Sexual Dysfunction: Types, Causes and Treatment

What counts as sexual dysfunction

The sexual response involves desire, arousal (erection or lubrication and swelling), orgasm and resolution. A problem at any stage can count as dysfunction when it is persistent, usually lasting at least 6 months, and causes distress. Occasional difficulties are normal and do not need treatment. What matters is how the person and their partner feel about it.

Types in men

Types in women

Causes

Physical

• cardiovascular disease, high blood pressure and high cholesterol: reduce blood flow. ED can be an early warning sign of heart disease
• diabetes: damages nerves and blood vessels
• obesity and inactivity
• neurological conditions: MS, spinal cord injury, Parkinson's disease
• pelvic surgery or radiation, such as for prostate, bladder or cervical cancer
• chronic pain and fatigue

Hormonal

• low testosterone
• menopause and low estrogen, causing vaginal dryness and thinning
• after childbirth and while breastfeeding
• thyroid disorders and high prolactin

Medicines and substances

• SSRIs and SNRIs: reduced desire, delayed orgasm, ED
• blood pressure medicines such as some beta-blockers and thiazide diuretics
• antipsychotics, anti-androgens, finasteride
• hormonal contraception (in some women)
• opioids
• alcohol, smoking and recreational drugs

Psychological and relationship factors

• depression and anxiety
• performance anxiety
• stress, fatigue and body image concerns
• relationship conflict or poor communication
• past trauma or sexual abuse
• cultural or religious beliefs, and lack of sexual knowledge

Diagnosis

A doctor will ask about the specific problem, when it started, whether it happens in all situations, medicines, alcohol and drug use, mood, relationship and medical history. An examination may include genitals, pelvic exam and blood pressure.

Tests may include:

• blood sugar and HbA1c, cholesterol
• morning testosterone in men with low desire or ED
• thyroid function and prolactin when indicated
• cardiovascular risk assessment for men with ED

Treatment

Address underlying causes

• control diabetes, blood pressure and cholesterol
• lose weight, exercise, stop smoking and limit alcohol
• review medicines: switching, lowering doses or timing changes can help, but do not stop prescribed medicines on your own
• treat depression and anxiety

For men

• PDE5 inhibitors (sildenafil, tadalafil): effective for most men with ED. Never combine with nitrates
• vacuum devices, injections, urethral suppositories and penile implants
• testosterone therapy for confirmed low testosterone with symptoms
• for premature ejaculation: behavioral techniques, topical numbing agents and some SSRIs taken under medical guidance

For women

• vaginal moisturizers, lubricants and low-dose vaginal estrogen for dryness and pain after menopause
• pelvic floor physical therapy for pain, vaginismus and arousal difficulties
• vaginal dilators for vaginismus
• medicines for low desire in premenopausal women, such as flibanserin or bremelanotide, which have modest effects
• treating conditions like endometriosis or vulvodynia

Psychological approaches

• sex therapy: education, communication skills and graded exercises such as sensate focus
• cognitive behavioral therapy for anxiety and negative thoughts
• couples therapy for relationship factors
• mindfulness-based therapy, which has good evidence for low desire and arousal in women

Frequently asked questions

What are the types of sexual dysfunction?

The four main types are problems with desire (low libido), arousal (such as erectile dysfunction or lack of lubrication), orgasm (delayed, absent or premature ejaculation), and pain during sex. They can occur in men and women and often overlap.

What causes sexual dysfunction?

Common causes include heart disease, diabetes, hormonal changes such as menopause or low testosterone, medicines like antidepressants and some blood pressure drugs, alcohol, smoking, depression, anxiety, stress, relationship issues and past trauma.

Is sexual dysfunction common?

Yes. Surveys suggest around 4 in 10 women and 3 in 10 men experience a sexual problem at some point. It becomes more common with age and chronic illness, but it is not an inevitable part of aging, and treatment helps most people.

Can antidepressants cause sexual dysfunction?

Yes. SSRIs and SNRIs commonly cause reduced desire, delayed orgasm and erection problems. Options include adjusting the dose, switching to an antidepressant with fewer sexual side effects such as bupropion, or adding treatment. Talk to your prescriber before making changes.

Who should I see for sexual problems?

Start with your primary care doctor, gynecologist or urologist. They can check for medical causes and medicines and offer treatment or referral. Sex therapists, pelvic floor physical therapists and mental health professionals also specialize in sexual health.