“Sex sells” has long been a popular marketing strategy. Everything from hit songs (check out Doja Cat’s “Kiss Me More”) to clothing ads — Google #MyCalvins — to binge-worthy shows (hello, Sex/Life) is full of sex, lots of sex that often involves satisfied participants. Sexual references, sexual innuendos, and nudity that in some circles might be considered porn are prevalent in our culture right now.  But what if sex for you isn’t all that?

When there’s not much magic happening in your boudoir, the constant barrage can make you feel deeply alone and embarrassed. Thoughts like “Everyone has an amazing sex life but me,” can consume you. And since the subject is so personal, seeking support—even from professionals—can feel overwhelming and intimidating.

Pressure to perform, body image insecurity, past sexual experiences (both good and bad), work-related stress, and a host of other factors can add up to problem sex, or a great reason to avoid the bedroom.

It might help you to know you are hardly alone.

In fact, one benchmark study in 1999 found that up to 53% of men and 62% of women in the US experience sexual dysfunction at some point. A more recent (2020) study in Germany had the numbers at 33% for men and 46% for women and the Cleveland Clinic puts it at 43% for women and 31% for men.

What Is Sexual Dysfunction?

Sexual dysfunction happens easily. That’s one of the reasons it’s so common. The formula for good sex is having a mind and body that are in sync. Physical and mental health both have a role to play.

Your heart, lungs, muscles, hormones, and sex organs all have a role. And then there’s your brain, our largest sex organ. One Stanford study found that three different parts of the brain (the medial frontal gyrus, right inferior frontal gyrus, and bilateral putamen) play a huge role in our sexual response as each functioned differently in women with low libido versus those with typical sex drive. Sexual dysfunction can also have causes that aren’t connected to underlying disease (i.e. a heart condition, diabetes, or mental health diagnosis) but related to stress, alcohol consumption, and drug use.

Add to that, personal histories (were you the victim of sexual abuse?), cultural norms about what we “should” or “shouldn’t” do in bed, and the fact that common medications, like SSRI antidepressants (Zoloft, Prozac), can cause sexual dysfunction, and it’s easy to understand how prevalent the problem is.

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Sexual disorders and dysfunctions are treatable, however, when you connect with the right professionals. We’ve recruited a few to help.

Sexual Dysfunction or Sexual Disorder?

Most doctors use the terms sexual dysfunction and sexual disorder interchangeably but this is misleading.

In the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), sexual dysfunction is defined as “a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure.”

The word “significant” here means that the problem must be present for at least a few months and “be causing the individual a degree of distress,”  explains Leah S. Millheiser, MD, FACOG, NCMP, clinical assistant professor, Obstetrics and Gynecology, at Stanford University in Stanford, California.

Sexual dysfunction is generally broken down into four types of disorders (see, below) having to do with desire, arousal, orgasm, and pain.

How Do You Know if You Have a Sexual Disorder?

Sex is meant to be enjoyed. If sex, or the anticipation of it, doesn’t bring you any joy it may be worth discussing with your doctor. An awkward conversation we know.

A sexual disorder refers to the following:

  • Sexual Desire: You have low or no libido.
  • Arousal: Your desire is there but you have trouble becoming or staying excited.
  • Orgasm: It takes a longer or shorter time than you’d like to climax, you aren’t able to orgasm, or it doesn’t feel fully satisfying.
  • Sexual Pain: When Any aspect of sexual activity hurts or causes discomfort.
  • Masturbatory Orgasm: The person is able to reach orgasm only by masturbation, only aroused and/or stayed aroused by watching porn.

Some disorders only impact women, some disorders only impact men, and some disorders overlap (i.e. fetishes, voyeurism—more on this category, later)

Age Matters

As the years creep up, so do rates of sex problems.

For instance, mild and moderate erectile dysfunction affects approximately 10% of men per decade of life (so, 50% of men in their 50s, 60% in their 60s). “Similarly, as women go through menopause, decreasing estrogen production can cause low libido and drying of the vaginal tissue, which results in painful intercourse,” says Dr. Millheiser.

Sexual Dysfunction in Men

Most of us know the James Bond example of masculinity: Always ready, willing, and able to get it on. But any man can experience sexual disorder for a variety of reasons.

  • Erectile Dysfunction (or ED)

    It’s all systems go for sex, but your penis isn’t cooperating with an erection. This is very common. Studies say anywhere from 10% to 70% of men experience ED at some point. The issue is caused by decreased blood flow to the penis, thanks to medication or a cardiovascular issue, among other factors.

  • Premature Ejaculation

    Climaxing sooner than you’d like during intercourse affects 30% to 40% of men and often both physical and psychological factors are at work.

  • Delayed Ejaculation

    The opposite issue. Orgasm requires prolonged stimulation and can also be attributed to a combination of physical and psychological factors.

  • Male Hypoactive Sexual Desire Disorder

    Or low libido is when your desire fizzles. “It tends to be more common in midlife and older men,” says Arthur Burnett, MD, a professor of urology at the Johns Hopkins School of Medicine in Baltimore, Maryland. Some health problems associated with aging (diabetes, obesity) can lessen testosterone, a key hormone in sexuality.

  • Substance/Medication-Induced Sexual Disorder

    Occurs when, as the name indicates, a substance, like alcohol, or a medication, interferes with sexual functioning.

Sexual Dysfunction in Women

It’s important to note one major misconception here: that it’s all emotional.

“Contrary to popular belief, for the vast majority of women who have pain with sex or sexual disorder, it starts with a physical problem that leads to fear, worry, anger, and grief,” says Stacy Tessler Lindau, professor of Ob/Gyn and Medicine-Geriatrics at the University of Chicago, in Chicago, Illinois. “We tend to approach this as if the problem starts in her head, but that is just not the case.”

For women, sexual issues fall into two camps:

Female Sexual Interest/Arousal Disorder

Also known as hypoactive sexual desire disorder (or HSDD). It’s that “thanks, but no thanks” feeling about sex — maybe the idea is as enticing as cleaning the bathroom, or maybe you do crave intimacy, but your body isn’t responsive. It’s a complex but super-common issue, with nearly one-third of women ages 18 to 59 saying they’ve lost interest in sex. Exhaustion, stress, relationship issues, and hormonal shifts all come into play.

Female Orgasmic Disorder

Impacting up to 42% of women at some point, it refers to a delay, inability, or unsatisfying climax.

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Genito-Pelvic Pain/Penetration Disorder

Or, painful sex. There are a few varieties:

  • Vaginismus

    Tightness in the vagina, making intercourse difficult or impossible

  • Vulvodynia

    Pain in the outer genitalia (the labia and opening of the vagina).

  • Interstitial Cystitis

    A condition in which the pelvic floor muscles are extremely tight. In menopausal women, declining estrogen production leads to thinning and dryness of the vaginal tissues, which causes painful intercourse. Understandably, these experiences can lead a person to avoid sex.

Which Sexual Dysfunctions Affect Men and Women?

“I have a headache” is an old cliché tied to women, but all genders experience low libido and arousal disorders. Hormone levels, medications, stress, depression, and other causes don’t discriminate by gender.

Similarly, both men and women may experience issues with achieving orgasm.

Sexual Dysfunctions and Disorder Causes

The reasons for trouble between the sheets are as complex as the people experiencing them. Here’s a list of some of the many contributors to an unsatisfying sex life.

Underlying conditions tied to the heart, hormones, brain, metabolism, and more can cause sexual dysfunction. Men with diabetes are three times as likely to experience ED because of nerve and blood vessel damage, where women who have had chemotherapy (which can lower estrogen production and cause vaginal sores) saw rates of sexual dysfunction anywhere from 30% to 100%.

Environmental factors: Stress, a high-fat diet, and excessive alcohol use can snuff out anyone’s sexual desire. What’s more, endocrine disruptors – substances like the now-banned plastic-softening agent bisphenol-A, which was found in water bottles until 2013, interfere with hormonal function and sexual health.

Personal history: Traumatic experiences can understandably affect your sex life, and if you have a challenging or abusive relationship, or one that lacks communication, you may withdraw from sex. Women with a history of childhood sexual abuse are also more likely to face sexual dysfunction.

Can Medications Cause Sexual Dysfunctions and Disorders?

It’s super frustrating that the very medications we take to feel better can contribute to sexual disorders. Among the most common:

  • High Blood Pressure Meds

    Can lessen blood flow to the penis, making it more difficult to achieve an erection. They can also lower testosterone and sex drive.

  • Antidepressants (SSRI’s)

    SSRIs and other antidepressants are known to lower libido, make it difficult to become aroused, sustain that feeling, and climax. These symptoms are more common with age.

  • Antipsychotics

    Antipsychotics are valuable medications, but sexual dysfunction is a common side effect impacting up to 80% of patients.

  • Antiandrogen drugs

    Antiandrogen drugs are designed to interfere with testosterone as a treatment for prostate cancer. As you might guess, they can diminish sexual function.

If these or other medications are affecting your sex life, talk to your doctor about what you’re experiencing. Oftentimes there are other options that can minimize or even eliminate sexual dysfunction.

When Should I Seek Professional Help for Sexual Dysfunctions and Disorders?

If you started feeling tightness in your chest, you’d seek help. The same should hold true for your sex life.

If it’s been a source of pain and frustration for a few months, check with your GP about scheduling a visit or getting a referral to a urologist or an Ob/Gyn who is trained in sexual disorders. Once a qualified doctor has taken your history and done an exam, they might suggest tests (to check hormone levels), treatment, or speaking with a sexual disorder therapist.

“The mind and body are entwined,” says Elisabeth Gordon, MD, an integrative sexual health psychiatrist, sex therapist, and past clinical instructor at the NYU School of Medicine in New York City. “Even if treatment gets rid of, for example, chronic pain with intercourse, you may still have patterns in your relationship that emerged when you were experiencing the pain. Therapy can help you iron out those problems.”

Gordon explains that therapy for sex disorders will typically involve mindful exercises to do at home and that “all people in the relationship are part of the therapy and sex is initially taken off the table.” She says that the treatment is usually successful after a few months to a year.

Therapy will also likely be advised if you have a history of sexual abuse, as one in six American women (who report it) do. The stats aren’t as available for men, who report abuse less often. While “having been abused does not guarantee you will have sexual dysfunction,” says Dr. Gordon, “studies show a correlation between the two.”

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After experiencing sexual abuse, the emotional scars may remain, and depression, anxiety, and low self-esteem are common. When it comes to sexual function, women often report low interest in sex or pain, and men may have ED. If you are experiencing issues, do seek help (see our Resources) to heal the wounds and optimize enjoyment in your sex life.

Sexual Dysfunctions and Disorder Treatments

First: Hurrah! There are treatments—and highly effective ones.

Medication

You’ve probably seen ads for ED meds like Viagra. These work by increasing blood flow to the penis which aids in firmness to allow for intercourse. Medications can help women, too. Both the female (estrogen) and male (testosterone) sex hormones can help boost desire or arousal, and there are also brands like Addyi and Vyleesi that treat low sexual desire in premenopausal women.

Devices

Vacuum tubes placed over the penis, hand- or battery-powered pumps to achieve an erection, and penile implants (which require surgery) can all improve or resolve ED. For women experiencing pain, dilators (tube-shaped devices inserted to gently stretch vaginal tissue) are helpful, and vibrators can play a role in enhancing arousal and orgasm.

Counseling and Physical Therapy

Sexual dysfunction is hard to talk about, but seeing a therapist can have excellent results. For women experiencing pain due to hypertonia (tight pelvic-floor muscles), a pelvic-floor physical therapist trained in sexual issues can offer relief.

Can You Prevent Sexual Dysfunctions and Disorders?

You can’t prevent sexual disorders, but you can lower the odds of experiencing one. All the usual advice about maintaining a healthy diet, healthy weight, and staying active hold true, as does managing stress. Don’t forget it takes two to have a satisfying sex life, so communication is big here. If you aren’t connecting well with your partner, feel unsupported or unsafe, issues like low desire and arousals can crop up.

While sexual dysfunction can provoke anxiety and embarrassment, there are a ton of resources out there to help you enjoy one of life’s big pleasures to the fullest.

Sexual Dysfunction Resources

Sexual Dysfunction FAQs

What symptoms are associated with sexual disorder?

The symptoms of sexual disorder are as varied as the individual. That said, some common ones for women are low or no sexual desire; issues with getting and staying aroused; difficulty reaching orgasm; and pain during sexual activity. For men, frequent symptoms are low sexual desire, trouble getting or maintaining an erection; and climaxing sooner or later than desired.

Why is it difficult to diagnose a sexual disorder?

Because sexual disorders are so complex, with both mind and body involved! It could be your emotional state, your hormones, your neurological or cardiovascular system, your meds – and more. That’s why it’s important to see a well-trained healthcare practitioner.

How many different categories of sexual dysfunction disorders are in the DSM-5?

The times – and the DSM – are a changin’. The most recent edition of the Diagnostic and Statistical Manual, the handbook that medical professionals rely upon, has condensed the categories of sexual dysfunction a bit. For women, the categories are female sexual interest/arousal disorder, female orgasmic disorder, and genito-pelvic pain/penetration disorder. For men, they are erectile disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, and delayed ejaculation.

How do sexual dysfunctions differ from paraphilic disorders?

Experiencing a sexual dysfunction means that you are having “typical” sexual feelings but you’re grappling with a sexual performance issue – lack of desire, say, or inability to have an orgasm. With a paraphilic disorder, a person isn’t having a performance problem but their sexual interest is atypical – like a foot fetish – and may involve issues of consent, as with voyeurism. If you feel you have a paraphilic disorder and want to speak with a counselor, check our resource list.

Why do SSRIs cause sexual dysfunction?

Let’s have a mini science class: SSRIs are selective serotonin reuptake inhibitors, which needs some explaining. Serotonin is a neurotransmitter – a chemical that acts like a messenger, carrying signals between brain cells, and is then reabsorbed by nerve cells. SSRIs block these chemicals from being reabsorbed by nerve cells, which means they can continue ferrying signals between nerve cells. This increase in serotonin may boost your mood, but it also impacts other hormones and neurotransmitters, such as testosterone (which impacts arousal) and dopamine (which plays a part in achieving orgasm).

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Last Updated: Oct 12, 2021