Sexual Dysfunctions

Thomas Wise, M.D., Chester W. Schmidt, Jr., M.D.


  • Sexuality can be understood from multiple perspectives.[1] Procreation, interpersonal intimacy, and personal pleasure may all be involved in a sexual experience. Sexual dysfunctions reviewed in this chapter are disruptions in the three elements of the sexual response cycle of drive, arousal, and release. (Figure 1)
    • Difficulties in sexual ability can be categorically classified (using a disease perspective) as disorders in the DSM-5 if they satisfy the specific criteria.
    • One’s sexual experience is also part of his or her life story.
      • For example, sexual trauma such as early sexual abuse or a rape during young adulthood will often modify subsequent sexual enjoyment and function.
    • Sexual drive is a dimensional phenomenon which may differ between the patient and his or her sexual partner. It is this difference in drives that can cause problems. Differences in personality may also create problems in the sexual relationship.
    • Finally, sexuality is a motivated behavior, in that libido is a tension state that moves along a sexual response cycle of drive, arousal and orgasm to release this tension (Table Sexual Response Cycle). Sexual dysfunctions reviewed in this module are disruptions in the sexual response cycle of drive, arousal and release.
  • The physiological underpinnings of sexual drive and response include the central and peripheral nervous system and the endocrine system, with significant input from the androgenic hormones and the vascular system.
    • Both aging and disease states (including treatments) may foster dysfunctions.
    • Emotional factors also determine libidinal motivation as well as function.
    • Thus, the clinician must consider the medical model, life story, personality issues of both the subject and the partner, and the actual behaviors inherent in sexual functioning.
Sexual Response Cycle






Libidinal urge





Libidinal urge

Vaginal lubrication

and swelling

Sense of release

Vaginal contractions

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Last updated: September 3, 2017