Sexual Disorders: Types, Symptoms, Causes & Treatments

What Is Sexual Dysfunction?

Sexual dysfunction refers to experiencing any range of difficulties having or enjoying sex. Sexual dysfunctions are recurrent and chronic, and they can result in problems with sexual arousal and orgasm. They may also cause physical pain. Although they are common, sexual dysfunctions can affect self-esteem and confidence, and they can impact the quality of a person’s intimate relationships.

What Causes Sexual Dysfunction?

Problems with sexual function can come from a variety of factors affecting the mind and body. Psychological influences may be related to anxiety, depression, stress, low self-confidence, and anxiety regarding sexual performance or body image. Poor relationship quality and lack of communication, as well as adverse partner characteristics (like arousal non-concordance), can also impact sexual function. Physical contributors include anatomy malformations, injury or illness, current medication use, and age.

Who Is Affected by Sexual Dysfunction?

Sexual problems can occur throughout the lifespan and affect people of any age. Although some sexual dysfunction is viewed as normal for younger adults, they may experience the same conditions as older adults, including premature ejaculation, lack of pleasure or orgasm, erectile difficulties, or pain during sex.²

Aging’s Effects of Sexual Function

As a person ages, a decline in sexual response and activity is expected, particularly as women approach menopause which can affect later life sexuality. Men may experience changes in testosterone and bodily functioning, even though no comparable physical midlife changes exist. The strengths and characteristics of the partnered relationship can influence how well a couple adjusts their sexual activity to these physiological changes.²

Physical Health Concerns

Those with a chronic illness or disability can also be affected by sexual dysfunction, although there is great variability on how their sexuality is impacted depending on the condition. Sexual dysfunction can also affect sexual minority clients, including those in same-sex relationships, open relationships, and transgender individuals.

What Are Sexual Disorders?

When a sexual dysfunction develops into a problem, it may become a sexual disorder. The Diagnostic and Statistical Manual (DSM) is the official handbook that clinicians use to determine an appropriate diagnosis.³

These disorders are written in the DSM from a binary perspective about “men” and “women” and will be described as such for consistency. It is important to note, however, that these heteronormative and binary terms may not accurately represent how an individual self-identifies.

Important Terms Related to Sexual Dysfunction

Some important terms to note when discussing sexual disorders include:

• Acquired: The disorder started at some point throughout one’s life. It is not a lifelong condition.
• Lifelong: The disorder has always been present.
• Situational: The problem occurs in specific contexts, such as only with a specific partner, or during partnered intercourse but not during solo masturbation.
• Generalized: The problem occurs in all situations.

Desire & Arousal Disorders

Desire and arousal disorders include female sexual interest/arousal disorder, male hypoactive sexual desire disorder, and erectile dysfunction.

Female Sexual Interest/Arousal Disorder (FSIAD)

People affected by FSIAD experience a lack of interest in or aversion to sexual activities and fantasies, reduced arousal or sensation during sexual encounters, or some combination thereof.³ These symptoms must be present for a minimum of six months and occur in at least 75% of sexual encounters. FSIAD can be lifelong or acquired, generalized or situational, and can be mild, moderate, or severe.

Causes of FSIAD

Many factors can contribute to FSIAD.⁴ Menopause, mood disorders, and medication can impact hormones and sexual arousal or desire. Lack of intimacy or trust in the relationship can create sexual barriers, and negative sociocultural messages about sexual desire, masturbation, or sexual response can also have an adverse impact.

Treatment

FSIAD treatment typically includes a mixture of pharmacological and psychological interventions, including hormone treatment, cognitive behavioral therapy (CBT), and mindfulness-based interventions.⁴ The therapist should also explore any psychosocial factors that may be contributing to symptoms.

Male Hypoactive Sexual Desire Disorder

This condition is otherwise known as low sexual desire in men. To meet criteria for a diagnosis, the symptoms must be present for a minimum of six months and he must find the symptoms distressing. Male HSDD can be lifelong or acquired, generalized or situational, and can be diagnosed with the specifiers mild, moderate, or severe.³

Risk Factors for HSDD

Risk factors for developing male HSDD can include problems in the relationship, sociocultural messages about masculinity, early negative messages about sex, and biomedical factors such as age, hormone production, illness, and side effects from medication.⁵

Treatment of HSDD in Males

Hormone replacement therapy can assist those with low testosterone, and medications may be prescribed or current medications adjusted.⁶ CBT can help someone develop emotion regulation skills, challenge unhelpful thoughts, engage in stimulus control or sensate focus, and take steps to improve the relationship.⁵

Erectile Dysfunction (ED)

Men with erectile dysfunction have difficulty obtaining or maintaining an erection until completing sexual activity. They may also experience decreased rigidity.³ The problem must persist for at least six months and cause significant distress to the affected person to be diagnosed. ED can be lifelong or acquired, generalized or situational, and has a mild, moderate, or severe specifier for diagnosis.

Causes of ED

There can be a variety of factors impacting ED, and the therapist will need to ask thorough questions to determine etiology. Common contributors to ED include vascular disorders, medication, performance anxiety, negative thoughts, and relationship issues.⁷

Treatment for Erectile Dysfunction

Medication may be one of the most well-known treatment methods for erectile dysfunction. Psychological treatment approaches include the use of CBT to decrease negative thought patterns and reduce performance anxiety.⁸ Other behavioral interventions such as sensate focus and sexual stimulation techniques have been used.⁷ A physical examination by a physician or urologist to rule out physiological problems might also be recommended.

Orgasm Disorders

Orgasm disorders include female orgasmic disorder, premature ejaculation, and delayed ejaculation.

Female Orgasmic Disorder (FOD)

Those with female orgasmic disorder may experience difficulty or delay of orgasm or feel less intense sensations during orgasm. FOD can be lifelong or acquired, generalized or situational, and includes a specification for women who have never experienced orgasm at all.³ These symptoms must be present in at least 75% of sexual encounters to receive an FOD diagnosis.

Causes of Female Orgasmic Disorder

FOD can be caused by individual variables, such as levels of sexual anxiety, stress, or fatigue. Relationship factors, like the quality of partner interaction and communication, can impact a woman’s ability to orgasm. In some cases, physical illness, neurological or gynecological issues, diabetes, spinal cord injury, and medication can create problems associated with FOD.⁹

Risk Factors for Female Orgasmic Disorder

Poor physical and mental health has been associated with FOD, as well as problems within the partnered relationship. FOD has a high comorbidity rate with other sexual concerns regarding arousal, sexual desire, and lack of vaginal lubrication.⁹

Treatment of FOD

People with FOD can practice stimulation techniques, sensate focus, and receive psychological CBT interventions that decrease performance anxiety and encourage erotic fantasy.^9,10 Other treatments include medication and/or hormone treatment.⁹

Premature Ejaculation (PE)

People affected by premature ejaculation tend to ejaculate with minimum stimulation during intercourse, typically within one minute of penetration. The problem must last a minimum of six months and occur in at least 75% of sexual encounters. It can be lifelong or acquired, generalized or situational, and it can be mild, moderate, and severe.³

Causes of Premature Ejaculation

PE can be due to medical conditions, such as neurological disorders, urological problems, or physical injury.¹¹ Psychological factors include performance anxiety, stress, poor confidence or body image, and negative early learned experiences¹¹

Treatment for PE

Pharmacological treatments include topical creams or medication such as SSRIs.¹² Penile exercises, CBT, and individual or conjoint therapy are other treatment options.^8,12

Delayed Ejaculation (DE)

Men with delayed ejaculation find it difficult or impossible to orgasm and ejaculate, even with sufficient stimulation, erection, and a desire to orgasm, leading to marked distress.³ DE is one of the least common and understood sexual disorders, and is also known as male orgasmic disorder, delayed orgasm, and inhibited/impaired ejaculation.¹³

Causes of Delayed Ejaculation

During the assessment, the therapist will complete a thorough history of the problem’s progression, noting factors that improve or aggravate symptoms. There is still a lot to learn about what causes DE, although it is believed to be impacted by individual, biological, psychological, and relationship factors. Specifically, unique masturbation habits and age can be influencers.¹³

Treatment of Delayed Ejaculation

Treatment often includes an integration of medication, psychotherapy, and behavioral masturbatory retraining.¹³ The clinician should also assess for and address any performance anxiety and self-criticism.

Pain Disorders

Pain disorders include dyspareunia and vaginismus. These disorders present similarly, but while vaginismus is solely a female disorder, both males and females may experience dyspareunia.

Dyspareunia

Those with dyspareunia experience significant genital pain during intercourse, and also with insertion of tampons, fingers, or during gynecological examinations.¹⁴ Both males and females can be affected by dyspareunia, although more attention has been given to dyspareunia in females.

Causes of Dyspareunia

Physiological factors, including nerve damage or dysfunction, extreme sensitivity, damage from surgeries (like episiotomies), and more rarely, vaginal or genital malformations can all contribute to genital pain.^14,15 Psychologically, pain may be exacerbated by anxiety, catastrophizing, negative thoughts or expectations, or lack of sexual attraction to partner.^9,14

Treatment for Dyspareunia

Less invasive strategies are used first in treatment of dyspareunia, and include medication. Topical lidocaine may be recommended, as well as Osphena, an FDA-approved oral medication approved for treating dyspareunia. CBT for pain management and therapy may also improve sexual functioning within the partnered relationship. More physical treatments of pelvic floor therapy and manual or insertion exercises may be recommended. More invasive treatments, such as surgery, depend on the nature of the pain and what direction of treatment the person wishes to take.¹⁴

Vaginismus

Similar to dyspareunia, those with vaginismus have difficulty with vaginal penetration due to genital pain. The musculature surrounding the vaginal opening is subject to spasms and hypertonicity, making sexual intercourse virtually impossible. Women may feel burning, stretching, or tearing sensations around the vaginal opening, and often experience an extreme level of fear regarding penetration.^15,16

Causes of Vaginismus

Much more research needs to be done on vaginismus before we find a specific cause. Conservative perspectives, history of sexual abuse, lack of sex education, and issues in the relationship have been identified as causal variables for vaginismus, but none have been verified through empirical research.¹⁷

Treatment of Vaginismus

Many treatments used with dyspareunia are helpful with treating vaginismus. Less invasive treatments are explored first, including medication, topical creams, decreasing negative thoughts, addressing the cycle of fear-avoidance, and improving the partnered relationship.

More intense treatments may be required, such as pelvic floor therapy or surgery.¹⁶ Undergoing a medical examination by a physician or gynecologist may be one of the first interventions for addressing vaginismus.⁸

Other Sexual Disorders

Other sexual disorders include paraphiliac disorders, persistent genital arousal disorder, and hypersexuality disorder.

Paraphiliac Disorders

Paraphilias are unusual sexual interests, and include:

• Voyeurism
• Exhibitionism
• Pedophilia
• Fetishism
• Sexual sadism
• Frotteuristic disorder
• Masochism

The lines between sexual deviance and psychopathology are complicated by the fact that there is no scientific answer to what is considered “normal” sexual behavior. Many people who seek help for a paraphilia are referred for treatment after a criminal sexual offense.¹⁸

Causes of Paraphilias

Due to a lack of research and possible underreporting out of fear of marginalization, what we know about paraphilias is limited. What has been considered sexually deviant has evolved throughout history, and the question of whether paraphilias should be considered a disorder at all remains controversial.

Treatment for Paraphilic Disorders

Not all individuals view their non-normative sexual interests to be problematic, and treatment for paraphilias is implemented only when there is significant distress or dysfunction. Treatment for sex offenders and those whose paraphilias are of a public concern (like pedophilia) include pharmacological, psychological, and community support interventions, although controversy exists regarding whether these treatments are effective.¹⁸

Persistent Genital Arousal Disorder (PGAD)

Those with PGAD feel unwanted and highly distressing genital arousal sensations that do not subside even after multiple orgasms.¹⁹ Women report feelings of imminent orgasm or genital contractions, and some experience vaginal or clitoral pain or pain with penetration. Triggers can vary from psychological stress and anxiety to wearing tight clothing or sitting for longer periods.

While PGAD is not classified as a sexual disorder, it is a harmful condition to sexuality. It can appear similar to hypersexuality because repeated masturbation is seen in both conditions. However, the motivation for masturbation in PGAD is due to unwanted arousal, which sets it apart from hypersexuality.¹⁹

Treatment for PGAD

Treatment for PGAD often begins with a genital or pelvic examination by a physician or gynecologist. Medication and pelvic floor physical therapy may be recommended, as well as an assessment of any comorbid issues. Psychological approaches like mindfulness-based CBT can help women observe their PGAD symptoms rather than focus on the negative thoughts. Treatment primarily focuses on symptom management and enhancing sexual pleasure, rather than on finding a cure.¹⁹

Hypersexuality Disorder & Sex Addiction

Those with hypersexuality disorder experience disinhibited frequent and repetitive sexual urges, fantasies, and behaviors.²⁰ You may more commonly recognize this disorder as sexual addiction.

Causes of Sex Addiction

The root cause of hypersexuality is unknown.²⁰ Hypersexuality disorder may be comorbid with mood disorders such as anxiety, depression, or with other sexual disorders. There is also a link between ADHD and hypersexuality, and in the context of other episodic symptoms of mania, hypersexuality is a hallmark symptom of bipolar disorder.

Treatment of Hypersexuality

Medication and psychological treatment such as individual or conjoint therapy, group therapy, CBT, and behavioral therapy have been used to treat hypersexuality.²⁰