Sexual Dysfunctions

Roughly 43% of women and 31% of men suffer from a clinically significant impairment to their ability to experience sexual pleasure or responsiveness as outlined by the SRC (Rosen, 2000). The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM) refers to these difficulties as sexual dysfunctions.

According to the DSM, there are four male-specific dysfunctions:

• delayed ejaculation
• erectile disorder (ED)
• male hypoactive sexual desire disorder
• premature ejaculation (PE)

There are three female-specific dysfunctions:

• female orgasmic disorder
• female sexual interest/arousal disorder
• genito-pelvic pain/penetration disorder

There is also one non-gender-specific sexual dysfunction: substance-/medication-induced sexual dysfunction (American Psychiatric Association, 2013). The most commonly reported male sexual dysfunctions are premature ejaculation (PE) and erectile dysfunction (ED), whereas females most frequently report dysfunctions involving desire and arousal. Females are also more likely to experience multiple sexual dysfunctions (McCabe et al., 2016).

PE is a pattern of early ejaculation that impairs sexual performance and causes personal distress. In severe cases, ejaculation may occur prior to the start of sexual activity or within 15 seconds of penetration (American Psychiatric Association, 2013). PE is a fairly common sexual dysfunction, with prevalence rates ranging from 20-30%. Relationship and intimacy difficulties, as well as anxiety, low self-confidence, and depression, are often associated with PE. Most males with PE do not seek treatment (Porst et al., 2007).

ED is the frequent difficulty to either obtain or maintain an erection, or a significant decrease in erectile firmness. Normal aging increases the prevalence and incidence rates of erectile difficulties, especially after the age of 50 (American Psychiatric Association, 2013). However, recent studies have found significant increases in the prevalence of ED in young men, less than 30 years of age (e.g., Capogrosso et al., 2013).

Female sexual interest/arousal disorder (FSIAD) is characterized by reduced or absent sexual interest or arousal. A person diagnosed with FSIAD has had an absence of at least three of the following emotions, behaviors, and thoughts for more than six months:

• interest in sexual activity
• sexual or erotic thoughts and fantasies
• initiation of sexual activity
• sexual excitement or pleasure during sexual activity
• sexual interest/arousal in response to sexual or erotic cues
• genital or non-genital sensations during sexual activity

FSIAD is not diagnosed if the presenting symptoms are a result of insufficient stimulation or lack of sexual knowledge—such as the erroneous expectation that penile-vaginal intercourse always results in orgasm (American Psychiatric Association, 2013).

Treatments

When it comes to treating sexual dysfunctions, there’s some good news and there’s some bad news. The good news is that most sexual dysfunctions have treatments—however, most people don’t seek them out (Gott & Hinchliff, 2003). So, the further good news is that—once you have the knowledge (say, from this module)—if you experience such difficulties, getting treatment is just a matter of making the choice to seek it out. Unfortunately, the bad news is that most treatments for sexual dysfunctions don’t address the psychological and sociocultural underpinnings of the problems, but instead focus exclusively on the physiological roots. For example, Montague et al. (2007, pg. 1-7) make this point perfectly clear in The American Urological Association’s treatment options for ED: “The currently available therapies…for the treatment of erectile dysfunction include the following: oral phosphodiesterase type 5 inhibitors, intra-urethral alprostadil, intracavernous vasoactive drug injection, vacuum constriction devices, and penile prosthesis implantation.”

Treatments that focus solely on managing symptoms with biological fixes neglect the fundamental issue of sexual dysfunctions being grounded in psychological, relational, and social contexts. For example, a female seeking treatment for inadequate lubrication during intercourse is most likely to be prescribed a supplemental lubricant to alleviate her symptoms. The next time she is sexually intimate, the lubricant may solve her vaginal dryness, but her lack of natural arousal and lubrication due to partner abuse, is completely overlooked (Kleinplatz, 2012).

There are numerous factors associated with sexual dysfunctions, including: relationship issues; adverse sexual attitudes and beliefs; medical issues; sexually-oppressive cultural attitudes, codes, or laws; and a general lack of knowledge. Thus, treatments for sexual dysfunctions should address the physiological, psychological, and sociocultural roots of the problem.

Sexual DysPhoria

Paraphilias

Paraphilias are described as sexual arousal to atypical objects, situations, and/or targets (APA, 2024).  Atypical objects or targets may include children, corpses, animals, or clothing items. Although this is atypical and therefore unusual, sexual attraction to these targets does not in itself mean a diagnosis of a paraphiliac disorder is warranted. To be diagnosed as a disorder the reaction must be:

1. Intense and persistent
2. Cause significant distress or impairment in social, occupational, or other important areas of functioning
3. Or they harm or have the potential to harm others (such as children or non-consenting adults)

The following source provides additional details about types of paraphilias and diagnosis: https://www.ncbi.nlm.nih.gov/books/NBK554425/

Acknowledgements

The authors are indebted to Robert Biswas-Diener, Trina Cowan, Kara Paige, and Liz Wright for editing drafts of this module.