Sexual disorders are conditions that prevent people from having rich and fulfilling sexual relationships. These disorders involve problems related to sexual functioning, desire or performance.
There are three major categories of sexual disorders:
- Sexual dysfunctions. Persistent or recurrent problems that occur during sexual response. These include low sexual desire disorders, sexual arousal disorders, orgasmic disorders, sexual pain disorders, and secondary and other sexual dysfunctions.
- Paraphilias. A class of sexual disorder that involves behavior most people find distasteful, unusual or abnormal. They produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning. Some of these disorders can also be criminal acts. The most prominent examples are pedophilia, exhibitionism, voyeurism and frotteurism.
- Gender identity disorders. Involve feelings of strong identification with the gender opposite to that of the person. There is some controversy in the psychological community whether gender identity issues should still be regarded as sexual disorders.
Emotional, psychological and physical factors can all contribute to the development of sexual disorders. Symptoms associated with some sexual disorders include lack of interest in or desire for sex, difficulty becoming aroused and pain during intercourse.
Temporary sexual dysfunctions may not require consultation with a physician. However, when a patient is bothered by a sexual disorder, when sex causes pain or when significant distress or impairment in psychosocial functioning persists, consulting a physician may be helpful. During diagnosis, the patient may undergo a complete physical examination. The patient’s medical history and results of psychological testing may provide important clues to the nature of the disorder that is present.
Treatment options vary depending on the nature of the suspected sexual disorder. In some cases, a physical problem can be treated with medical procedures. Medications and psychotherapy can also be beneficial for some patients. Sexual disorders can sometimes be prevented from occurring in the first place. Parents who communicate openly and honestly with children about sexual issues may help prevent them from developing anxiety and guilt that may later lead to sexual disorders. Open communication between sexual partners is also helpful. People who have experienced abuse or other sexual violence may develop a sexual disorder as a result of their trauma. Such people are urged to seek counseling, which may help them come to terms with their experience and therefore reduce the risk of developing a disorder.
About sexual disorders
Sexual disorders involve any problems related to sexual functioning, desire or performance. A person with one of these conditions may have physical or emotional difficulty enjoying sexual activity, or may have sexual feelings that most people do not consider to be conventional.
In some cases, sexual disorders begin very early in a person’s life, whereas other people may develop these conditions later in life after enjoying many years of healthy sexual activity. These disorders appear in a variety of forms.
Some sexual disorders occur suddenly, whereas others develop slowly over time. Patients may experience a partial inability to perform part of a sex act, or may be completely disinterested in any type of sexual activity. The disorder itself may be related to a physical problem, a psychological condition or a combination of both.
Sexual disorders can be divided into three categories: sexual dysfunctions, paraphilias and gender identity disorders.
Sexual dysfunctions are persistent or recurrent problems that occur during the various stages of sexual response. These stages are described as appetitive (desires and fantasies about sexual activities), excitement (feelings of pleasure and physiological change), orgasm (release of sexual tension at the height of sexual excitement) and resolution (general relaxation and a sense of well-being).
Sexual dysfunctions include:
- Low sexual desire disorders. Patients may have an extremely low desire for sex. Low sexual desire disorder occurs when patients are not generally interested in sex, but may perform adequately after sexual activity has begun. Sexual aversion disorder is marked by a feeling of disgust toward the notion of sexual activity.
- Sexual arousal disorders. Patients are interested in sex, but not enough to complete a sex act. In female sexual arousal disorder, a woman may not achieve adequate levels of lubrication to permit vaginal sex. In male erectile disorder, the penis may not achieve an erection sufficient to begin or complete sex.
- Orgasmic disorders. Patients are partially or completely unable to experience sexual climax. This may occur despite adequate sexual interest and arousal. Female orgasmic disorder occurs when a woman experiences either a delayed or nonexistent climax, whereas male orgasmic disorder involves the same criteria for males. In addition, males may experience premature ejaculation, which involves repeated climaxes before, during or shortly after penetration.
- Sexual pain disorders. These disorders involve pain during the sex act. In dyspareunia, either a woman or man feels genital pain at some point during intercourse, particularly during insertion. Vaginismus is a severe spasm of the vagina that prevents penetration.
- Secondary and other sexual dysfunctions. Sexual dysfunction due to a general medical condition (involving anatomical or other physical problems) and substance-induced sexual dysfunction (caused by intoxication or withdrawal from alcohol or drugs) may feature symptoms listed in the disorders above. Sexual dysfunction not otherwise specified is used when the sexual disturbances do not meet criteria for any specific sexual dysfunction. A lack of sexual interest may be caused by another mental disorder, such as somatotization disorder, depression or schizophrenia.
Paraphilias are a class of sexual disorder that involves behaviors most people find distasteful, unusual or abnormal, and that are associated with clinically significant distress or disability. The word paraphilia means “abnormal or unnatural attraction.” Patients with paraphilias have sexual desires that relate to objects or animals (other than humans), humiliation or suffering of oneself or one’s partner, or nonconsenting partners. Desires or fantasies usually are not usually sufficient to diagnose a paraphilia; more commonly, the patient must actually act on these desires before a diagnosis is made. Paraphilias usually begin in adolescence and affect males almost exclusively. Many types of paraphilias – such as pedophilia, exhibitionism and voyeurism – involve acts that are against the law in many societies.
Four types of paraphilias occur more commonly than the rest. These disorders may be identified through crimes perpetrated against another person.
They include the following (in descending order of frequency):
- Pedophilia. Urges involving sexual activities with children.
- Exhibitionism. Involves a compelling urge to display one’s genitals to people who do not expect it.
- Voyeurism. Sexual urges related to watching an unsuspecting person disrobe or engage in sexual activity.
- Frotteurism. Compelling urge to rub one’s genitals against a person who has not consented to such an action.
Other paraphilias occur much less commonly than those listed above. These include:
- Fetishism. Sexual urges related to the use of inanimate objects.
- Sexual masochism. Sexual satisfaction from being bound, humiliated or injured.
- Sexual sadism. Sexual satisfaction from inflicting suffering or humiliation on someone else.
- Transvestic fetishism. Sexual urges on the part of a heterosexual man that are related to the act of cross-dressing.
- Paraphilia not otherwise specified. There are many paraphilias that are either so rare or unstudied that they have not received official classifications to date. These include sexual urges involving specific parts of the human anatomy (partialism), corpses (necrophilia), animals (zoophilia), feces (coprophilia), urine (urophilia), enemas (klismaphilia) or making obscene phone calls (telephone scatalogia).
Gender identity disorders involve feelings of strong identification with the opposite gender. These disorders are not related to sexual preference. Patients feel uncomfortable with their own gender roles and some patients detest their genitals. In many cases, these patients begin wearing clothing associated with the opposite sex. Some patients request hormone therapy that helps them develop sexual characteristics of the opposite gender (e.g., breasts), whereas others undergo sex-change operations. Intersex conditions (such as hermaphroditism, in which a person has genitalia and secondary sexual characteristics of both genders) and people with ambiguous sexual assignment may be classified in the category general identity disorder not otherwise specified.
Whether gender identity disorders will remain categorized as sexual disorders is uncertain. There is significant controversy over whether transgendered or intersexed persons should be considered to have a mental health disorder. The concept that heterosexuality is the only normal form of sexual expression has been and will continue to be questioned by both professionals and lay-persons. However, at this time a person who requests hormonal treatment or a sex-change operation requires evaluation by a mental health professional and a diagnosis of a gender identity disorder. Finally, sexual problems that do not meet the criteria for the other categories may be classified as sexual disorder not otherwise specified.
Potential causes of sexual disorders
A variety of factors can contribute to the development of sexual disorders. Psychological factors that can cause sexual disorders include mental illnesses such as depression, past episodes of sexual abuse or other sexual trauma, and fears or guilt related to sexual issues.
There are many physical factors that can contribute to a person’s sexual problems. They include:
- Birth defects.
- Blood-supply problems.
- Conditions and diseases. Examples include diabetic neuropathy (nerve damage resulting from high levels of blood sugar), multiple sclerosis (autoimmune disorder that affects the central nervous system), tumors (abnormal growth of tissue) and tertiary syphilis (a late-phase form of the sexually transmitted disease). Research also indicates that conditions such as high blood pressure may be linked to sexual dysfunction in some cases.
- Drugs. These may include alcohol, nicotine, narcotics, stimulants, antihypertensives (high blood pressure medications), antihistamines (allergy medications) and psychotherapeutic medications.
- Endocrine disorders. These may include problems with the thyroid, pituitary or adrenal glands.
- Enlarged prostate gland.
- Failure of various organ systems. These may include problems with the heart and lungs.
- Hormonal deficiencies. Including low leves of testosterone, estrogen or androgens.
- Injuries to the back.
- Nerve damage. Examples include spinal cord injuries.
People who abuse drugs and alcohol are at higher risk for developing sexual dysfunctions, as are people who have diabetes and degenerative neurological disorders, persistent psychological problems or difficulty with relationships. Age may also be a factor as people in their late-20s and 30s are especially likely to experience these problems and incidence levels rise again in seniors.
Signs and symptoms of sexual disorders
Symptoms associated with sexual disorders that may be experienced by either gender include:
- Lack of interest in or desire for sex
- Difficulty becoming aroused
- Pain during intercourse
Symptoms that may affect women include:
- Difficulty relaxing vaginal muscles enough for intercourse
- Lack of adequate vaginal lubrication prior to and during intercourse
- Inability to have an orgasm
- Burning pain on the vulva or in the vagina during sexual contact
Symptoms that may affect men include:
- Difficulty or inability to attain or maintain an erection
- Delay or absence of ejaculation even after adequate stimulation
- Inability to control the timing of an ejaculation
Some types of sexual disorders may lead to infertility. Patients may also experience depression or may find that relationships with significant others deteriorate due to the disorder.
Diagnosis and treatment of sexual disorders
Patients who complain of symptoms related to a sexual disorder will undergo a complete physical examination. The physician will also compile a thorough medical history of the patient. A psychiatric evaluation that focuses on any fears, anxieties or preferences may also be necessary. Psychological testing may also be performed.
Treatment options vary depending on the nature of the sexual disorder that is suspected. In some cases, a physical problem can be treated through surgery or another medical procedure. Patients whose sexual disorder is the result of illness or disability may find relief through physical therapy or mechanical aids that can be used during sex.
Medications may also be helpful in some instances. Sildenafil became the first oral medication for erectile dysfunction and has been widely touted as a treatment for men who have difficulty maintaining an erection. Since then, other medicationshave been approved, providing more options for oral therapy. Among oral medications, lubricating gels, hormone creams and hormone replacement therapy have all been used to help treat inadequate vaginal lubrication.
Psychotherapy may also be beneficial for some patients, especially if the source of their symptoms is believed to be psychological in nature. Behavior therapy techniques can help patients who have problems becoming aroused or achieving orgasm. Individual counseling sessions can help patients address feelings of guilt or shame associated with sex, or other psychological problems, such as poor body image.
Couples can attend joint counseling sessions to improve communication problems that may be at the root of sexual disorders.
Treatment approaches for paraphilias include behavior therapy techniques and medication therapy. In some cases, a class of drugs called antiandrogens that drastically lowers the sex drive in males and reduces the frequency of paraphiliac urges may be prescribed. Serotonergic antidepressants may be prescribed for treatment of paraphilias with sexual impulsivity. Patients taking these medications should also receive treatment that includes a specialized sex offender program, group therapy, a 12-step “sexual addiction/compulsion” recovery program or a therapist familiar with paraphilias.
Prevention methods for sexual disorders
Prevention of sexual disorders can begin relatively early in a person’s life. Parents who openly communicate with their children about sexual issues and body image may prevent them from developing feelings of anxiety and guilt that can later lead to sexual disorders. Open communication is also a key to preventing sexual disorders from developing in adults. Sexual partners are urged to openly and honestly communicate their feelings and desires to one another.
People who do not abuse drugs and alcohol lower their risk of developing sexual disorders. Avoiding certain medications can also reduce or eliminate symptoms related to sexual disorders. Patients should consult their physician about which drugs to avoid, and which alternative medicines may be available. Patients should not stop taking drugs without first consulting their physician. Finally, victims of rape, sexual abuse or other sexual trauma are urged to seek psychiatric counseling to help address and treat the psychological consequences of surviving violent acts.
Questions for your doctor on sexual disorders
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to sexual disorders:
- My sex life is not satisfying, but how do I know if the problem is related to a sexual disorder?
- My sexual preferences feel normal to me. Why do you think I have a disorder?
- What type of methods will you use to diagnose my suspected sexual disorder?
- Do you suspect that my disorder is primarily physical or primarily emotional?
- What is the likely cause of my sexual disorder?
- Will I have to take medication for my sexual disorder?
- Do you recommend psychotherapy for my sexual disorder?
- What are my other treatment options?
- Given the nature of my disorder, what is my prognosis?
- Are there ways to prevent sexual disorders from developing in the first place?