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t main article erectile dysfunction erectile dysfunction ed or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis there are various underlying causes of ed including damage to anatomical structures psychological causes medical disease and drug use many of these causes are medically treatable psychogenic ed is defined as ed primarily due to psychological disease or interpersonal factors chronic psychological psychogenic erectile dysfunction ed is characterized by difficulty achieving or maintaining an erection primarily due to psychological or interpersonal factors factors such as performance anxiety relationship distress or ongoing stress can initially lead to temporary erectile difficulties if these psychological factors persist over time they may contribute to physiological changes in vascular and neural pathways potentially resulting in chronic erectile dysfunction 10 psychogenic ed is also strongly associated with depression or low mood and addressing the underlying psychological or mental health conditions is recommended for effective management 11 medical conditions are also common causes of erectile dysfunction diseases such as cardiovascular disease multiple sclerosis kidney failure vascular disease and spinal cord injury can cause erectile dysfunction 12 it is estimated that around 30 million men in the united states and 152 million men worldwide have erectile dysfunction 13 14 however social stigma low health literacy and social taboos lead to under reporting which makes an accurate prevalence rate hard to determine ed from vascular disease is seen in individuals who have atherosclerosis vascular disease is common in individuals who smoke or have diabetes peripheral vascular disease or hypertension cardiovascular disease can decrease blood flow to penile tissues making it difficult to develop or maintain an erection 15 drugs are also a cause of erectile dysfunction individuals who take drugs that lower blood pressure antipsychotics antidepressants sedatives narcotics antacids or alcohol can have problems with sexual function and loss of libido 16 hormone deficiency is a relatively rare cause of erectile dysfunction in individuals with testicular failure as in klinefelter syndrome or those who have had radiation therapy chemotherapy or childhood exposure to the mumps virus the testes may fail to produce testosterone other hormonal causes of erectile failure include brain tumors hyperthyroidism hypothyroidism or adrenal gland disorders 17 orgasm disorders edit anorgasmia edit main article anorgasmia anorgasmia is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75 of sexual encounters 18 368 the disorder can have physical psychological or pharmacological origins ssri antidepressants are a common pharmaceutical culprit as they can delay orgasm or eliminate it entirely a common physiological cause of anorgasmia is menopause one in three women report problems obtaining an orgasm during sexual stimulation following menopause 19 premature ejaculation edit main article premature ejaculation premature ejaculation is when ejaculation occurs before the partner achieves orgasm or a mutually satisfactory length of time has passed during intercourse there is no correct length of time for intercourse to last but generally premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis 20 for a diagnosis the patient must have a chronic history of premature ejaculation poor ejaculatory control and the problem must cause feelings of dissatisfaction as well as distress for the patient the partner or both 21 premature ejaculation has historically been attributed to psychological causes but newer theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation 22 post orgasmic disorders edit post orgasmic disorders cause symptoms shortly after orgasm or ejaculation post coital tristesse pct is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours sexual headaches occur in the skull and neck during sexual activity including masturbation arousal or orgasm in men post orgasmic illness syndrome pois causes severe muscle pain throughout the body and other symptoms immediately following ejaculation these symptoms last for up to a week 23 24 25 some doctors speculate that the frequency of pois in the population may be greater than has been reported in the academic literature 26 and that many with pois are undiagnosed 27 pois may involve adrenergic symptoms rapid breathing paresthesia palpitations headaches aphasia nausea itchy eyes fever muscle pain and weakness and fatigue the etiology of this condition is unknown however it is believed to be a pathology of either the immune system or autonomic nervous systems it is defined as a rare disease by the nih but the prevalence is unknown it is not thought to be psychiatric in nature but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such there is no known cure or treatment 9 dhat syndrome is another condition which occurs in men it is a culture bound syndrome which causes anxious and dysphoric mood after sex it is distinct from the low mood and concentration problems acute aphasia seen in pois sexual pain disorders edit sexual pain disorders in women include dyspareunia painful intercourse and vaginismus an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse dyspareunia may be caused by vaginal dryness poor lubrication may result from insufficient excitement and stimulation or from hormonal changes caused by menopause pregnancy or breastfeeding irritation from contraceptive creams and foams can also cause dryness as can fear and anxiety about sex it is unclear exactly what causes vaginismus but it is thought that past sexual trauma such as rape or abuse may play a role another female sexual pain disorder is vulvodynia or vulvar vestibulitis when localized to the vulval vestibule in this condition women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas its cause is unknown in men structural abnormalities of the penis like peyronie s disease can make sexual intercourse difficult and or painful the disease is characterized by thick fibrous bands in the penis that lead to excessive curvature during erection it has an incidence estimated at 1 20 of men and is most common in men aged 40 70 although cases have occurred in younger individuals and adolescents 28 29 peyronie s disease has no certain cause but the leading hypothesis is that it arises from dysregulated wound healing in response to chronic microtrauma of the erect penis risk factors include age genetics minor trauma potentially during cystoscopy or transurethral resection of the prostate chronic systemic vascular diseases diabetes smoking and alcohol consumption 28 priapism is a painful erection that occurs for several hours and occurs in the absence of sexual stimulation this condition develops when blood is trapped in the penis and is unable to drain if the condition is not promptly treated it can lead to severe scarring and permanent loss of erectile function the disorder is most common in young men and children individuals with sickle cell disease and those who use certain medications can often develop this disorder 30 causes edit there are many factors which may result in a person experiencing a sexual dysfunction these may result from emotional or physical causes emotional factors include interpersonal or psychological problems which include depression sexual fears or guilt past sexual trauma and sexual disorders 31 sexual dysfunction is especially common among people who have anxiety disorders 2 32 33 5 ordinary anxiety can cause erectile dysfunction in men without psychiatric problems but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation 34 pain during intercourse is often a comorbidity of anxiety disorders among women 35 physical factors that can lead to sexual dysfunctions include the use of drugs such as alcohol nicotine narcotics stimulants antihypertensives antihistamines and some psychotherapeutic drugs 36 for women almost any physiological change that affects the reproductive system premenstrual syndrome pregnancy and the postpartum period and menopause can have an adverse effect on libido 36 back injuries may also impact sexual activity as can problems with an enlarged prostate gland problems with blood supply or nerve damage as in sexual dysfunction after spinal cord injuries diseases such as diabetic neuropathy multiple sclerosis tumors and rarely tertiary syphilis may also impact activity as can the failure of various organ systems such as the heart and lungs endocrine disorders thyroid pituitary or adrenal gland problems hormonal deficiencies low testosterone other androgens or estrogen and some birth defects in the context of heterosexual relationships one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction this can be very distressing for the male partner causing poor body image and it can also be a major source of low desire for these men 37 in aging women it is natural for the vagina to narrow and atrophy if a woman does not participate in sexual activity regularly in particular activities involving vaginal penetration she will not be able to immediately accommodate a penis without risking pain or injury if she decides to engage in penetrative intercourse 37 this can turn into a vicious cycle that often leads to female sexual dysfunction 37 according to emily wentzell american culture has anti aging sentiments that have caused sexual dysfunction to become an illness that needs treatment instead of viewing it as a natural part of the aging process not all cultures seek treatment for example a population of men living in mexico often accept ed as a normal part of their maturing sexuality 38 with ssri medication edit sexual problems are common with ssris 39 which can cause anorgasmia erectile dysfunction diminished libido genital numbness and sexual anhedonia pleasureless orgasm 40 poor sexual function is also one of the most common reasons people stop the medication 41 in some cases symptoms of sexual dysfunction may persist after discontinuation of ssris 40 42 43 14 44 45 this combination of symptoms is sometimes referred to as post ssri sexual dysfunction 46 47 pelvic floor dysfunction edit main article pelvic floor dysfunction pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men and is treatable by pelvic floor physical therapy a type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas 48 49 50 51 52 female sexual dysfunction edit several theories have looked at female sexual dysfunction from medical to psychological perspectives three social psychological theories include the self perception theory the overjustification hypothesis and the insufficient justification hypothesis self perception theory people make attributions about their own attitudes feelings and behaviours by relying on their observations of external behaviours and the circumstances in which those behaviours occur citation needed overjustification hypothesis when an external reward is given to a person for performing an intrinsically rewarding activity the person s intrinsic interest will decrease citation needed insufficient justification based on the classic cognitive dissonance theory inconsistency between two cognitions or between a cognition and a behavior will create discomfort this theory states that people will alter one of the cognitions or behaviours to restore consistency and reduce distress citation needed the prevalence of sexual dysfunction in women is not well known due to a paucity of epidemiological studies inconsistent criteria for sexual dysfunction across different studies and incomplete recruitment with studies often excluding women who were without a partner or who were sexually inactive however based on incomplete population based studies from the united states europe and australia unspecified arousal dysfunction in which a woman is unable to achieve desirable genital or non genital sexual arousal despite adequate stimulation and desire was present in 3 9 of women aged 18 44 5 7 5 aged 45 64 and 3 6 in women older than 65 53 anorgasmia with distress in which women were unable to achieve an orgasm was present in 7 8 of women younger than 40 5 7 aged 40 64 and 3 6 of those older than 65 53 poor sexual self image leading to distress was seen in 13 4 of women younger than 40 in an australian population based study 53 the importance of how a woman perceives her behavior should not be underestimated many women perceive sex as a chore as opposed to a pleasurable experience and they tend to consider themselves sexually inadequate which in turn does not motivate them to engage in sexual activity 37 several factors influence a women s perception of her sexual life these can include race gender ethnicity educational background socioeconomic status sexual orientation financial resources culture and religion 37 cultural differences are also present in how women view menopause and its impact on health self image and sexuality a study found that african american women are the most optimistic about menopausal life caucasian women are the most anxious asian women are the most inhibited about their symptoms and hispanic women are the most stoic 37 since these women have sexual problems their sexual lives with their partners can become a burden without pleasure and may eventually lose complete interest in sexual activity some of the women found it hard to be aroused mentally while others had physical problems several factors can affect female dysfunction such as situations in which women do not trust their sex partners the environment where sex occurs being uncomfortable or an inability to concentrate on the sexual activity due to a bad mood or burdens from work other factors include physical discomfort or difficulty in achieving arousal which could be caused by aging or changes in the body s condition 54 sexual assault has been associated with excessive menstrual bleeding genital burning and painful intercourse attributable to disease injury or otherwise medically unexplained dysmenorrhea menstrual irregularity and lack of sexual pleasure citation needed physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms multiple assaults assaults accomplished by persuasion spousal assault and completed intercourse wer...
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