Sexual Dysfunction

Diseases and conditions that affect sexual health are typically diagnosed by a primary care physician. Sexual dysfunction is most often diagnosed from a patient’s symptom report, though a medical history, physical exam, and blood test may be conducted in order to confirm the diagnosis and rule out other causes.

Sexual dysfunction in women is grouped into different disorders: problems with desire, arousal problems, sexual pain, and orgasm difficulty. Changes in hormone levels, medical conditions, and other factors can contribute to low libido and other forms of sexual dysfunction in women.

Specifically, sexual dysfunction in women may be due to:

• Low libido. Fatigue, depression, and anxiety can lead to low libido, as can certain medications, including some antidepressants. Lack of sexual desire can also be caused by lower levels of the hormone estrogen.
• Vaginal dryness. Vaginal dryness can result from hormonal changes that occur during and after menopause or while breastfeeding and can lead to low libido as well as problems with arousal and desire, as sex can be uncomfortable or even painful when the vagina isn’t lubricated enough. Psychological issues, like anxiety about sex, can also cause vaginal dryness.
• Difficulty achieving orgasm. Orgasm disorders, such as delayed orgasms or the inability to have one at all, can affect both men and women. Some antidepressant medications are known to have this effect, talk to your doctor if you think your medication may be interfering with your sex life.
• Pain during sex. Pain is sometimes from a known cause, such as vaginal dryness or problems with the ovaries, but sometimes the cause of painful sex is elusive. Known as vulvodynia or vulvar vestibulitis, experts don’t know what’s behind this mysterious type of chronic, painful intercourse.

The types of sexual dysfunction men may experience include:

• Erectile dysfunction (ED). ED can be caused by medical conditions, like diabetes or heart disease, or by anxiety about having sex. Depression, chronic stress, and fatigue can also contribute to erectile dysfunction.
• Ejaculation problems. Premature ejaculation—ejaculation that occurs too early during intercourse—and the inability to ejaculate at all are the primary ejaculation problems. Causes include anxiety about sex, medications, like some antidepressants, a history of sexual or relationship trauma.
• Low libido. Psychological issues like chronic stress and depression, as well as anxiety about having sex can lead to decreased or no sexual desire. As well, decreased hormone levels—particularly if testosterone is low—physical illnesses, and medication side effects may also play a role in low libido in men.

Depending on the results of your examination, your doctor may order further testing or send you to an infectious disease specialist who is knowledgeable about sexually transmitted diseases or an endocrinologist who works with hormonal issues.