Editing Sexual dysfunction (section)

== Causes ==
There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which include [[clinical depression|depression]], sexual fears or guilt, past sexual trauma, and sexual disorders.<ref name="Michetti_et_al_2006">{{cite journal | vauthors = Michetti PM, Rossi R, Bonanno D, Tiesi A, Simonelli C | title = Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED) | journal = International Journal of Impotence Research | volume = 18 | issue = 2 | pages = 170–174 | year = 2005 | pmid = 16151475 | doi = 10.1038/sj.ijir.3901386 | doi-access = free }}</ref>

Sexual dysfunction is especially common among people who have [[anxiety disorders]].<ref name="Lo_2020"/><ref name="pmid3170497">{{cite journal | vauthors = Kaplan HS | title = Anxiety and sexual dysfunction | journal = The Journal of Clinical Psychiatry | volume = 49 Suppl | issue = | pages = 21–5 | date = October 1988 | pmid = 3170497 | doi = | url = }}</ref><ref name="pmid5789606">{{cite journal | vauthors = Cooper AJ | title = A clinical study of "coital anxiety" in male potency disorders | journal = Journal of Psychosomatic Research | volume = 13 | issue = 2 | pages = 143–7 | date = June 1969 | pmid = 5789606 | doi = 10.1016/0022-3999(69)90055-5 }}</ref><ref name="Norton_1984"/> Ordinary anxiety can cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as [[panic disorder]] commonly cause avoidance of intercourse and premature ejaculation.<ref>{{Cite web | url=http://www.astrokapoor.com/ask/premature-ejaculation-treatment@60.html |title = Premature Ejaculation Treatment in Ayurveda &#124; Cure Premature Ejaculation|date = 2018-09-06}}</ref> Pain during intercourse is often a comorbidity of anxiety disorders among women.<ref name="Coretti">{{Cite journal|vauthors=Coretti G, Baldi I|title=The Relationship Between Anxiety Disorders and Sexual Dysfunction |journal=Psychiatric Times |volume=24 |issue=9 |date=August 1, 2007|url=http://www.psychiatrictimes.com/anxiety/article/10168/54881}}</ref>

Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol, [[nicotine]], [[narcotic]]s, stimulants, [[antihypertensive drug|antihypertensives]], [[antihistamine]]s, and some psychotherapeutic drugs.<ref name="Saks">{{Cite journal|author=Saks BR|title=Common issues in female sexual dysfunction |journal=Psychiatric Times |volume=25 |issue=5 |date=April 15, 2008 |url=http://www.psychiatrictimes.com/sexual-issues/article/10168/1153918}}</ref> For women, almost any physiological change that affects the reproductive system—[[premenstrual syndrome]], pregnancy and the postpartum period, and menopause—can have an adverse effect on libido.<ref name="Saks"/> Back injuries may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in [[sexuality after spinal cord injury|sexual dysfunction after spinal cord injuries]]). Diseases such as [[diabetic neuropathy]], [[multiple sclerosis]], [[tumor]]s, and, rarely, tertiary [[syphilis]] may also impact activity, as can the failure of various organ systems (such as the heart and lungs), [[endocrine]] disorders ([[thyroid]], [[pituitary]], or [[adrenal gland]] problems), hormonal deficiencies (low [[testosterone]], other [[androgen]]s, or [[estrogen]]), and some [[birth defect]]s.

In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for the male partner, causing poor body image, and it can also be a major source of low desire for these men.<ref name="king" /> In aging women, it is natural for the vagina to [[Menopause#Urogenital atrophy|narrow and atrophy]]. If a woman does not participate in sexual activity regularly (in particular, activities involving vaginal penetration), she will not be able to immediately accommodate a penis without risking pain or injury if she decides to engage in penetrative intercourse.<ref name="king" /> This can turn into a vicious cycle that often leads to female sexual dysfunction.<ref name="king" />

According to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become "an illness that needs treatment" instead of viewing it as a natural part of the aging process. Not all cultures seek treatment; for example, a population of men living in Mexico often accept ED as a normal part of their maturing sexuality.<ref>{{cite journal | vauthors = Wentzell E | title = Aging respectably by rejecting medicalization: Mexican men's reasons for not using erectile dysfunction drugs | journal = Medical Anthropology Quarterly | volume = 27 | issue = 1 | pages = 3–22 | date = March 2013 | pmid = 23674320 | doi = 10.1111/maq.12013 }}</ref>

=== With SSRI medication ===

Sexual problems are common with SSRIs,<ref>{{cite journal | vauthors = Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K | title = Strategies for managing sexual dysfunction induced by antidepressant medication | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | pages = CD003382 | date = May 2013 | pmid = 23728643 | doi = 10.1002/14651858.CD003382.pub3 | doi-access = free }}</ref> which can cause [[anorgasmia]], [[erectile dysfunction]], diminished [[libido]], genital numbness, and [[sexual anhedonia]] (pleasureless orgasm).<ref name="Bahrick">{{cite journal| vauthors = Bahrick AS |year=2008|title=Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence|url=https://benthamopen.com/ABSTRACT/TOPSYJ-1-42|journal=The Open Psychology Journal|volume=1|pages=42–50|doi=10.2174/1874350100801010042|doi-access=free}}</ref>  Poor sexual function is also one of the most common reasons people stop the medication.<ref>{{cite journal | vauthors = Kennedy SH, Rizvi S | title = Sexual dysfunction, depression, and the impact of antidepressants | journal = Journal of Clinical Psychopharmacology | volume = 29 | issue = 2 | pages = 157–164 | date = April 2009 | pmid = 19512977 | doi = 10.1097/jcp.0b013e31819c76e9 | s2cid = 739831 }}</ref> In some cases, symptoms of sexual dysfunction may persist after discontinuation of SSRIs.<ref name="Bahrick" /><ref>{{Cite book|title=Neurology of Sexual and Bladder Disorders|vauthors=Waldinger MD|year=2015|isbn=978-0-444-63247-0|series=Handbook of Clinical Neurology|volume=130|pages=479–83|chapter=Psychiatric disorders and sexual dysfunction|doi=10.1016/B978-0-444-63247-0.00027-4|pmid=26003261}}</ref><ref name="Prozac_Insert">{{cite web|url=http://pi.lilly.com/us/prozac.pdf|title=Prozac Highlights of Prescribing Information|date=24 March 2017|publisher=Eli Lilly and Company}}</ref>{{rp|14}}<ref name=":3">{{cite journal | vauthors = Reisman Y | title = Sexual Consequences of Post-SSRI Syndrome | journal = Sexual Medicine Reviews | volume = 5 | issue = 4 | pages = 429–433 | date = October 2017 | pmid = 28642048 | doi = 10.1016/j.sxmr.2017.05.002 | quote = Initial SSRI registration studies found that such side effects were reported by fewer than 10% of patients.  When doctors specifically asked about treatment-emergent sexual difficulties, some found that they were present in up to 70% of patients. }}</ref><ref name="DSM5">{{cite book | author=American Psychiatric Association|year=2013|title=Diagnostic and Statistical Manual of Mental Disorders | edition = 5th |location=Arlington|publisher=American Psychiatric Publishing|pages=449|isbn=978-0-89042-555-8 }}</ref> This combination of symptoms is sometimes referred to as [[Selective serotonin reuptake inhibitor#Sexual dysfunction|post-SSRI sexual dysfunction]].<ref name=":4">{{cite journal | vauthors = Healy D | title = Post-SSRI sexual dysfunction & other enduring sexual dysfunctions | journal = Epidemiology and Psychiatric Sciences | volume = 29 | pages = e55 | date = September 2019 | pmid = 31543091 | pmc = 8061302 | doi = 10.1017/S2045796019000519 | quote = Close to 100% of takers of a selective serotonin reuptake inhibitor (SSRI) have a degree of genital sensory change within 30 min of taking. | doi-access = free }}</ref><ref name=":2">{{Cite journal| vauthors = Bahrick AS |date=2006|title=Post SSRI sexual dysfunction|url=https://www.researchgate.net/publication/236587031|journal=American Society for the Advancement of Pharmacotherapy|volume=Tablet 7.3|pages=2–3}}</ref>

=== Pelvic floor dysfunction ===
{{Main|Pelvic floor dysfunction}}
Pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men, and is treatable by [[pelvic floor physical therapy]], a type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas.<ref name="malepelvicfloor.com">{{Cite web|title=Male Pelvic Floor: Advanced Massage and Bodywork|url=http://malepelvicfloor.com/sd.html}}</ref><ref>{{Cite web|date=2015-02-23|title=Pelvic Floor Dysfunction, Perineum Pain, Sore Pelvis|url=http://www.pelvicpainhelp.com/pelvic-floor-dysfunction/}}</ref><ref>{{Cite web|title=Sexual Dysfunction &#124; Beyond Basics Physical Therapy &#124; New York City, Manhattan|url=http://www.beyondbasicsphysicaltherapy.com/sexual-dysfunction|access-date=2016-08-31|archive-date=2018-04-14|archive-url=https://web.archive.org/web/20180414014503/http://www.beyondbasicsphysicaltherapy.com/sexual-dysfunction|url-status=dead}}</ref><ref>{{cite journal | vauthors = Handa VL, Cundiff G, Chang HH, Helzlsouer KJ | title = Female sexual function and pelvic floor disorders | journal = Obstetrics and Gynecology | volume = 111 | issue = 5 | pages = 1045–1052 | date = May 2008 | pmid = 18448734 | pmc = 2746737 | doi = 10.1097/AOG.0b013e31816bbe85 }}</ref><ref name="ReferenceA">{{cite journal | vauthors = Rosenbaum TY, Owens A | title = The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME) | journal = The Journal of Sexual Medicine | volume = 5 | issue = 3 | pages = 513–523 | date = March 2008 | pmid = 18304280 | doi = 10.1111/j.1743-6109.2007.00761.x }}</ref>

===Female sexual dysfunction===
Several theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include: the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis:

*Self-perception theory: people make attributions about their own attitudes, feelings, and behaviours by relying on their observations of external behaviours and the circumstances in which those behaviours occur{{Citation needed|date=September 2024}}
*Overjustification hypothesis: when an external reward is given to a person for performing an intrinsically rewarding activity, the person's intrinsic interest will decrease{{Citation needed|date=September 2024}}
*Insufficient justification: based on the classic [[cognitive dissonance]] theory (inconsistency between two cognitions or between a cognition and a behavior will create discomfort), this theory states that people will alter one of the cognitions or behaviours to restore consistency and reduce distress{{Citation needed|date=September 2024}}

The prevalence of sexual dysfunction in women is not well known due to a paucity of epidemiological studies, inconsistent criteria for sexual dysfunction across different studies and incomplete recruitment, with studies often excluding women who were without a partner or who were sexually inactive. However, based on incomplete population based studies from the United States, Europe and Australia, unspecified arousal dysfunction (in which a woman is unable to achieve desirable genital or non-genital sexual arousal despite adequate stimulation and desire) was present in 3-9% of women aged 18–44, 5-7.5% aged 45–64 and 3-6% in women older than 65.<ref name="Davis 2024">{{cite journal |last1=Davis |first1=Susan R. |title=Sexual Dysfunction in Women |journal=New England Journal of Medicine |date=22 August 2024 |volume=391 |issue=8 |pages=736–745 |doi=10.1056/NEJMcp2313307|pmid=39167808 }}</ref> Anorgasmia with distress (in which women were unable to achieve an orgasm) was present in 7-8% of women younger than 40, 5-7% aged 40–64 and 3-6% of those older than 65.<ref name="Davis 2024" /> Poor sexual self image leading to distress was seen in 13.4% of women younger than 40 in an Australian population based study.<ref name="Davis 2024" />

The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity.<ref name="king" /> Several factors influence a women's perception of her sexual life. These can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion.<ref name="king" /> Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study found that African American women are the most optimistic about menopausal life; Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic.<ref name="king" />

Since these women have sexual problems, their sexual lives with their partners can become a burden without pleasure, and may eventually lose complete interest in sexual activity. Some of the women found it hard to be aroused mentally, while others had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners, the environment where sex occurs being uncomfortable, or an inability to concentrate on the sexual activity due to a bad mood or burdens from work. Other factors include physical discomfort or difficulty in achieving arousal, which could be caused by aging or changes in the body's condition.<ref>{{Cite web | url=http://www.merckmanuals.com/home/womens_health_issues/sexual_dysfunction_in_women/overview_of_sexual_dysfunction_in_women.html | title=Overview of Sexual Dysfunction in Women - Women's Health Issues}}</ref>

[[Sexual assault]] has been associated with excessive menstrual bleeding, genital burning, and painful intercourse (attributable to disease, injury, or otherwise), medically unexplained dysmenorrhea, menstrual irregularity, and lack of sexual pleasure.{{Citation needed|date=September 2024}} Physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms. Multiple assaults, assaults accomplished by persuasion, spousal assault, and completed intercourse were most strongly related to sexual symptoms.{{Citation needed|date=September 2024}} Assault was occasionally associated more strongly with reproductive symptoms among women with lower income or less education, possibly because of economic stress or differences in assault circumstances. Associations with unexplained menstrual irregularity were strongest among African American women; ethnic differences in reported circumstances of assault appeared to account for these differences. Assault was associated with sexual indifference only among Latinas.<ref>{{Cite web|title=Saint Louis University Libraries {{!}} Saint Louis University|url=https://login.ezp.slu.edu/login?qurl=https://pubmed.ncbi.nlm.nih.gov%2f12296010%2f|access-date=2020-12-17|website=login.ezp.slu.edu}}</ref>

===Menopause===
The most prevalent of female sexual dysfunctions that have been linked to menopause include lack of desire and libido; these are predominantly associated with hormonal physiology. Specifically, the decline in serum estrogens causes these changes in sexual functioning. Androgen depletion may also play a role, but current knowledge about this is less clear. The hormonal changes that take place during the menopausal transition have been suggested to affect women's sexual response through several mechanisms, some more conclusive than others.

===Aging in women===
Whether or not aging directly affects women's sexual functioning during menopause is controversial. However, many studies have demonstrated that aging has a powerful impact on sexual function and dysfunction in women, specifically in the areas of desire, sexual interest, and frequency of orgasm.<ref name="eden"/><ref name="king" /><ref>{{cite journal | vauthors = Laumann EO, Paik A, Rosen RC | title = Sexual dysfunction in the United States: prevalence and predictors | journal = JAMA | volume = 281 | issue = 6 | pages = 537–544 | date = February 1999 | pmid = 10022110 | doi = 10.1001/jama.281.6.537 | doi-access = free }}</ref> The primary predictor of sexual response throughout menopause is prior sexual functioning,<ref name="eden" /> which means that it is important to understand how the physiological changes in men and women can affect sexual desire.<ref name="king" /> Despite the apparent negative impact that menopause can have on sexuality and sexual functioning, sexual confidence and well-being can improve with age and menopausal status.<ref name="eden" />

Testosterone, along with its metabolite [[dihydrotestosterone]], is important to normal sexual function in men and women. Dihydrotestosterone is the most prevalent androgen in both men and women.<ref name="king">{{cite journal | vauthors = Kingsberg SA | title = The impact of aging on sexual function in women and their partners | journal = Archives of Sexual Behavior | volume = 31 | issue = 5 | pages = 431–437 | date = October 2002 | pmid = 12238611 | doi = 10.1023/A:1019844209233 | s2cid = 7762943 }}</ref> Testosterone levels in women at age 60 are on average about half of what they were before the women were 40. Although this decline is gradual for most women, those who have undergone [[bilateral oophorectomy]] experience a sudden drop in testosterone levels, as the ovaries produce 40% of the body's circulating testosterone.<ref name="king" />

Sexual desire has been related to three separate components: drive, beliefs and values, and motivation.<ref name="king" /> Particularly in postmenopausal women, drive fades and is no longer the initial step in a woman's sexual response.<ref name="king" />