What is a
Sexual Problem?

Literate Systems

What is a Sexual Problem?

Let’s start with what is “normal” sexual function. This encompasses…

A satisfactory experience of…

Desire, both appetitive (spontaneous, innate) and cognitive (by choice)

Arousal
subjective excitement
genital arousal (erection or vaginal lubrication/swelling)

Orgasm

Ejaculation (this is not exclusively a male experience)

Physical and emotional pleasure

A sense of well-being, both personal and within the context of any relationship

An absence of physical and psychological pain, or interpersonal difficulty

The processes of “desire + arousal + orgasm/ejaculation” are sometimes described as the “sexual response cycle”. They do not always occur in the sequence shown in this very simple model; there are more complex models of the response cycle that may be better in helping us to understand some sexual concerns.

Sexual problems may be divided into “sexual concerns”, which cause bother to the affected individual and, perhaps, their partner, and “sexual dysfunctions”, which are clearly-defined complexes of symptoms that meet certain very specific diagnostic criteria.

Sexual concerns are common and can usually be resolved through education, counselling and simple behavioural change. They are not “medical” problems, although a Sexual Physician can help alleviate concerns by providing a thorough assessment and any necessary education, counselling and behavioural advice.

These are a normal part of the human experience

They usually stem from poor past experience, lack of knowledge and false beliefs

They may be resolved by positive sexual experience, education and behavioural advice

Sexual concerns are NOT dysfunctions or disorders

Unwarranted “medicalisation” of sexual concerns should be avoided

Unwarranted “medicalisation” may damage patient and public confidence in the care of “true” dysfunctions

Sexual dysfunctions are less common and are more often a medical issue, at least in part; the most widely used definitions are those found in the Diagnostic and Statistical Manual of the American Psychiatric Association, Version IV (Text Revised). The full definitions are found on our "Definitions" page.  The main categories are as follows:

Sexual Desire Disorders

Hypoactive sexual desire disorder

Sexual aversion disorder

Sexual Arousal Disorders

Erectile dysfunction

Inadequate vaginal lubrication/swelling/excitement (genital, subjective and mixed arousal disorders are recognised)

Orgasmic Disorders

Premature/rapid ejaculation

Delayed or absent orgasm

Sexual Pain Disorders (dyspareunia and Vaginismus may be components of the same sexual pain disorder)

Dyspareunia

Vaginismus

These definitions have evolved from “expert panel” discussion and consensus within the American Psychiatric Association over decades. They are not a recent invention. To be defined as a “dysfunction” these disorders must also cause marked distress or interpersonal difficulty, and not be exclusively due to a general medical condition.

A more-recently identified sexual dysfunction, Persistent Genital Arousal Disorder (PGSD, PSAD, PSAS) has been described in professional literature after the publication of DSM-IV(TR). It is likely to be included in the new DSM-V definitions, due for publication in 2010.

Finally, it is important to remember that these problems may co-exist.

Problems with one phase of the sexual response cycle often cause problems in other phases, leading to multiple or mixed dysfunctions

Anorgasmia + Low Desire + Poor Arousal + Sexual Pain

Low Desire + Poor Arousal + Anorgasmia +/- Sexual Pain

Poor Arousal + Sexual Pain +/- Anorgasmia + Low Desire

Some degree of anxiety or aversion often accompanies sexual dysfunctions

May have a predominantly involuntary psychosomatic basis
Accompanied by symptoms and signs of anxiety and sympathetic arousal

May have a predominantly cognitive, voluntary motivation
Sexual intimacy is perceived as frustrating or leading to an increase in feelings of sexual inadequacy
Avoidance behaviours may impede resolution of sexual dysfunction
 

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