View source for Sexual dysfunction

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{{DiseaseDisorder infobox |
  Name        = Sexual dysfunction |
  ICD10       = F52 |
  ICD9        = {{ICD9|302.7}} |
}}
{{SI}}
{{CMG}}; {{AE}} {{KS}} {{SHA}}

==Overview==

'''Sexual dysfunction''' or '''sexual malfunction''' (see also [[sexual function]]) is difficulty during any stage of the [[sexual act]] (which includes [[Interpersonal attraction|desire]], [[sexual arousal|arousal]], [[orgasm]], and resolution) that prevents the individual or couple from enjoying sexual activity.

==Onset==
Emotional factors affecting sex include both interpersonal problems (such as marital/relationship problems, or lack of trust and open communication between partners) and psychological problems within the individual ([[clinical depression|depression]], sexual fears or guilt, past sexual trauma, sexual disorders,<ref name="Michetti_et_al_2006">{{cite journal | last = Michetti | first = Paolo Maria | coauthors = Roberta Rossi, Daniele Bonanno, Andrea Tiesi and Chiara Simonelli | year = 2006 | title = Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED) | journal = International Journal of Impotence Research | volume = 18 | issue = 2 | pages = 170–174 | id = {{PMID|16151475}} | url = http://www.nature.com/ijir/journal/v18/n2/full/3901386a.html | accessdate = 2007-02-02}}</ref> and so on).

Physical factors include drugs (alcohol, [[nicotine]], [[narcotic]]s, stimulants, antihypertensives, [[antihistamine]]s, and some psychotherapeutic drugs); injuries to the back, problems with an enlarged prostate gland, problems with blood supply, nerve damage (as in spinal cord injuries); or disease ([[diabetic neuropathy]], [[multiple sclerosis]], [[tumor]]s, and, rarely, tertiary [[syphilis]]); failure of various organ systems (such as the heart and lungs); [[endocrine]] disorders ([[thyroid]], [[pituitary]], or [[adrenal gland]] problems); hormonal deficiencies (low [[testosterone]], [[estrogen]], or [[androgen]]s); and some [[birth defect]]s.

==Classification==

Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.

#Sexual desire disorders or decreased libido can be caused by a decrease in normal estrogen (in women) or testosterone (in both men and women) production. Other causes may be aging, fatigue, pregnancy, medications (such as the [[selective serotonin reuptake inhibitor|SSRIs]]) or psychiatric conditions, such as depression and anxiety.  Loss of [[libido]] from SSRIs usually reverses after SSRIs are discontinued, but in some cases it does not.  This is known as [[PSSD]].
#Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced with a number of terms describing specific problems with, for example, desire or arousal.<br>For both men and women, these conditions can manifest as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.<br>There may be medical causes to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease can also contribute, as well as the nature of the relationship between the partners. As the success of [[sildenafil]] (Viagra) attests, most erectile disorders in men are primarily physical, not psychological conditions.
#Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder can occur in both women and men. Again, the [[SSRI]] antidepressants are frequent culprits -- these can delay the achievement of orgasm or eliminate it entirely.
#Sexual pain disorders affect women almost exclusively and are known as [[dyspareunia]] (painful intercourse) and [[vaginismus]] (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication ([[vaginal dryness]]) in women.

Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by [[menopause]], [[pregnancy]], or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse) may play a role. Another female sexual pain disorder is called [[vulvodynia]] or [[vulvar vestibulitis]]. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late twenties through thirties. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.

Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships or chronic disharmony with the current sexual partner can also interfere with [[sexual function]].

==Differential Diagnosis of Male Hypoactive Sexual Desire Disorder==

*Another medical condition

:*Central nervous system disease
:*[[Diabetes mellitus]]
:*[[Hypogonadism]]
:*[[Thyroid disease|Thyroid dysfunction]]

*lnterpersonal factors

:*Severe relationship distress

*Nonsexual mental disorders
*Other sexual dysfunctions

:*[[Premature ejaculation|Early ejaculation]]
:*[[Erectile dysfunction|Erectile difficulties]]

*Substance/medication use<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>

==Risk Factors of Male Hypoactive Sexual Desire Disorder==

*Age
*Attitudes
*[[Alcohol]]
*[[Anxiety]]
*Emotional connection
*[[Hypogonadism]]
*[[Hyperprolactinemia]]
*Interpersonal problems
*Lack of adequate sex education
*Mood
*Man's feelings about himself
*Partner's sexual desire
*Social and cultural contextual factors
*Trauma from early life experiences<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>

==Diagnosis==
===Symptoms===
====Psychological sexual disorders====
The fourth edition of the [[Diagnostic and Statistical Manual of Mental Disorders]] lists the following psychological sexual disorders:

*[[Hypoactive sexual disorder]] (see also [[asexuality]])
*[[Bestiality]]
*[[Sexual aversion disorder]] (avoidance of or lack of desire for sexual intercourse)
*[[Female sexual arousal disorder]] (failure of normal lubricating arousal response)
*[[Erectile dysfunction|Male erectile disorder]]
*Female orgasmic disorder (see [[Anorgasmia]])
*Male orgasmic disorder (see [[Anorgasmia]])
*[[Premature ejaculation]]
*[[Dyspareunia]]
*[[Vaginismus]]
*[[Secondary sexual dysfunction]]
*[[Paraphilia]]s
*[[Gender identity disorder]]
*[[PTSD]] due to genital mutilation or childhood sexual abuse

====Other sexual problems====

*Sexual dissatisfaction (non-specific)
*Lack of sexual desire
*[[Anorgasmia]]
*[[Erectile dysfunction|Impotence]]
*[[Sexually transmitted disease]]s
*Delay or absence of [[ejaculation]], despite adequate stimulation
*Inability to control timing of ejaculation
*Inability to relax [[vagina]]l muscles enough to allow [[intercourse]]
*Inadequate vaginal lubrication preceding and during intercourse
*Burning pain on the [[vulva]] or in the vagina with contact to those areas
*Unhappiness or confusion related to [[sexual orientation]]
*[[Transsexual]] and [[transgender]] people may have sexual problems (before or after [[sex reassignment surgery|surgery]]), though actually being transgendered or transsexual is not a sexual problem in itself.
*[[Persistent sexual arousal syndrome]]
*[[Post SSRI Sexual Dysfunction]]
*[[Sexual addiction]]
*[[Hypersexuality]]
*[[Female genital cutting]] has occurred more in the USA than previously thought
*[[Male circumcision]] alters the natural sexual function for both partners

====Other related problems====

*[[Infertility]]
*[[Paraphilia]]

==Diagnostic Criteria==
===DSM-V Diagnostic Criteria for Male Hypoactive Sexual Desire Disorder <ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===
{{cquote|

*A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and socio cultural contexts of the individual’s life.

'''''AND'''''

*B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

'''''AND'''''
*C. The symptoms in Criterion A cause clinically significant distress in the individual.

'''''AND'''''

*D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
<br>
Specify whether:

*Lifelong: The disturbance has been present since the Individual became sexually active.

*Acquired; The disturbance began after a period of relatively normal sexual function.

Specify whether:

*Generaiized: Not limited to certain types of stimulation, situations, or partners.

*Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:

*Mild: Evidence of mild distress over the symptoms in Criterion A.

*Moderate: Evidence of moderate distress over the symptoms In Criterion A.

*Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.
}}

==Clinical studies==
Since people tend not to talk to one another about their sexual problems, many people imagine that they are "abnormal", or that their sexual problems are unique or [[shame]]ful. Images of sexuality presented by [[society]] and the [[mass media|media]] often present people with unrealistic ideals of sexual behavior, whether of the ideals of [[chastity]] and sexual fidelity presented by [[religion]], or the ideal of sexual inexhaustibility and [[promiscuity|promiscuous]] availability presented by [[pornography]]. Neither image appears to be representative of human behavior in real life: this has been summed up in the phrase ''"everyone lies about sex"''.

The earliest attempts at treating sexual dysfunctions, especially [[erectile dysfunction]], date back to [[Islamic medicine|Muslim physicians and pharmacists]] in the [[Islamic Golden Age|medieval Islamic world]]. They were the first to prescribe [[medication]] for the treatment of this problem, and they developed several methods of [[therapy]] for this issue, including a single-drug therapy method where a [[drug]] was prescribed and a "combination method of either a drug or [[food]]." Most of these drugs were oral medication, though a few patients were also treated through [[topical]] and [[Transurethral resection of the prostate|transurethral]] means. Sexual dysfunctions were being treated with clinically [[Drug test|tested drugs]] in the Islamic world since the 9th century until the 16th century by a number of Muslim physicians and pharmacists, including [[Muhammad ibn Zakarīya Rāzi]], [[Thabit bin Qurra]], [[Ibn Al-Jazzar]], [[Avicenna]] (''[[The Canon of Medicine]]''), [[Averroes]], [[Ibn al-Baitar]], and [[Ibn al-Nafis]] (''The Comprehensive Book on Medicine'').<ref>A. Al Dayela and N. al-Zuhair (2006), "Single drug therapy in the treatment of male sexual/erectile dysfunction in Islamic medicine", ''Urology'' '''68''' (1), p. 253-254.</ref>

In modern times, the genuine clinical study of sexual problems is usually dated back no further than 1970 when [[William Masters and Virginia Johnson|Masters and Johnson's]] ''[[Human Sexual Inadequacy]]'' was published. It was the result of over a decade of work at the Reproductive Biology Research Foundation in St. Louis, involving 790 cases. The work grew from Masters and Johnson's earlier ''[[Human Sexual Response]]'' (1966).

Prior to Masters and Johnson the clinical approach to sexual problems was largely derived from the thinking of [[Freud]]. It was held with [[psychopathology]] and approached with a certain pessimism regarding the chance of help or improvement. Sexual problems were merely symptoms of a deeper malaise and the diagnostic approach was from the psychopathological. There was little distinction between difficulties in function and variations nor between perversion and problems. Despite work by psychotherapists such as Balint sexual difficulties were crudely split into [[frigidity]] or [[Erectile dysfunction|impotence]], terms which too soon acquired negative connotations in popular culture.

The achievement of ''Human Sexual Inadequacy'' was to move thinking from psychopathology to ''learning'', only if a problem did not respond to educative treatment would psychopathological problems be considered. Also treatment was directed at couples, whereas before partners would be seen individually. Masters and Johnson saw that sex was a joint act. They believed that sexual communication was the key issue to sexual problems not the specifics of an individual problem. They also proposed co-therapy, a matching pair of therapists to the clients, arguing that a lone male therapist could not fully comprehend female difficulties and vice versa.

The basic Masters and Johnson treatment program was an intensive two week program to develop efficient sexual communication. Couple-based and therapist led the program began with discussion and then sensate focus between the couple to develop shared experiences. From the experiences specific difficulties could be determined and approached with a specific therapy. In a limited number of male only cases (41) Masters and Johnson had developed the use of a female surrogate, an approach they soon abandoned over the ethical, legal and other problems it raised.

In defining the range of sexual problems Masters and Johnson defined a boundary between dysfunction and deviations. Dysfunctions were transitory and experience by the majority of people, dysfunctions bounded male primary or secondary [[Erectile dysfunction|impotence]], [[premature ejaculation]], [[ejaculatory incompetence]]; female primary [[orgasmic dysfunction]] and situational orgasmic dysfunction; pain during intercourse ([[dyspareunia]]) and [[vaginismus]]. According to Masters and Johnson [[sexual arousal]] and [[orgasm|climax]] are a normal physiological process of every functionally intact adult, but despite being autonomic it can be inhibited. Masters and Johnson treatment program for dysfunction was 81.1% successful.

Despite the work of Masters and Johnson the field in the US was quickly over-run by ethusiastic rather than systematic approaches, blurring the space between 'enrichment' and therapy. Although it has been argued that the impact of the work was such that it would be impossible to repeat such a clean experiment.



<br />

==Overview==

==Historical Perspective==

==Classification==
According to the [[Diagnostic and Statistical Manual of Mental Disorders]] 5 (DSM-5), the list of sexual dysfunctions include:<ref name="Diagnostic and statistical manual of mental disorders : DSM-5 2013 p.">{{cite book | title=Diagnostic and statistical manual of mental disorders : DSM-5 | publisher=American Psychiatric Association,American Psychiatric Association | publication-place=Arlington, VA Washington, D.C | year=2013 | isbn=0-89042-555-8 | oclc=830807378 | page=}}</ref>

*[[Delayed ejaculation]]
*Erectile disorder
*Female [[Orgasmic dysfunction|orgasmic]] disorder
*Female sexual interest/[[arousal]] disorder
*[[Genito-pelvic pain]]/[[penetration disorder]]
*Male [[hypoactive sexual desire disorder]]
*[[Premature ejaculation|Premature (early) ejaculation]]
*[[Substance]]/[[medication]] induced sexual dysfunction
*Other specified sexual dysfunction
*Unspecified sexual dysfunction.  

==Pathophysiology==

==Causes==

==Differentiating Sexual Dysfunction from other Diseases==

==Epidemiology and Demographics==

=== Prevalence ===
The US National Health and Social Life Survey (NHSLS) showed that the prevalence of sexual problems among the individuals in the US include:<ref name="pmid10022110">{{cite journal| author=Laumann EO, Paik A, Rosen RC| title=Sexual dysfunction in the United States: prevalence and predictors. | journal=JAMA | year= 1999 | volume= 281 | issue= 6 | pages= 537-44 | pmid=10022110 | doi=10.1001/jama.281.6.537 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10022110  }} </ref>

==== Women ====

* The [[prevalence]] of sexual complaints is approximately 43% and the most common problems include:
** [[Desire]] (33%)
** [[Orgasm]] (24%)
** [[Lubrication]] (19%)

==== Men ====

* The [[prevalence]] of sexual complaints is approximately 31% and the most common problems include:
** [[Premature ejaculation]] (21%)
** [[Erectile dysfunction]] (5%)
** Low [[desire]] (5%)

==Risk Factors==
According to a consensus statement from the 4th International Consultation on Sexual Medicine in 2015, the risk factors of sexual dysfunction include:<ref name="pmid26953830">{{cite journal| author=McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD | display-authors=etal| title=Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. | journal=J Sex Med | year= 2016 | volume= 13 | issue= 2 | pages= 153-67 | pmid=26953830 | doi=10.1016/j.jsxm.2015.12.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26953830  }} </ref>

====Risk Factors for Women====

*[[Biological]] factors: 
**Poor [[health]]
**Lower levels of physical activities  
**[[Diabetes mellitus|Diabetes Mellitus (DM)]]
**[[Hypertension]]  
**[[Antihypertensive drugs]] 
**[[Chronic diseases]]:
***[[Hyperthyroidism]],  [[hypothyroidism]], and [[thyroid disease]]
***[[Fibromyalgia]]
***[[Arthritis]]
***[[Multiple sclerosis]]
***[[Systemic sclerosis]]
***[[Spinal cord injury]]
***[[Metabolic syndrome]]  
***Untreated [[obstructive sleep apnea]]  
**Stress [[urinary incontinence]]  
**[[Urinary tract]] symptoms 
**[[Hysterectomy]]  
**Female genital mutilation or cutting   
*[[Psychology|Psychological]] and [[psychiatric]] factors:  
**[[Mood Disorder|Mood]] or [[anxiety disorders]]  
**[[Antidepressants]]  
**[[Schizophrenia]]  
**[[Antipsychotic drugs]]
*Sociocultural factors:  
**History of [[sexual abuse]]  
**Emotional and [[physical abuse]] during childhood 
**Sexual dysfunctions in the male partner
**Low education  
**[[Stress]] at work or unemployment
**[[Substance abuse]] ([[alcohol]], [[tobacco]], and [[opioids]])

====Risk Factors For Men====

*[[Biology|Biological]] factors:
**Poor [[health]]  
**Age  
**[[Diabetes mellitus|Diabetes Mellitus (DM)]] 
**[[Obesity]], [[metabolic syndrome]], and [[Erectile dysfunction|erectile dysfunction (ED)]]
**[[Cardiovascular disease]] and [[hypertension]]  
**[[Smoking]] or other [[tobacco]] use  
**[[Hormone|Hormonal]] or [[endocrine]] factors  
**[[Urinary tract]] diseases and lower [[urinary tract]] symptoms  
**Other [[chronic diseases]]: 
***[[Polyneuropathy]]  
***[[Parkinson disease]]  
***[[Multiple sclerosis]]  
***[[Anxiety]] and [[depression]]  
***[[Spinal cord injury]]  
***[[Sleep apnea]]
***[[Chronic obstructive pulmonary disease|Chronic obstructive pulmonary disease (COPD)]]
***[[Scleroderma]]  
***[[Hypertension]]  
**[[Surgery]] and [[trauma]]: 
***[[Spinal cord injury]]  
***[[Radical prostatectomy]] for [[prostate cancer]]  
*[[Psychology|Psychological]] and [[psychiatric]] factors:  
**[[Medication|Medications]] and [[recreational drugs]]:
***[[Cardiovascular]], [[hormonal]], [[anticholinergic]], [[cytotoxic]], and [[Psychotropic drugs|psychotropic]] drugs
***[[Alcohol]], [[marijuana]], and [[narcotics]]
**[[Anxiety]] and [[depression]]  
*Sociocultural factors: 
**Early childhood experiences
**Lack of physical activity
**Not being married
**[[Sexual]] problems in the partner
**Unemployment
**Lower level of education  

==Screening==

==Natural History, Complications, and Prognosis==

==Diagnosis==

===Diagnostic Study of Choice===

*[[Diagnostic and statistical manual of mental disorders|DSM-5]] is used to diagnose different types of sexual dysfunction.<ref name="Diagnostic and statistical manual of mental disorders : DSM-5 2013 p.">{{cite book | title=Diagnostic and statistical manual of mental disorders : DSM-5 | publisher=American Psychiatric Association,American Psychiatric Association | publication-place=Arlington, VA Washington, D.C | year=2013 | isbn=0-89042-555-8 | oclc=830807378 | page=}}</ref>
*According to [[Diagnostic and statistical manual of mental disorders|DSM-5]], sexual dysfunction is a group of [[disorders]] that cause clinical impairment in the ability to respond sexually or experience [[sexual pleasure]]. Most disorders are diagnosed with persisted symptoms for at least 6 months on least 75% of sexual occassions.<ref name="Diagnostic and statistical manual of mental disorders : DSM-5 2013 p.">{{cite book | title=Diagnostic and statistical manual of mental disorders : DSM-5 | publisher=American Psychiatric Association,American Psychiatric Association | publication-place=Arlington, VA Washington, D.C | year=2013 | isbn=0-89042-555-8 | oclc=830807378 | page=}}</ref>

===History and Symptoms===

===Physical Examination===

===Physical Examination===

===Electrocardiogram===

===X-ray===

===Echocardiography or Ultrasound===

===CT scan===

===MRI===

===Other Imaging Findings===

===Other Diagnostic Studies===

==Treatment==

===Medical Therapy===

===Surgery===

===Primary Prevention===

===Secondary Prevention===

==See also==

*[[Sexual function]] for information about assessing sexual dysfunction
*[[Sexual arousal disorder]]
*[[Female sexual arousal disorder]]
*[[Post SSRI Sexual Dysfunction]]
*[[Agony aunt]]
*[[Anorgasmia]]
*[[Premature ejaculation]]
*[[Dapoxetine]]
*[[Sexless marriage]]

==References==
{{reflist|2}}

==Further reading==

*Kaplan, Helen Singer, ''The New Sex Therapy: Active Treatment Of Sexual Dysfunctions'', New York, Brunner/Mazel, 1974. ISBN 0876300832

==External links==

*[http://www.nlm.nih.gov/medlineplus/ency/article/001951.htm NIH site on sexual problems]
*[https://web4health.info/eu/kom/sex-menu.htm 100 FAQs about sexual dysfunction]
*[http://www.vaginismus-awareness-network.co.uk/index.html Vaginimus Awareness Network: A non-profit site offering facts and advice to women with vaginismus, their partners and gynaecologists]
*[http://recover.forumup.org Sexual Dysfunction Research Community]
*[http://www.healthystrokes.com Traumatic Masturbatory Syndrome and other masturbation issues]
*[http://www.sexhealthmatters.org/index.html Sexual Medicine Society of North America's website: SexHealthMatters.org]
*[http://www.psas.nl Persistent Sexual Arousal Syndrome - Language: Dutch and English]
*[http://www.premature-ejaculation-selfhelp.com Premature Ejaculation] Self Help Treatment
*[http://www.sexuality-encyclopedia.com/dr-ruth/index.php?title=Sexual_Dysfunction%2C_Male Dr. Ruth Westheimer on male sexual dysfunction]

{{Mental and behavioural disorders}}

[[Category:Sexual health]]
[[Category:Sexual arousal]]
[[Category:Orgasm]]

[[bs:Poremećaji seksualnog nagona]]
[[ca:Disfunció sexual]]
[[de:Sexuelle Dysfunktion]]
[[es:Disfunción sexual]]
[[is:Kynlífsraskanir]]
[[pl:Dysfunkcja seksualna]]
[[zh:性冷感]]

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{{WH}}
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