Sexual Aversion Disorder (SAD): Symptoms, Causes, & Treatments

What Is Sexual Aversion Disorder?

The Diagnostic Statistic Manual (DSM) has previously described sexual aversion disorder as “characterized by recurrent or persistent extreme aversion to, and avoidance of, all genital contact with a sexual partner that is not attributable to another psychiatric disorder.”¹ Sex aversion disorder has since been removed from the DSM-V due to rare use and lack of supporting research. It now falls under the diagnosis of a sexual dysfunction.²

There’s been debate over whether SAD should be classified as a phobia or sexual disorder. Associated anxiety can be severe enough to cause phobic responses, but a key feature of a phobic disorder is that the fear or anxiety is limited to the presence of a particular situation or object.^2,3

Sexual dysfunctions are a group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or experience sexual pleasure. An individual may have several sexual dysfunctions at the same time, in which case, all of the dysfunctions should be diagnosed.² The rationale for why SAD is classified as a sexual dysfunction vs. a phobia isn’t clear.^1,4

Two Types of Sexual Aversion Disorder

The are two types of sex aversion disorder: lifelong (primary) aversion and acquired (secondary) aversion:

1. Lifelong Aversion

Lifelong aversion develops from a negative or unenthusiastic response to sexual interactions prior to an individual experiencing healthy partnered sexual behavior.⁵ This can occur, for example, when raised in a strict religious environment that shuns sexual acts for pleasure.

2. Acquired Aversion

Acquired aversion, on the other hand, is developed in response to a significant negative sexual experience, such as a trauma or abuse, after first experiencing a period of healthy sexual behaviors. Acquired aversion can also be present in a specific relationship and absent outside of it.

Sex Aversion Disorder vs. HSDD, FSAD, & Asexuality

SAD is often confused with other disorders and sexual identities. For example, male hypoactive sexual desire disorder (HSDD) is a recurrent or persistent lack of desire for sexual activity.² Although someone with HSDD may also avoid sexual encounters, it differs from SAD in that desire can remain present for individuals with SAD, despite their aversion to certain stimulus.

Female sexual arousal disorder (FSAD) is another disorder with similar symptoms. It’s a recurrent or persistent inability to attain/maintain adequate physical response of sexual excitement, such as poor vaginal lubrication and expansion or the swelling of the external genitalia.² FSAD is a physical response vs. a psychological response. Those experiencing FSAD are not averse to sexual stimulation; they’re physically unable to adequately engage in the acts.

Asexuality is an identity that often is confused with a sexual disorder. Asexuality refers to those individuals who have little to no sexual attraction to others in terms of their sexual orientation. Asexuality is not a disorder, and therefore no treatment would be indicated.

Sexual Aversion Disorder Symptoms

A Sexual Aversion Scale based on the DSM criteria is sometimes used to assess sexual fears and avoidance and discuss sexual aversion disorder symptoms.⁶

Check in with yourself to asses if you have these signs and symptoms of SAD:⁶

• I am afraid to engage in sexual intercourse with another person
• I have repeatedly avoided all or almost all genital sexual contact with a sexual partner
• I have avoided sexual relations recently because of my sexual fears
• I believe my attitudes about sex are abnormal
• My sex life has always been a source of dissatisfaction
• I try to avoid situations where I might get involved sexually

Effects of Sexual Aversion

SAD can have various effects on people and their relationships, including avoidance of any interaction that has the potential of becoming sexual, such as dating or being left alone with a potential partner.

Other effects of sexual aversion include:

• Strains in romantic relationships
• Power struggles in relationships
• Sexual anxiety or panic attacks
• If the aversion stems from a traumatic experience, post-traumatic stress disorder (PTSD) is possible

Causes of Sexual Aversion Disorder

Sexual aversion disorder develops in response to negative sexual experiences and messages. The prevalence of SAD is unknown and difficult to establish because these individuals avoid sexual encounters, as well as intimate relationships, and therefore rarely present to sex aversion therapy or couples therapy clinics.⁴

SAD is largely reported by women. Men with SAD are more likely to avoid relationships and, therefore, distress due to sexual performance anxiety or orgasm anxiety.⁶ Although what causes SAD to develop in some and not others is unknown, a family history of anxiety disorder and phobia is common in those with SAD.³

Health conditions and medical treatment can also play a role in the development of sexual aversion. Some diseases, such as various cancers, cause physical changes that impact an individual’s sexual functioning and/or body image. Some medications, such as SSRIs, can decrease orgasmic response, creating an unpredictable and sexually frustrating environment and experience.³

How to Cope With Sexual Aversion Disorder

Learning to cope with SAD and its related anxiety can be overwhelming. Identify ways to gain control over the situation, practice relaxation or mindfulness, and consider going to sex aversion therapy to address the maladaptive learned behavior.

Here are some tips to help you cope with sexual aversion disorder:

1. Identify Ways to Gain Control Over the Situation

Build on your ability to identify desires, set healthy boundaries, and hold these boundaries with your partner. When you are ready, discuss your sexual history with your partner, including history of any sexual trauma.

2. Practice Relaxation or Mindfulness

Skills such as grounding techniques are effective in managing anxiety responses by controlling your breathing and heart rate, as well as redirecting your attention to the present, safe space.

3. Go to Therapy to Address the Maladaptive Learned Behavior

A therapist can support in exploring the negative thoughts that are associated to sex that encourage this aversion. These thoughts can be restructured into more helpful thoughts, which will promote healthy sexual behaviors.

Treatment for Sexual Aversion Disorder

Sexual aversion disorder treatment is recommended when the fear of engaging in sexual activity is excessive compared the actual risk (or lack thereof).⁶ Treatment options include medical help, mental health options, and physical therapy. To begin the process of finding a therapist, explore an online therapist directory.

Individual Therapy Options

Cognitive behavioral therapy (CBT) can effectively treat SAD.³ It focuses on challenging and changing distorted thoughts, beliefs, and attitudes and their corresponding behaviors (the aversion) to improve emotional regulation and develop personal coping strategies that target anxious symptoms.

Psychodynamic psychotherapy is the treatment of choice for those who report psychic pain as a component of their sexual aversion, or those who conceptualize their problems as symptomatic of early childhood issues.⁵ This form of treatment should emphasize deeper conflicts, defense mechanisms, and transference, as well as the integration of behavioral strategies and insight-oriented approaches.

Couples Therapy Options

Couples therapy allows both members of the relationship to effectively address sexual aversion and its effects. It teaches skills in communication, negotiation skills, systematic desensitization, and relaxation.³ If available, the couple should work collaboratively with a sexual health professional team, including physician, psychologist, sex therapist, or physical therapist.³

How to Be Supportive If Your Partner Is Sex Averse

If you or your partner are sexually averse, know that having a supportive partner can make a world of positive difference. Aim to respect their situation, trust boundaries, and communicate effectively.

Here are ways to be a supportive partner:

• Respect your partner and their situation; avoid pressuring them to engage in sexual activities
• Support them to create and maintain control within the relationship
• Respect the boundaries they set and avoid seeing them as a personal slight or attack; avoid falling into a power struggle, as this will likely make things worst
• Attend couples therapy with them to gain education on their situation and experiences and learn effective communication skills
• Find alternative ways to be intimate with your partner that don’t involve their triggers; this will strengthen your bond and build trust

Final Thoughts On Aversion to Sex

Sexual aversion disorder can be difficult to overcome; however, with support, its symptoms can be managed and more normative sexual experiences can be shared. Since being sex averse is a learned behavior, it can also be unlearned, and new messages can be adopted in its place.