Sexual Dysfunctions, Causes, and Treatments

There are a number of dysfunctions that can occur in the expression of sexuality. This sheet provides basic information on common conditions.

Loss of desire

Loss of desire affects both men and women, and is characterized by infrequent sexual activity or lack of desire, including few or no sexual dreams or fantasies.

Physical factors that contribute to loss of desire or inhibited sexual desire (ISD) include hormone deficiencies, depression, alcoholism, kidney failure, and chronic illness. Psychological factors that contribute include stress, relationship problems, sexual trauma, major life changes, and pairing negative memories with sexual interactions.

Treatment is based on the causes of the loss, which may be physical, medical, or psychological. If testosterone deficiency is the cause, replacement therapy is indicated.

Dyspareunia

Dyspareunia is a condition in women characterized by recurrent genital pain with sexual activity (usually with vaginal penetration but can occur during nonpenetrative genital stimulation).

Symptoms of dyspareunia include burning, itching, stinging, and feeling inflamed, in any area of the perineum. The main causes are vulvovaginitis, genital herpes, atrophic vulvitis, urethral problems, episiotomy, radiation vaginitis, and sexual trauma, as well as inadequate lubrication and topical irritants such as spermicides or latex. Deep pelvic pain is often associated with thrusting by the partner hitting an ovary during sexual intercourse, pelvic inflammatory disease (PID), pelvic or abdominal surgery, postoperative adhesions, endometriosis, genital or pelvic tumors, irritable bowel syndrome, urinary tract infection, and ovarian cysts. Dyspareunia can also have psychological causes.

Treatment involves treating the physical or psychological causes of the pain.

Vaginismus

Vaginismus is difficult, uncomfortable, or impossible penetration due to involuntary contractions of vaginal muscles.

The cause of the condition is often physical or sexual abuse that causes a phobic reaction at the prospect of vaginal penetration. Other causes include painful first intercourse, relationship problems, fear of pregnancy, rape, and belief that the vagina is too small.

Treatment involves a program of specific exercises for relaxing the muscles around the vagina and systematic desensitization of the vagina. The woman learns to control her vaginal muscle spasm while gently introducing inserters of gradually increasing size into her vagina, progressing to the point of being able to introduce her partner’s penis on her own.

Anorgasmia

Anorgasmia is a condition in men and women characterized by a persistent or recurrent delay in or absence of orgasm following a normal sexual excitement or plateau phase. (Note: A woman is not anorgasmic if she can achieve orgasm through means other than penile-vaginal stimulation.)

Causes of anorgasmia in women include anger and hostility toward one's partner, ineffective sexual technique, anxiety, familial or religious teachings that cause women to avoid or actively discourage effective sexual stimulation, and strong fear of loss of control over feelings and behavior. In men the cause is rarely physical and is usually associated with a traumatic sexual experience, hostility, loss of control, or lack of trust.

Treatment involves individual and couple work, focused on treating the desire to “hold back,” treating the fear or phobia of orgasm or losing control, and resolution of conflicts while increasing stimulation.

Premature ejaculation (PE)

Premature ejaculation is a condition in men characterized by persistent or recurrent ejaculation with minimal sexual stimulation, before, on, or shortly after penetration and before the person wishes it. PE occurs when a man is unable to exert reasonable voluntary control of his ejaculatory response and is unaware of erotic sensations leading to the “point of inevitability.”

Causes of PE are rarely physical; some infections of the urethra and prostate, neglected gonorrhea, and overly tight uncircumcised foreskin have been considered as possible causes. Most commonly, the man has not learned to pay attention to the sensory feedback that lets him know that ejaculation is imminent.

Treatment interventions may include psychological approaches aimed at reducing anxiety and improving ejaculatory control through special techniques, such as “pause and squeeze”; drug therapy with the use of formulations that delay ejaculation can improve sexual satisfaction in the client and his partner.

Erectile dysfunction (ED)

Erectile dysfunction is a condition in men characterized by persistent or recurrent inability to attain or maintain erection until completion of sexual activity.

Causes can include alcohol, diabetes, drugs, HIV, multiple sclerosis, Parkinson’s disease, or spinal cord lesions. Causes may be psychological, physical, or a combination of both.

Treatment approaches depend on the cause of the dysfunction and may include

• Intracavernosal injection of medication or combination of drugs (e.g., Papverine)
• Intraurethral pellets (e.g., prostaglandin)
• Oral preparations (sildenafil)
• Hormonal augmentation (testosterone)
• Surgical options

© 2007 EngenderHealth