- What’s sexuality?
- What are sexual dysfunctions?
- DSM-5 diagnoses
- Disorder overviews
- Paraphilias
- Sex addiction
- Gender dysphoria
- Recap
Sexual disorders, dysfunctions, and paraphilias (atypical sexual interests) can impact your everyday functioning and enjoyment of sex.
As we grow up, we learn about our sexual interests and what we like or don’t like. Sometimes, we also face roadblocks that make sex and sexuality more challenging.
If you’re experiencing ongoing issues with sexual pleasure or sexual response that are causing you significant distress, you may have sexual dysfunction.
About 43% of women and 31% of men say they experience sexual dysfunction. A large multinational study from 2017 estimated the prevalence of erectile dysfunction in young men to be as high as 30%.
This 2018 article states that “nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth.”
Paraphilias are sexual interests and behaviors that involve objects, activities, or situations that aren’t typical. They are persistent and recurrent.
What is sexuality?
Sexuality refers to your inherent capacity to experience pleasure from sexual activity, including but not limited to sexual intercourse. Sexuality is fluid — there’s no right or wrong way to experience it, as long as you don’t impose on someone else’s sexual experiences or interests.
Your sexuality is a fundamental part of who you are and influences your thoughts, feelings, and behaviors. The ability to accept and enjoy your sexuality positively affects your physical and mental health.
Sexual dysfunctions
Sexual dysfunction is when you’re facing significant challenges related to your ability to experience pleasure or respond sexually.
If you’re having difficulty with sexual activity, getting aroused, or experiencing pleasure during sexual activity, you might be experiencing sexual dysfunction.
It’s important to note that not everyone who is experiencing changes in their sexual thoughts or behavior has sexual dysfunction. Your sexual feelings and behaviors may change as you age or your circumstances change.
Also, keep in mind that what’s normal to you in terms of sexual activity might be different from what’s normal for someone else. This applies to different sexual preferences and frequency of sexual activity.
4 Main categories
There are four main categories of sexual dysfunction:
- Desire disorders: characterized by low sexual interest or desire
- Arousal disorders: focused on the physical inability to become sexually aroused
- Orgasm disorders: characterized by a delay or absence of orgasms
- Pain disorders: marked by physical discomfort and pain during sexual activity
Sexual disorders that only affect males
There are other sexual disorders exclusive to males:
- premature or early ejaculation
- erectile disorder
- male hypoactive sexual desire disorder
Sexual disorders that only affect females
These sexual disorders occur only in females:
- female orgasmic disorder
- female sexual interest/arousal disorder
- genito-pelvic pain/penetration disorder
Other conditions that overlap
Other conditions sometimes overlap with sexual dysfunctions:
- exhibitionistic disorder
- fetishistic disorder
- frotteuristic disorder
- sexual masochism and sadism
- transvestic disorder
- voyeuristic disorder
Suggested read: Fetishistic disorder symptoms
What are the DSM-5 diagnostic criteria?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a handbook that the American Psychiatric Association publishes with guidelines on diagnosing and treating sexual disorders and many other mental health conditions.
Compared with previous versions of the manual, the DSM-5 has expanded on the number of conditions that they define as sexual dysfunctions. The updated text includes more information on gender dysphoria and paraphilic disorders.
The new manual also groups female disorders involving desire and arousal into a new disorder called “female sexual interest/arousal disorder.”
Before a healthcare professional makes an official diagnosis of sexual dysfunction, they will look at your physical and mental health history. They will also ask you questions about your sex life.
For the healthcare professional to make a diagnosis, the problem had to persist for a minimum of 6 months and occur 75% to 100% of the time.
A doctor may look for the following symptoms that could suggest a sexual dysfunction:
- difficulty getting aroused
- lack of interest in having sex
- pain during intercourse
You must be experiencing significant distress about these issues for the condition to be considered a sexual dysfunction.
It’s important to note that some people are not distressed about not being interested in having sex. These people would not receive a sexual dysfunction diagnosis.
For example, someone who is asexual does not experience much sexual attraction or experiences none at all. This is normal and just as valid as any other shade of sexuality.
Descriptions of each sexual disorder
Below are brief descriptions of the different types of sexual dysfunctions that may help you recognize them.
Delayed ejaculation
Delayed ejaculation occurs when people with a penis have trouble reaching ejaculation or take a longer time than they would like to ejaculate.
There are physical and psychological factors that may cause delayed ejaculation, such as a medical condition or fear of intimacy.
Talking with a doctor will help you determine the cause of this condition and whether medication might help. These might include drugs that treat physical issues, such as Viagra, or antidepressants for psychological issues.
Erectile disorder
Erectile disorder is also known as erectile dysfunction. You might have this condition if you have trouble maintaining an erection throughout sexual intercourse.
Erectile disorder is common in people with a penis as they get older. About 30 million people who identify as men in the United States experience it.
The good news is you can reduce your chances of erectile disorder by taking steps to maintain your health.
Consider eating healthier meals, limiting your alcohol intake, and exercising regularly. Your doctor can also prescribe medication to increase blood flow in your genitals and increase sexual stimulation.
Female orgasmic disorder
Female orgasmic disorder happens when people with a vulva have difficulty reaching orgasm. There may be biological or psychological factors influencing this, or both.
If you experience female orgasmic disorder, a healthcare professional may help you treat the condition with a combination of cognitive behavioral therapy (CBT) and physical therapy.
Female sexual interest/arousal disorder
The DSM-5 now considers hypoactive sexual interest and female sexual arousal disorder to be the same condition, called female sexual interest/arousal disorder.
This condition involves a low level of — or a lack of — sexual excitement or pleasure. People also have trouble feeling physically aroused during sex.
Genito-pelvic pain/penetration disorder
This occurs when people with a vagina feel pain during vaginal intercourse. You might have this disorder if you experience one of the following symptoms:
- pelvic pain during intercourse
- pain during penetration
- recurring fear or anxiety of possible pain during sex
- pelvic muscles that tend to become tense during penetration
Male hypoactive sexual desire disorder
A diagnosis of this disorder means you have little to no interest in thinking about or having sex.
The lack of sexual desire needs to persist for 6 months and cause you significant distress.
Premature or early ejaculation
Premature or early ejaculation is a disorder where a person with a penis orgasms and releases semen much sooner than they expect or want during sex. About 1 in 3 people who are biologically male from ages 18 to 59 experience this issue, according to experts.
The condition often has a psychological cause, but at times, it can also be biological.
Substance/medication-induced sexual dysfunction
If you’re on medication and having problems with having sex, you may be experiencing substance/medication-induced sexual dysfunction.
Research reports that using some drugs regularly, such as MDMA, can cause delayed orgasms and erectile dysfunction.
Heavy alcohol use can reduce sexual arousal in females and suppress testosterone in males, making it hard to maintain an erection.
Prescribed medications can also produce sexual dysfunction. These can include antidepressants and blood pressure medication.
Suggested read: The fundamentals of sex
Paraphilias
Paraphilias are conditions involving a persistent sexual interest in inanimate objects or activities that are atypical. Updated guidelines from the DSM-5 give paraphilias their own category.
They also make the distinction between paraphilias and paraphilic disorders.
If you have a paraphilic disorder, you not only have a recurring sexual interest but your interest or behavior causes severe distress.
The DSM-5 says people who exhibit symptoms of paraphilia involving a nonconsenting person, such as pedophilia, have symptoms of a paraphilic disorder when they act on their urges.
Pedophilic disorder
Pedophilic disorder is a condition where you feel a persistent sexual attraction toward a minor.
The DSM-5 updated the diagnosis of pedophilia to distinguish it from pedophilic disorder. Pedophilic disorder involves recurring sexual thoughts and urges toward a child that impairs your ability to function. Some people with symptoms of pedophilic disorder may act out their urges, such as by watching child pornography.
Exhibitionistic disorder
Exhibitionistic disorder is a sexual disorder where you get sexually aroused by exposing your genitals or acting out sexual acts for a stranger to see.
Voyeuristic disorder
Voyeuristic disorder is the chronic urge to observe a person naked, undressing, or engaging in sexual activity without their consent.
Sexual sadism disorder
Sexual sadism disorder is when you enjoy sexual activities involving the extreme pain, suffering, or humiliation of another person.
Sexual masochism disorder
This is when you receive sexual pleasure from experiencing extreme pain or suffering.
Frotteuristic disorder
Frotteuristic disorder is when you get sexual pleasure from rubbing your genitals on an unsuspecting person without their consent.
Fetishism
Fetishism is a condition where your sexual fantasies or activities depend on using inanimate objects, such as shoes, or nonsexual body parts, such as feet or hair.
It becomes a disorder when people feel extreme distress over it or the behavior starts to impair their everyday life.
What is sex addiction?
If you find yourself preoccupied with sexual urges or thoughts, and it’s impacting your relationships and your ability to function, it might be a sign of something more serious.
There is no formal diagnosis of sex addiction in the DSM-5. However, many experts call this condition compulsive sexual behavior disorder or hypersexuality.
Having an honest conversation with a healthcare professional can help if you’re experiencing challenging sexual thoughts or behavior.
Suggested read: Symptoms of sex addiction: Why it's more than a high sex drive
What is gender dysphoria?
Gender dysphoria is a feeling of distress you experience when your sex assigned at birth does not match your gender identity. Not every person who is transgender or gender diverse will experience gender dysphoria.
Recap
Sex can be a difficult topic to talk about, but research has shown that embracing your sexuality can help your mental health.
If you have recurring problems with sex, consider going to a doctor for a checkup. Your doctor is there to help you find the source of your distress, and they can provide medical treatment or refer you to a mental health specialist if needed.
Getting treatment could help you live your best, most fulfilling life.
