Sexual Dysfunctions
Sexual dysfunctions are a varied group of conditions affecting desire, arousal, erection, orgasm, ejaculation, pleasure or pain and penetration in a clinically significant way.
A change in sexual function is not automatically a disorder
Assessment considers personal distress, duration, frequency, desired and adequate stimulation, age, anatomy, health, medicines, relationship safety, culture and the person’s preferences. A difference in desire between partners or low interest without personal distress is not enough for diagnosis.
Some diagnostic names are gendered, but care should be inclusive. When anatomy is relevant, assessment is based on current anatomy and the person’s experience rather than assumptions about sex assigned at birth, identity or sexual orientation.
Integrated assessment
- The clinician clarifies which sexual function is affected, whether the difficulty was lifelong or acquired, and whether it is generalised or situation-specific.
- Most specific disorders require symptoms for about six months and clinically significant personal distress; partner dissatisfaction alone is insufficient.
- Desired stimulation, knowledge, communication, coercion, relationship safety, mental health, substances and medicine effects are explored sensitively.
- Medical assessment may examine cardiovascular, endocrine, neurological, gynaecological, urological and pelvic factors according to the symptom.
Treatment options
Education about sexual response, communication and realistic expectations can reduce shame and performance anxiety. Sex therapy, CBT or couples therapy may help with avoidance and intimacy when the relationship is safe and both people consent to the work.
Pelvic-floor physiotherapy, gradual pain-focused approaches or medical treatment for erectile, hormonal, gynaecological, urological or neurological factors are selected individually. Medicines are reviewed with the prescriber; prescribed treatment should not be stopped abruptly and unregulated products can be unsafe.
When to seek help
Seek assessment when a difficulty persists, causes personal distress, pain or avoidance, begins suddenly or follows a medicine change, illness, surgery or childbirth. New erectile difficulty also deserves medical review because it can be associated with cardiovascular or metabolic factors.