Sexual Dysfunction

Now that we have discussed the history of sexual science, and explored the concept of healthy sexuality from a scientific perspective, we now turn our attention to specific sexual dysfunctions. Throughout our discussion on sexual dysfunction, we will provide information about the known causes and contributing factors, specific to each type of dysfunction. But there are general biological and psychological risk factors associated with all sexual disorders. As previously mentioned, there have been some very dramatic shifts in how we view sexual dysfunction. Initially, the focus was primarily on psychological factors. The spawn of medically-focused treatment options for sexual dysfunction has caused the focus to shift to the biological causes of such dysfunctions. Wincze, Bach, and Barlow (2008) have categorized risk factors into the following categories: direct biological risk factors, indirect biological risk factors, psychosocial risk factors, and relationship factors. A review of these risk factors (as proposed by Wincze, Bach, and Barlow, 2008) follows.

There are several direct, biological risk factors (vascular disease, diabetes, hormone levels, alcohol, and medications) that may contribute to sexual dysfunction. However, positive psychosexual factors (healthy sexual attitudes and knowledge about sex) may override the potential effects of the conditions we are about to describe. Here is how these various biologic risk factors can operate to interfere with normal sexual functioning: 1) Vascular disease may limit blood flow. As we know, for women and men to become physically aroused increased blood flow to the genitalia is necessary. Additionally vascular disease may allow blood that has entered the genitalia to slowly escape. 2) As discussed previously, diabetes impacts blood flow and can even cause nerve damage, which can lead to vaginal dryness in women and erectile difficulties in men. 3) Hormonal levels (testosterone in men and women and estrogen in women) can impact sexual function. 4) Researchers have identified heavy alcohol use as a risk factor for sexual dysfunction. 5) Medication side effects can impact desire, arousal, or orgasm in both men and women.

In terms of indirect biological risk factors, the natural aging process and certain lifestyle choices create indirect risk factors for sexual dysfunction. For example, smoking indirectly increases risk because it increases the risk of developing heart disease, high blood pressure, etc. which are direct biologic risk factors.

Psychosocial risk factors include psychological disorders (i.e., depression, anxiety, substance use disorders, eating disorders), emotions (i.e., anxiety), maladaptive thoughts (i.e., being distracted during sex), and negative attitudes towards sex (i.e., masturbation is dirty, premarital sex is wrong, sex within marriage is solely for the purpose of procreation). Additionally, racial, ethnic, and religious background, impact what we believe and expect with regard to sex. If these expectations and beliefs are negative they may serve as a risk factor. The quality of one's relationship is also a risk factor for developing, or worsening sexual dysfunction. Finally, lack of education about normal sexual functioning is a risk factor for developing sexual dysfunction.

While each of the sexual dysfunction classes have specific symptoms, it is also important to keep in mind that all sexual dysfunctions can be: 1) lifelong (meaning the symptoms have always been present), or 2) acquired (meaning that they have just recently appeared), or 3) generalized (meaning the symptoms occur in all situations), or 4) situational (meaning that the symptoms occur in only specific situations). And, each disorder can be influenced by psychological factors, medical factors, or a combination of psychological and medical factors

As mentioned, Masters and Johnson established the three-phase Sexual Response Cycle consisting of Desire, Arousal, and Orgasm. Sexual Disorders are grouped or classified according to these three phases of the Sexual Response Cycle. Per the Diagnostic and Statistical Manual 4th Edition, Text Revision (DSM-IV-TR: APA, 2000) sexual dysfunction includes three important components: 1) a disruption in one or more of the three phases described above, 2) distress regarding the disruption, and 3) a disturbance in interpersonal relationships. When all three criteria are fulfilled, a sexual disorder may be diagnosed. There are also other disorders that do not rely on the Sexual Response Cycle classification. These are: Sexual Pain Disorders, Gender Identify Disorder, and the Paraphillias. There are two basic questions that are useful to ask oneself when considering sexual dysfunction: 1) "Is this problem or difficulty distressing to me?", and 2) "Is this problem or difficulty negatively affecting my relationships with others?" If your answer to these questions is yes, you may wish to consider the possibility of a sexual dysfunction.