Purpose of This Module

There are many factors involved in sexual response—feelings, behaviors, attitudes, expressions, age, environment, and health. The range of what is considered “normal” within the sexual response cycle is wide, with sexual satisfaction, enhanced intimacy, or both being the desired outcome.

Most women and men at one time or another experience some alteration in sexual response, and an occasional problem in this regard is not an indication of dysfunction. Even a single episode of altered response or failure to perform sexually can cause unnecessary concern and may even perpetuate the problem, since anxiety about sexual performance can diminish sexual functioning.

Differentiating between natural alterations in sexual response and actual sexual dysfunction can help the client avoid becoming drawn into a cycle of anxiety and can help providers diagnose and treat the causes of true sexual dysfunction. In this module, we will:

• Define “sexual dysfunction” and explain the factors that contribute to it
• Describe the presentation, causes, and treatment of the following common sexual dysfunctions: inhibited sexual desire, dyspareunia, vaginismus, anorgasmia, premature ejaculation, male orgasmic disorder, and erectile dysfunction (impotence)
• Briefly explain the sexual concerns common among adolescents, adults, and perimenopausal women

What Is “Sexual Dysfunction”?

Sexual dysfunction is the persistent or recurrent inability to react emotionally or physically to sexual stimulation in a way expected of the average healthy person or according to one’s own standards of acceptable sexual response. Sexual dysfunction can occur during the desire, excitement, plateau, or orgasm stage of the sexual response cycle.

For example, one of the most common dysfunctions is inhibited arousal during the excitement stage. This presents as erectile dysfunction (impotence) in men or lack of lubrication in women. Occasional inhibited arousal is common and not dysfunctional; however, chronic inhibited arousal is a sexual dysfunction that can be caused by recreational drug use, certain medications, certain diseases, physical damage, or psychological factors. Any of the following factors can contribute to sexual dysfunction:

• Psychological/emotional factors, including stress, negative body image, performance anxiety, expectation of failure, fear of pregnancy, memory of negative sexual experiences, and fear of acquiring or transmitting a sexually transmitted disease
• Biological/physiological factors, including changes related to aging, certain medical conditions (arthritis, reproductive cancers, diabetes, cardiac disease, hypertension), physical injury (such as spinal cord injuries), the effects of hormonal contraceptive methods, pregnancy, and substance abuse
• Interpersonal/social factors, including peer pressure, poor communication with a partner, sexual abuse, attitudes toward sexual orientation, uncertainty of how to behave, and conflicts with one’s partner
• Environmental factors, including cultural influences, gender dynamics, availability of partners (partner ratio), and physical setting (lack of privacy)

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