 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.<ref>{{Cite book | vauthors = Jannini EA, McMahon CG, Waldinger MD |url=https://books.google.com/books?id=iCXF3sWtgegC |title=Premature Ejaculation: From Etiology to Diagnosis and Treatment |date=2012-08-31 |publisher=Springer Science & Business Media |isbn=978-88-470-2646-9 |language=en}}</ref>

When conservative therapies fail, are an unsatisfactory treatment option, or are contraindicated for use, the insertion of a [[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.<ref>{{cite journal | vauthors = Rajpurkar A, Dhabuwala CB | title = Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice | journal = The Journal of Urology | volume = 170 | issue = 1 | pages = 159–163 | date = July 2003 | pmid = 12796670 | doi = 10.1097/01.ju.0000072524.82345.6d }}</ref>

Pelvic floor physical therapy has been shown to be a valid treatment for men with sexual problems and pelvic pain.<ref>{{Cite web | url=http://www.healpelvicpain.com/about-book | title=About Book &#124; Heal Pelvic Pain | access-date=2016-08-31 | archive-date=2019-04-26 | archive-url=https://web.archive.org/web/20190426072541/http://www.healpelvicpain.com/about-book }}</ref>

The 2020 guidelines from the [[American College of Physicians]] support the discussion of [[testosterone (medication)|testosterone]] treatment in adult men with age-related [[Low T|low levels of testosterone]] 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.<ref name="ANN-20200106">{{cite journal | vauthors = Qaseem A, Horwitch CA, Vijan S, Etxeandia-Ikobaltzeta I, Kansagara D, Forciea MA, Crandall C, Fitterman N, Hicks LA, Lin JS, Maroto M, McLean RM, Mustafa RA, Tufte J | display-authors = 6 | title = Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians | journal = Annals of Internal Medicine | volume = 172 | issue = 2 | pages = 126–133 | date = January 2020 | pmid = 31905405 | doi = 10.7326/M19-0882 | doi-access = free }}</ref><ref name="MSCP-20200107">{{cite news | vauthors = Parry NM |title=New Guideline for Testosterone Treatment in Men With 'Low T' |url=https://www.medscape.com/viewarticle/923449 |date=7 January 2020 |work=Medscape.com |access-date=7 January 2020 }}</ref>

===Females===
In 2015, [[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.<ref>{{cite web|url=https://www.webmd.com/women/news/20150818/fda-approves-addyi-drug-boost-womens-sex-drive#1|title=FDA Approves First Drug to Boost Women's Sex Drive|website=www.webmd.com|access-date=2019-05-31}}</ref> 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.<ref name="Davis 2024" /> Flibanserin should not be taken with alcohol.<ref name="Davis 2024" /> [[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.<ref name="Davis 2024" /> Women experiencing pain with intercourse are often prescribed pain relievers or desensitizing agents; others are prescribed [[personal lubricant|vaginal lubricants]]. Many women with sexual dysfunction are also referred to a [[mental health counselor|counselor]] or [[sex therapy|sex therapist]].<ref name=Amato>{{cite web | vauthors = Amato P | title = An update on therapeutic approaches to female sexual dysfunction | url = http://www.femalesexualdysfunctiononline.org/commentaries/commentaries.cfm?abs_id%3Dabs_007 | work = Female Sexual Dysfunction Online &#124; A Blog to Document the High's and Low's of My Life |access-date=2008-10-24 |archive-url=https://web.archive.org/web/20081004092107/http://www.femalesexualdysfunctiononline.org/commentaries/commentaries.cfm?abs_id=abs_007 |archive-date=2008-10-04 }}</ref> Counselling for female sexual dysfunction, including [[sex therapy|sexual counselling]], [[cognitive behavioral therapy]], body awareness counselling, and [[couples counselling]] have been found to be helpful.<ref name="Davis 2024" />

Estrogen replacement therapy, outside of the indicated use for menopausal symptoms, is not recommended for the treatment of sexual dysfunction in women.<ref name="Davis 2024" />

====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.<ref name="eden" /> 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.<ref name="eden" /> Women experiencing vaginal dryness who cannot use commercial lubricants may be able to use coconut oil as an alternative.<ref>{{Cite journal |last1=Evangelista |first1=Mara Therese Padilla |last2=Abad-Casintahan |first2=Flordeliz |last3=Lopez-Villafuerte |first3=Lillian |date=January 2014 |title=The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial |journal=International Journal of Dermatology |language=en |volume=53 |issue=1 |pages=100–108 |doi=10.1111/ijd.12339|pmid=24320105 |doi-access=free }}</ref>

Androgen therapy for hypoactive sexual desire disorder has a small benefit but its safety is not known.<ref name=Wri2015/> It is not approved as a treatment in the United States.<ref name=Wri2015>{{cite journal | vauthors = Wright JJ, O'Connor KM | title = Female sexual dysfunction | journal = The Medical Clinics of North America | volume = 99 | issue = 3 | pages = 607–628 | date = May 2015 | pmid = 25841603 | doi = 10.1016/j.mcna.2015.01.011 }}</ref> 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.<ref name="eden" /> As with all pharmacological drugs, there are side effects in using androgens, which include [[hirsutism]], acne, [[Polycythemia|polycythaemia]], increased high-density lipoproteins, cardiovascular risks, and [[endometrial hyperplasia]].<ref name="eden" /> Alternative treatments include topical estrogen creams and gels that can be applied to the vulva or vagina area to treat vaginal dryness and atrophy.<ref name="eden" />

==Research==
{{Unreferenced section|date=May 2021}}
{{See also|List of investigational sexual dysfunction drugs}}

In modern times, clinical study of sexual problems is usually dated back no earlier than 1970 when [[William Masters and Virginia Johnson|Masters and Johnson's]] ''[[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 (book)|Human Sexual Response]]'' (1966).

Prior to Masters and Johnson, the clinical approach to sexual problems was largely derived from [[Sigmund Freud]]. It was held to be [[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]], 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]]; female primary [[orgasmic dysfunction]] and situational orgasmic dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson, [[sexual arousal]] and [[orgasm|climax]] 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 ==
{{Portal|Human sexuality}}
{{Columns-list|colwidth=25em|* [[Agony aunt]]
* [[Dapoxetine]]
* [[Orgastic impotence]]
* [[Premature ejaculation]]
* [[Sex and drugs]]
* [[Sex after pregnancy]]
* [[Sexless marriage]]
* [[Sexual arousal disorder]]
* [[Dapoxetine]]
}}

== References ==
{{Reflist}}

== External links ==
*{{Commons category-inline}}
*[https://web.archive.org/web/20131018092257/http://www.nlm.nih.gov/medlineplus/ency/article/001951.htm NIH site on sexual problems] (archived 18 October 2013)
{{Medical resources
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|   ICD9           = {{ICD9|302.7}} 
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|   OMIM           = 
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|   eMedicineSubj  = 
|   eMedicineTopic = 
|   MeshID         = D020018 
}}
{{Sex}}
{{Human sexuality}}
{{Mental and behavioural disorders|selected = physical}}
{{Post-orgasmic diseases}}
{{Male diseases of the pelvis and genitals}}
{{Reproductive health}}
{{Authority control}}

[[Category:Sexual health]]
[[Category:Sexual arousal]]
[[Category:Sexuality]]
[[Category:Sexology]]
[[Category:Orgasm]]
[[Category:Sexual dysfunctions|*]]