Sexual dysfunction is a problem that can happen during any phase of the sexual response cycle. It prevents you from experiencing satisfaction from sexual activity.
The sexual response cycle traditionally includes excitement, plateau, orgasm and resolution. Desire and arousal are both part of the excitement phase of the sexual response. It’s important to know women don’t always go through these phases in order.
While research suggests that sexual dysfunction is common, many people don’t like talking about it. Because treatment options are available, though, you should share your concerns with your partner and healthcare provider.
Sexual dysfunction generally is classified into four categories:
Sexual dysfunction can affect any age, although it is more common in those over 40 because it’s often related to a decline in health associated with aging.
In people assigned male at birth:
In people assigned female at birth:
Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcohol use disorder and substand use disorder. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual function.
Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image and the effects of a past sexual trauma.
Some prescription medications and even over-the-counter drugs can have an impact on sexual functioning. Some medicines can affect libido (desire) and others can affect the ability to become aroused or achieve orgasm. The risk of sexual side effects is increased when an individual is taking several medications.
Some over-the-counter antihistamines and decongestants can cause erectile dysfunction or problems with ejaculation.
The following medications may cause erectile dysfunction:
The following medications may decrease sexual desire:
In most cases, you recognize something’s interfering with your enjoyment (or a partner's enjoyment) of a sexual relationship. Your provider usually begins with a complete history of symptoms and a physical. They may order diagnostic tests to rule out medical problems that may be contributing to the dysfunction. Typically lab testing plays a very limited role in the diagnosis of sexual dysfunction.
An evaluation of attitudes about sex, as well as other possible contributing factors —fear, anxiety, past sexual trauma/abuse, relationship concerns, medications, alcohol or drug abuse, etc. — helps a clinician understand the underlying cause of the problem and recommend the right treatment.
Most types of sexual dysfunction can be addressed by treating the underlying physical or psychological problems. Other treatment strategies include:
Medication: When a medication is the cause of the dysfunction, a change in the medication may help. Men and women with hormone deficiencies may benefit from hormone shots, pills or creams. For men, drugs, including sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®, Staxyn®) and avanafil (Stendra®) may help improve sexual function by increasing blood flow to the penis. For women, hormonal options such as estrogen and testosterone can be used (although these medications are not approved for this purpose). In premenopausal women, there are two medications that are approved by the FDA to treat low desire, including flibanserin (Addyi®) and bremelanotide (Vyleesi®).
Mechanical aids: Aids such as vacuum devices and penile implants may help men with erectile dysfunction (the inability to achieve or maintain an erection). A vacuum device (EROS-CTD™) is also approved for use in women, but can be expensive. Dilators may help women who experience narrowing of the vagina. Devices like vibrators can be helpful to help improve sexual enjoyment and climax.
Sex therapy: Sex therapists can people experiencing sexual problems that can’t be addressed by their primary clinician. Therapists are often good marital counselors, as well. For the couple who wants to begin enjoying their sexual relationship, it’s well worth the time and effort to work with a trained professional.
Behavioral treatments: These involve various techniques, including insights into harmful behaviors in the relationship, or techniques such as self-stimulation for treatment of problems with arousal and/or orgasm.
Psychotherapy: Therapy with a trained counselor can help you address sexual trauma from the past, feelings of anxiety, fear, guilt and poor body image. All of these factors may affect sexual function.
Education and communication: Education about sex and sexual behaviors and responses may help you overcome anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps overcome many barriers to a healthy sex life.
The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a condition that can be treated or reversed.
A note from Cleveland Clinic
Please know that mild dysfunction that's related to stress, fear or anxiety often can be successfully treated with counseling, education and improved communication between partners. To improve your sexual health, it’s important to be motivated and take an active role in your health care, in collaboration with your medical provider.
Last reviewed by a Cleveland Clinic medical professional on 10/27/2020.