Sexual difficulties may begin early in a person’s life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.

  • Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
  • Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems, or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.

Types of sexual dysfunction

Sexual dysfunction generally is classified into four categories:

  • Desire disorders – lack of sexual desire or interest in sex.
  • Arousal disorders – inability to become physically aroused or excited during sexual activity. These include erectile dysfunction or prostate cancer.
  • Orgasm disorders – delay or absence of orgasm (climax). See also premature ejaculation.
  • Pain disorders – Pain during intercourse. Disorders could be classified as prostatitis, kidney or even bladder problems.

Prostate cancer could have all or more than one of these effects. Contact us immediately if you have any of these symptoms, so our expert urologists can look into the problem.

Prevention

Open, informative, and accurate communication regarding sexual issues and body image between parents and their children may prevent children from developing anxiety or guilt about sex, and may help them develop healthy sexual relationships.

Review all medications, both prescription and over-the-counter, for possible side effects that relate to sexual dysfunction. Avoiding drug and alcohol abuse will also help prevent sexual dysfunction.

Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. One partner should, ideally, be able to communicate desires and preferences to the other partner.

People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice. Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.

Symptoms

Men or women:

  • Inability to feel aroused
  • Lack of interest in sex (loss of libido)
  • Pain with intercourse (much less common in men than women)

Men:

  • Delay or absence of ejaculation, despite adequate stimulation
  • Inability to control timing of ejaculation
  • Inability to get an erection
  • Inability to keep an erection adequately for intercourse

Women:

  • Burning pain on the vulva or in the vagina with contact to those areas
  • Inability to reach orgasm
  • Inability to relax vaginal muscles enough to allow intercourse
  • Inadequate vaginal lubrication before and during intercourse
  • Low libido due to physical/hormonal problems, psychological problems, or relationship problems

Signs & Tests

The health care provider will investigate any physical problems and conduct tests based on the particular type of sexual dysfunction you’re experiencing. In any case, a complete medical history should be taken and physical examination should be done to:

  • Highlight possible fears, anxieties, or guilt specific to sexual behaviors or performance
  • Identify predisposing illness or conditions
  • Uncover any history of prior sexual trauma

A physical examination of both the partners should include the whole body and not be limited to the reproductive system.

Complications

Some forms of sexual dysfunction may cause infertility.

Persistent sexual dysfunction may cause depression in some individuals. The importance of the disorder to the individual (and couple, when applicable) needs to be determined. Decreased sexual function is important only if it is a cause of concern for the couple. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups.