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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 were most strongly related to sexual symptoms citation needed assault was occasionally associated more strongly with reproductive symptoms among women with lower income or less education possibly because of economic stress or differences in assault circumstances associations with unexplained menstrual irregularity were strongest among african american women ethnic differences in reported circumstances of assault appeared to account for these differences assault was associated with sexual indifference only among latinas 55 menopause edit the most prevalent of female sexual dysfunctions that have been linked to menopause include lack of desire and libido these are predominantly associated with hormonal physiology specifically the decline in serum estrogens causes these changes in sexual functioning androgen depletion may also play a role but current knowledge about this is less clear the hormonal changes that take place during the menopausal transition have been suggested to affect women s sexual response through several mechanisms some more conclusive than others aging in women edit whether or not aging directly affects women s sexual functioning during menopause is controversial however many studies have demonstrated that aging has a powerful impact on sexual function and dysfunction in women specifically in the areas of desire sexual interest and frequency of orgasm 3 37 56 the primary predictor of sexual response throughout menopause is prior sexual functioning 3 which means that it is important to understand how the physiological changes in men and women can affect sexual desire 37 despite the apparent negative impact that menopause can have on sexuality and sexual functioning sexual confidence and well being can improve with age and menopausal status 3 testosterone along with its metabolite dihydrotestosterone is important to normal sexual function in men and women dihydrotestosterone is the most prevalent androgen in both men and women 37 testosterone levels in women at age 60 are on average about half of what they were before the women were 40 although this decline is gradual for most women those who have undergone bilateral oophorectomy experience a sudden drop in testosterone levels as the ovaries produce 40 of the body s circulating testosterone 37 sexual desire has been related to three separate components drive beliefs and values and motivation 37 particularly in postmenopausal women drive fades and is no longer the initial step in a woman s sexual response 37 diagnosis edit list of disorders edit this section does not cite any sources please help improve this section by adding citations to reliable sources unsourced material may be challenged and removed may 2021 learn how and when to remove this message dsm edit the fourth edition of the diagnostic and statistical manual of mental disorders lists the following sexual dysfunctions hypoactive sexual desire disorder see also asexuality which is not classified as a disorder sexual aversion disorder avoidance of or lack of desire for sexual intercourse 57 58 female sexual arousal disorder failure of normal lubricating arousal response 59 male erectile disorder female orgasmic disorder see anorgasmia 60 male orgasmic disorder see anorgasmia 61 premature ejaculation dyspareunia vaginismus additional dsm sexual disorders that are not sexual dysfunctions include paraphilias ptsd due to genital mutilation or childhood sexual abuse other sexual problems edit sexual dissatisfaction non specific lack of sexual desire anorgasmia impotence sexually transmitted infections delay or absence of ejaculation despite adequate stimulation inability to control timing of ejaculation inability to relax vaginal muscles enough to allow intercourse inadequate vaginal lubrication preceding and during intercourse burning pain on the vulva or in the vagina with contact to those areas unhappiness or confusion related to sexual orientation transsexual and transgender people may have sexual problems before or after surgery persistent sexual arousal syndrome sexual addiction hypersexuality all forms of female genital cutting post orgasmic diseases such as dhat syndrome pct pois and sexual headaches hard flaccid syndrome 62 treatment edit males edit several decades ago the medical community believed most sexual dysfunction cases were related to psychological issues although this may be true for a portion of men the vast majority of cases have now been identified to have a physical cause or a correlation 63 if the sexual dysfunction is deemed to have a psychological component or cause psychotherapy can help situational anxiety arises from an earlier bad incident or lack of experience and often leads to development of fear towards sexual activity and avoidance which enters a cycle of increased anxiety and desensitization of the penis in some cases erectile dysfunction may be due to marital disharmony marriage counseling sessions are recommended in this situation lifestyle changes such as discontinuing tobacco smoking or substance use can also treat some types of ed 64 several oral medications like viagra cialis and levitra have become available to alleviate ed and have become first line therapy these medications provide an easy safe and effective treatment solution for approximately 60 of men in the rest the medications may not work because of wrong diagnosis or chronic history citation needed another type of medication that is effective in roughly 85 of men is called intracavernous pharmacotherapy which involves injecting a vasodilator drug directly into the penis to stimulate an erection 65 this method has an increased risk of priapism if used in conjunction with other treatments and localized pain 21 premature ejaculations are treated by behaviour...