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Disorders of Sexual Function

16 February, 2016 - 09:24

Sexual dysfunction is a psychological disorder that occurs when the physical sexual response cycleis inadequatefor reproduction or for sexual enjoyment. There are a variety of potential problems Table 12.7, and their nature varies for men and women (Figure 12.8). Sexual disorders affect up to 43% of women and 31% of men (Laumann, Paik, & Rosen, 1999). 1 Sexual disorders are often difficult to diagnose because in many cases the dysfunction occurs at the partner level (one or both of the partners are disappointed with the sexual experience) rather than at the individual level.

Table 12.7 Sexual Dysfunctions as Described in the DSM



Hypoactive sexual desire disorder

Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity

Sexual aversion disorder

Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner

Female sexual arousal disorder

Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement

Male erectile disorder

Persistent or recurrent inability to attain or maintain an adequate erection until completion of


the sexual activity

Female orgasmic disorder

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase

Male orgasmic disorder

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity

Premature ejaculation

Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it


Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female


Recurrent or persistent involuntary spasm of the musculature of the outer third o f the vagina that interferes with sexual intercourse

Figure 12.8 Prevalence of Sexual Dysfunction in Men and Women
This chart shows the percentage of respondents who reported each type of sexual difficulty over the previous 12 months.

Hypoactivesexual desiredisorder, one of the most common sexual dysfunctions, refers to a persistently low or nonexistent sexual desire. How “low sexual desire” is defined, however, is problematic because it depends on the person’s sex and age, on cultural norms, as well as on the relative desires of the individual and the partner. Again, the importance of dysfunction and distress is critical. If neither partner is much interested in sex, for instance, the lack of interest may not cause a problem. Hypoactive sexual desire disorder is often comorbid with other psychological disorders, including mood disorders and problems with sexual arousal or sexual pain (Donahey & Carroll, 1993). 2

Sexual aversion disorderrefers to an avoidance of sexual behavior caused by disgust or aversion to genital contact. The aversion may be a phobic reaction to an early sexual experience or sexual abuse, a misattribution of negative emotions to sex that are actually caused by something else, or a reaction to a sexual problem such as erectile dysfunction (Kingsberg & Janata, 2003). 3

Femalesexual arousal disorder refers to persistent difficulties becoming sexually aroused or sufficiently lubricated in response to sexual stimulation in women. The disorder may be comorbid with hypoactive sexual desire or orgasmic disorder, or mood or anxiety disorders.

Male erectiledisorder (sometimes referred to as “impotence”) refers to persistent and dysfunctional difficulty in achieving or maintaining an erection sufficient to complete sexual activity. Prevalence rates vary by age, from about 6% of college-aged males to 35% of men in their 70s. About half the men aged 40 to 70 report having problems getting or maintaining an erection “now and then.”

Most erectile dysfunction occurs as a result of physiological factors, including illness, and the use of medications, alcohol, or other recreational drugs. Erectile dysfunction is also related to anxiety, low self-esteem, and general problems in the particular relationship. Assessment for physiological causes of erectile dysfunction is made using a test in which a device is attached to the man’s penis before he goes to sleep. During the night the man may have a n erection, and if he does the device records its occurrence. If the man has erections while sleeping, this provides assurance that the problem is not physiological.

One of the most common sexual dysfunctions in men is premature ejaculation. It is not possible to exactly specify what defines “premature,” but if the man ejaculates before or immediately upon insertion of the penis into the vagina, most clinicians will identify the response as premature. Most men diagnosed with premature ejaculation ejaculate within one minute after insertion (Waldinger, 2003). 4 Premature ejaculation is one of the most prevalent sexual disorders and causes much anxiety in many men.

Female orgasmicdisorder refers to the inability to obtain orgasm in women. The woman enjoys sex and foreplay and shows normal signs of sexual arousal but cannot reach the peak experience of orgasm. Maleorgasmicdisorderincludes a delayed or retarded ejaculation (very rare) or (more commonly) premature ejaculation.

Finally, dyspareunia and vaginismusrefer to sexual pain disorders that create pain and involuntary spasms, respectively, in women, and thus make it painful to have sex. In most cases these problems are biological and can be treated with hormones, creams, or surgery.

Sexual dysfunctions have a variety of causes. In some cases the primary problem is biological, and the disorder may be treated with medication. Other causes include a repressive upbringing in which the parents have taught the person that sex is dirty or sinful, or the experience of sexual abuse (Beitchman, Zucker, Hood, & DaCosta, 1992). 5 In some cases the sex problem may be due to the fact that the person has a different sexual orientation than he or she is engaging in. Other problems include poor communication between the partners, a lack of sexual skills, and (particularly for men) performance anxiety.

It is important to remember that most sexual disorders are temporary—they are experienced for a period of time, in certain situations or with certain partners, and then (without, or if necessary with, the help of therapy) go away. It is also important to remember that there are a wide variety of sex acts that are enjoyable. Couples with happy sex lives work together to find ways that work best for their own styles. Sexual problems often develop when the partners do not communicate well with each other, and are reduced when they do.