Sexual Dysfunction

---

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), sexual dysfunctions are diagnosed when sexual symptoms:

• persist for at least 6 months,
   
• occur in most sexual encounters,
   
• cause significant distress or interpersonal difficulty, and
   
• are not better explained by another medical or relational condition.
   

Examples of sexual dysfunctions include (among men):

• Erectile Disorder
   
• Premature (Early) Ejaculation
   
• Delayed Ejaculation
   
• Male Hypoactive Sexual Desire Disorder
   

And among women:

• Female Sexual Interest/Arousal Disorder
   
• Female Orgasmic Disorder
   
• Genito‑Pelvic Pain/Penetration Disorder (which includes what was formerly called vaginismus and dyspareunia)

• Sexual Dysfunction is very common, affecting about 43% of women and 31% of men
  
   
• Specific dysfunctions: for example, among sexually‐active men, erectile dysfunction affected 6.6% and early ejaculation 4.5% in one recent study. Among women, hypoactive sexual desire was 6.9%, orgasmic dysfunction 5.8%
   
• For vaginismus (or genito‐pelvic pain/penetration disorder), prevalence estimates in general populations are 1‑6%

Recurrent inability to achieve and/or maintain an adequate erection for satisfactory sexual activity. 

Signs & Symptoms:

• Difficulty getting or keeping an erection during sexual experiences.
   
• Reduced firmness or rigidity
   
• Avoidance of sexual situations due to fear of failure

Impact on Self‑Esteem & Relationships:
 

• Can trigger shame, feelings of inadequacy, anxiety around sexual performance
   
• May lead a partner to feel rejected, unwanted, disconnected
   
• Over time, avoidance of sexual intimacy may erode relationship closeness and sexual confidence
   

Prevalence:
 

• ED affects a very wide range: an estimate for U.S. men is 30‑50 million. Globally, prevalence ranges from 3% to 76.5% depending on definition/age. 

Even though ED is highly recognized, it’s often treated medically (pills, devices) and less often from a relational or systemic lens — which means emotional and relational dimensions can be minimized.

Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration (or a clinically significant shorter latency), inability to delay ejaculation, and negative personal consequences.

Signs & Symptoms:

• Consistent or recurrent very rapid ejaculation
   
• Inability to delay ejaculation on most occasions
   
• Feelings of frustration, embarrassment, anxiety around sex
   
• Avoidance of sexual situations or partner disappointment
  Impact on Self‑Esteem & Relationships:
   
• May trigger shame or self‐blame (“I can’t satisfy her/him”)
   
• Partner may feel less satisfied or disconnected
   
• Communication about sexual rhythm and mutual pleasure may suffer
   
• PE is one of the most common male sexual dysfunctions with a 20‑30% prevalence. 

Some women experience ongoing pain, tightness, or anxiety around vaginal penetration. In the DSM‑5‑TR, this is now called Genito‑Pelvic Pain/Penetration Disorder (GPPPD). 

It’s diagnosed when symptoms:

• Make penetration difficult or impossible, whether during intercourse, inserting a tampon, or during a medical exam
   
• Cause pain or discomfort in the vulva or pelvic area
   
• Create fear or anxiety about sexual activity due to anticipated pain
   
• Involve involuntary tightening of pelvic muscles during attempts at penetration
   
• Persist for at least six months and lead to significant distress or affect your relationships
   

It’s important to know that these experiences are common and treatable, and having them does not mean anything is “wrong” with you. Therapy focuses on reducing pain, easing anxiety, and restoring sexual confidence and intimacy.

• Female Sexual Interest/Arousal Disorder (FSIAD): Lack of interest in sexual activity or arousal in women, with symptoms like reduced fantasies, desire, initiation, responsiveness or pleasure.
• Female Orgasmic Disorder (FOD): Delay, infrequency, or absence of orgasm, or markedly reduced intensity of orgasmic sensation.
• Male Hypoactive Sexual Desire Disorder (HSDD): Deficient (or absent) sexual thoughts/fantasies and/or desire for sexual activity, causing distress
• Delayed Ejaculation: Delay or absence of ejaculation in men in at least 75% of occasions, causing distress.
• Substance/Medication‑Induced Sexual Dysfunction: Sexual dysfunction due to the effects of substances or medications (e.g., antidepressants) — across genders.

Signs & Symptoms (general):

• Low or absent desire
   
• Difficulty becoming aroused even with adequate stimulation
   
• Difficulty reaching or enjoying orgasm
   
• Pain or discomfort associated with sexual activity
   
• When these symptoms persist and cause personal distress and interpersonal difficulty, a diagnosis may apply.
   

Impact on Self‑Esteem & Relationships:

• Sexual dysfunction often triggers shame, avoidance, marital or partner strain, reduced sexual satisfaction, decreased overall wellbeing
   
• One study found that among those meeting DSM‑5 criteria, reports of avoidance of sex and discomfort were significantly higher

• Many clinicians and scholars argue that the DSM‑5 definitions are male‑focused, with far more research historically on men’s dysfunctions than women’s.
   
• For example, while female sexual dysfunctions frequently relate to desire, arousal or relational factors, the DSM’s framing often leans on physiological/medical models with less emphasis on relational, cultural, systemic, or pleasure‐based frameworks.
   
• The revision in DSM‑5 (e.g., combining female desire/arousal into one disorder; merging vaginismus and dyspareunia into GPPPD) was motivated partly by the lack of clarity and research, particularly in women.
   
• Some critics say that the classifications can inadvertently disempower women by framing sexual issues in women as deficits or pathologies, rather than variations in desire, relational dynamics, cultural / sexual meaning, or normative changes over the lifespan.
   
• The prevalence estimates vary widely depending on how distress, duration, partner issues or physical causes are excluded — meaning many “sexual problems” are normal and transient, yet get pathologized.
   
• In therapy, there is value not only in medical or psychophysiological treatment but also in systemic, sex‐positive, relational, cultural lenses.

What we focus on:

• Understanding your sexual self (history, identity, pleasure, relational system)
   
• Mapping how sexual dysfunction is making sense in your life, and what beliefs or narratives  (“I’m broken”, “I’m less desirable”, “My partner expects X”) you hold onto.
   
• Creating a shift in meaning: from defect to signal. What if the dysfunction is a sign that your system (relationship, body, identity) is out of alignment
   
• Addressing self‑esteem, shame, communication and intimacy issues alongside physical/medical factors
   
• Using evidence‐informed tools (e.g., sensate focus, mindfulness, couples work, pelvic floor therapy when relevant) while remaining sex‑positive and inclusive
   
• Working with partners when appropriate to restore connection, mutual desire, and relational pleasure
   
• Reframing success not simply as “erections every time” or “orgasm on demand” but as connected sexual experience that aligns with your values, identity and relationship.