Sexual Dysfunction: a Widespread Problem

Return to Sexual Problems - Overview

Four of 10 women and three of 10 men experience sexual problems, according to a study in the Journal of the American Medical Association. The most common problems reported by women were low sexual desire (22 percent), problems with arousal (14 percent), and pain during intercourse (7 percent). Men most commonly reported problems with premature ejaculation (21 percent), erectile dysfunction (5 percent) and low desire (5 percent).

Other key findings include the following:

The prevalence of sexual problems in women tends to decrease with increasing age, except for those who report trouble lubricating. As men get older, however, they are more likely to experience sexual problems, such as erectile dysfunction and lack of desire for sex.
Younger women are more likely to experience sexual problems, perhaps due to lack of experience and the greater likelihood that they’re not in a stable relationship (for example single as opposed to married).
Married women and men are at lower risk for sexual problems than their non-married counterparts.
Women and men with lower educational levels report less pleasurable sexual experience and raised levels of sexual anxiety.
Emotional or stress-related problems, as well as financial difficulties, are important risk factors for sexual problems.
Past sexual trauma such as forced sexual contact or sexual assault is associated with long-term sexual problems, whether the person was the victim or aggressor.
Sexual problems are associated with unsatisfying personal experiences and relationships, lack of physical and emotional satisfaction, and low feelings of happiness.
Of course, these results don’t apply to everyone in exactly the same way, but they do create a compelling profile of sexual problems. The authors of the study conclude there is a “strong association between sexual dysfunction and impaired quality of life,” and that sexual dysfunction “warrants recognition as a public health concern.”

Sexual Problems: Why Diagnosis Is Difficult

Return to Sexual Problems - Causes

There is no set definition of what a “normal” sex life is. Individuals and couples vary widely in terms of how often they have sex and what that encounter involves. For some couples, once a week or month or even a few times a year may be perfectly normal. A sexual encounter may not always include intercourse, and each partner may not have an orgasm every time. And nearly everyone goes through periods when interest in sex or the ability to perform is hindered. This lack of a clear standard can make it difficult to diagnose whether or not someone has a “problem.”

The Merck Manual of Diagnosis and Therapy uses three phrases that can be helpful in judging whether a difficulty you’re experiencing is actually a problem with sex:

Persistent or recurrent: It isn’t an isolated or occasional event but persists a long time.
Causes personal distress: It upsets you and causes unusual anxiety.
Causes interpersonal problems: It hurts your relationship with your sexual partner.
The latter two categories are the most important. Many people may experience levels of desire or changes in function that don’t cause distress and do not impact their relationships. These changes would not then be considered a problem. However, these same changes may be very stressful for other people or couples and would be considered a sexual problem. Problems vary from person to person.

Another complicating factor is that most sexual problems cannot be traced to one specific cause. Rather, they result from a combination of the physical and the psychological. Proper sexual functioning depends on the sexual response cycle, which includes:

An initial mindset or state of desire.
The flow of blood to the genital areas (erection in men and swelling and lubrication in women) in response to arousal.
Orgasm.
Resolution, or a general sense of pleasure and well-being.
A breakdown in one of the cycle’s phases can be responsible for a sexual problem, and that breakdown can stem from a variety of causes.

Role of diabetes, smoking and other problems

According to the American Medical Association, sexual problems often result from physical conditions such as:

Diabetes
Heart disease
Neurological disorders (such as stroke, brain or spinal cord injury, or multiple sclerosis)
Pelvic surgery or trauma
Side effects of medications
Chronic disease such as kidney or liver failure
Hormonal imbalances
Alcoholism and drug abuse
Heavy smoking
The effects of aging
Psychological causes might include:

Stress or anxiety at work
Concern about performance, marital or relationship problems
Underlying mental disorders such as depression and anxiety
Previous traumatic sexual experience
These sets of causes often “play off” one another. Certain illnesses or diseases can cause people to feel anxious about their sexual performance, which, in turn, can make the problem worse.

When doctors suspect a sexual problem, they usually run a series of diagnostic tests to see if there is any physical cause such as a certain medication, hormonal imbalance, neurological problem or other illness or some other mental disorder such as depression, anxiety or trauma. If any of these causes are found, then treatment will begin. If such underlying problems are ruled out, then the nature of the relationship between the two people must be considered. A sexual problem may be “situational.” That is, the issues are specific to encounters with a certain person in a particular situation. In such cases, therapy is usually recommended for the couple.