The inability to become sexually aroused or achieve sexual satisfaction in the appropriate situations because of mental or emotional (also known as psychological) reasons. No physical problems, specific illnesses or medication side effects appear to cause the problem.

Although psychosexual dysfunction is not life threatening, it can have a major effect on your relationships and self-esteem. This condition is treatable; contact your doctor if you think you may have psychosexual dysfunction.

Causes

Psychosexual dysfunction is a sexual dysfunction that is due to psychological causes rather than physical problems, medical illnesses, or the side effects of medication.

Some of the psychological conditions include:

• Depression

• Anxiety (feelings of nervousness, fear, or worry)

• Traumatic sexual experience (abuse, rape)

• Guilty feelings

• Stress or anxiety

• Uncertainty about your sexual orientation

• Worry or fear about how you are able to perform sexually

• Negative body image

Risk Factors

Reduced sexual desire or activity is very common among women and men. Often, the condition is treatable, but first it is necessary to determine whether the dysfunction is caused by physical causes (such as diabetes, heart disease, alcoholism, heavy smoking, side effects of medications (a very common cause of decreased libido or desire), or hormonal problems or psychological causes. Only sexual dysfunction due to psychological factors is called psychosexual dysfunction.

A risk factor is something that increases your chances of getting a disease or condition.

The following factors increase your chances of developing psychosexual dysfunction. If you have any of these risk factors, tell your doctor:

• Stress or anxiety from work or social situations

• Recent pregnancy (This can result from the changes in hormone levels that occur after pregnancy, from postpartum depression, or for stress and fatigue that follow pregnancy because of adjusting to a new baby)

• Depression

• Uncertainty about your sexual orientation

• Worry about how you are able to perform sexually

• Fear due to previous disturbing or painful sexual experiences or encounters

• Conflict with your spouse

• Religious, social, or cultural restrictions

• Guilt

• Financial worries

• Family problems

• Abusive relationship with partner

• Negative body image

Symptoms

Symptoms of psychosexual disorder may differ for men and women.

Symptoms for men include:

• Not able to keep an erection

• Ejaculations are premature (occur too soon)

• Ejaculations do not occur

• Not able to become aroused when appropriately stimulated

• Not able to achieve orgasm

• Inhibited sexual desire

Symptoms for women include:

• Not able to become aroused when appropriately stimulated

• Not able to achieve orgasm

• Inhibited sexual desire

• Vaginimus–an unconscious spasm (seizure) or tightening of the muscles around the vagina that interferes with sexual intercourse

• Experiencing pain during sex

• Dry vagina

If you experience any of these symptoms do not assume it is due to psychosexual dysfunction. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

Diagnosis

Your doctor will ask about your symptoms, your medical history, and your sexual history. Your doctor will also perform a physical exam. Make sure to tell your doctor about all the medications you are currently taking. Your doctor may also ask questions about your partner.

Tests may include the following:

• Blood tests to check for problems in your hormones or blood vessels (arteries and veins)

• • Your doctor will most likely test your testosterone level. Testosterone is the hormone that creates sexual desire in both men and women.

• Depression scale to measure depression

• Mini Mental State Examination (MMSE)

• • A test to gauge mental awareness and judgment (also known as cognitive functioning)

• Additional tests for men:

• • Snap Gauge–A gadget used by physicians to help distinguish if the difficulty maintaining or achieving an erection is due to a physical condition or psychological reasons. You wear the Snap-Gauge for two nights in a row to determine if you experienced erections during your sleep—most healthy men experience a several erections in their sleep each night.

• • Vascular assessment–Your doctor needs to make sure the blood flow to the penis is sufficient

• Additional tests for women:

• • Gynecologic examination to rule out any physical causes

• • • Your doctor will most likely examine your external and internal genitalia, manually and with a speculum (a medical instrument that is used to open the vagina slightly wider so that the cervix can be seen more easily).

• • • Cultures and vaginal samples may be taken to test for any underlying conditions.

If your doctor does not find anything significant from the examination or these tests, your doctor may refer you to a psychologist or psychiatrist.

To locate mental health services in your area, visit the National Institute of Mental Health’s “Locate Services” website at: http://www.nimh.nih.gov/HealthInformation/GettingHelp.cfm.

Treatment

Talk with your doctor about the best treatment plan for you. The most appropriate treatment will depend on the cause of the psychosexual dysfunction.

Some medications can alleviate the symptoms (for example, medications to alleviate erectile dysfunction or to help overcome vaginal dryness). However, to successfully manage psychosexual dysfunction, it is important to treat and manage the mental and emotional issues that underlie the problem.

Treatment options for psychosexual dysfunction include the following:

Medication

Medications may be prescribed to treat the symptoms. Medications differ for men and women.

Medication/treatments for men include:

• For erectile problems:

• • Phosphodiesterase inhibitors (Viagra [sildenafil], Cialis [vardenafil], Levitra [tadalafil])–A phosphodiesterase inhibitor enhances blood flow in the penis and makes it easier to develop and sustain an erection. The medication is provided in a pill.

• • Vasoactive agents (phentolamine or papaverine)–This type of medication is given by injection. The medications cause blood vessels in the penis to expand. This increases the blood flow to the penis and results in an erection.

• • Testosterone replacement therapy–This might be helpful for some men, though there is little supporting evidence.

• • Mechanical devices–There are a number of mechanical devices that men can use to maintain an erection. These include:

• • • Constriction devices–A binding device is placed at the base of the penis to slow the outflow of blood to produce and maintain an erection.

• • • Vacuum devices–A device that creates a suction is placed over the penis. The suction causes blood to flow to the penis to produce and maintain an erection.

• For premature ejaculation

• • Medications in the SSRI family, such as Paxil (paroxetine) have been shown effective. They may be used on a daily basis, or several hours prior to intercourse

• • Anesthetic creams may be useful

Medications for women include:

• Testosterone replacement therapy (the hormone testosterone is thought to increase sexual activity and enjoyment, though this has not been proven)

• Vaginal estrogen creams or rings.

• Lubricants–used to ease vaginal dryness

Psychotherapy

You talk and work with a psychiatrist, psychologist, social worker or licensed counselor to figure out ways to deals with stressful or painful issues.

Sex Therapy

Sex therapists assist you by encouraging communications, teaching you about sexual fantasies, and helping you focus on sexual stimuli.

Behavioral Therapy

A psychiatrist, psychologist, social worker or licensed counselor works with you to unlearn automatic behaviors.

Marriage or Relationship Counseling

Couples meet with a psychologist, social worker or other type of mental health professional to discuss issues, including communications problems.

Prevention

There are no known ways to prevent psychosexual dysfunction.

To help reduce your chances of developing psychosexual dysfunction, take the following steps:

• Stay aware of your psychological or emotional health.

• • Call your doctor or mental health provider if you feel the problems surfacing again, you are experiencing excessive stress, or you anticipate a stressful situation in the near future.

• Spend time alone with your partner often, especially nonsexual intimate time, to help maintain the relationship. This will most likely lead to increase sexual interest.

• Continue to communicate openly with your partner about intimacy and sexual issues.

RESOURCES:

American Psychological Association (APA)
http://www.apa.org

International Society for Sexual Medicine (ISSM)
http://www.issm.info

Sexual Function & Infertility
American Urological Association
http://www.impotence.org

Sexual Health Issues
National Institutes of Health, US National Library of Medicine
http://www.nlm.nih.gov

Society for Sex Therapy and Research (SSTAR)
http://www.sstarnet.org

Society for the Scientific Study of Sexuality
http://www.sexscience.org

CANADIAN RESOURCES:

Canadian Psychological Association
http://www.cpa.ca/cpasite/home.asp

Sex Information and Education Council of Canada (SIECCAN)
http://www.sieccan.org

sexualityandu.ca–Your Link to Sexual Well-being
The Society of Obstetricians and Gynaecologists of Canada
http://www.sexualityandu.ca/home_e.aspx

References:

AACE male sexual dysfunction task force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem–2003 update. Endocrine Practice; 2003; 9(1):77-94.

Crenshaw TL, Goldberg JP, Stern WC. Pharmacologic modification of psychosexual dysfunction. Journal of Sex & Marital Therapy. Winter 1987; 13(4):239-52.

Cutler SJ, Smith W, Cutler HG. Treatment of sexual dysfunction. US Pharmacist; September 2002; 23(5).

Erectile dysfunction. Beers MH and Berkow R. (ed.) The Merck Manual of Diagnosis and Therapy, Section 21, Chapter 240, Men’s Health Issues: Sexual Dysfunction. The Merck Manual website. Available at: http://www.merck.com/mmhe/sec21/ch240/ch240b.html. Accessed on October 17, 2005.

Erection problems. Medical Encyclopedia, National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm. Accessed July 11, 2005.

Female sexual dysfunction. Medical Encyclopedia, National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003151.htm. Accessed July 11, 2005.

Glass CA. Addressing psychosexual dysfunction in neurological rehabilitation settings. Journal of Mental Health. July 1995; Vol. 4 (3).

Female sexual problems. American Association for Marriage and Family Therapy website. Available at: http://www.aamft.org/families/consumer_updates/femalesexualproblems.asp. Accessed on October 17, 2005.

Inhibited sexual desire. Medical Encyclopedia, National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001952.htm. Accessed July 11, 2005.

Phillips NA. Female sexual dysfunction: Evaluation and treatment. American Family Physician, July 2000; 62(1):127-36.

Reiner WG, Gearhart JP, Jeffs R. Psychosexual dysfunction in males with genital anomalies: Late adolescence, Tanner states IV to VI, Journal of the American Academy of Child & Adolescent Psychiatry. July 1999; 38(7):865-872.

Sexual dysfunction–silence about sexual problems can hurt relationships. JAMA Patient Page, American Medical Association–JAMA & Archives website. Available at: http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSAC20NAC&sub_cat=57. Accessed July 11, 2005

Yohimbine (systemic). Medline Plus, National Library of Medicine – National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202639.html. Accessed on October 19, 2005.