Estimated reading time: 6 minutes

By José Ramirez, LMHC

Continuing my blog series on sex, we’ve arrived at the more difficult part. The part that is arguably least talked about, but the most impactful on a person’s sexual well-being: sexual dysfunction. 

What exactly is sexual dysfunction?

Sexual dysfunction is any problem that affects a person from experiencing satisfaction during sexual activity. 

These affect people of all gender identities and sexual orientations and are classified into 4 general categories:

1. Arousal problems: Anything that affects a person’s ability to become or stay aroused.
2. Desire Disorders: Lack of sexual desire or interest. 
3. Pain Disorders: Problems with pain related to sexual activity.
4. Orgasm Disorders: Inability to reach orgasm or a delay in orgasm.

How common is sexual dysfunction? 

Sexual problems are more common than you might think. It’s estimated that around 43% of women and 31% of men report some degree of sexual dysfunction. Some of the more well-known among the general public include erectile dysfunction, lack of desire, premature or delayed orgasm, or ejaculation. 

What’s the cause of sexual dysfunction?

The causes of these problems can range from hormonal, medication side-effects, physiological issues, or psychological in nature. If this is an issue in the relationship, it’s imperative that it be acknowledged and discussed. 

What to do about sexual dysfunction

Finding support is an important first step in dealing with sexual dysfunction. Support comes in many ways, it can be your family, friends, partner(s), medical doctor, therapist, etc. 

Talk about it

The stigma surrounding sexual dysfunction is enormous, on par with the stigma surrounding Sexually Transmitted Infections (STIs). People don’t like to talk about their problems generally, and considering this is such an intimate issue, it becomes even more difficult to open up about. 

It’s paramount that people affected by sexual dysfunctions talk about it with their partner(s) not only for support but to learn how to deal with the issue together. Disclosing sexual dysfunctions to your partner(s) allows them to be there in a supportive role to help navigate the issue effectively. While the dysfunction may only be happening to one partner, it will affect the other(s) when it comes to sexual activity. 

Without talking about it, people may try to engage in sexual activity only to end up frustrated when the dysfunction makes it difficult to perform or enjoy sex. The other common outcome is that people stop engaging in sex as often or even all together as a form of avoidance. Forced abstinence for the sake of avoiding disclosing sexual dysfunction is not what we want. 

The important thing is to not bottle it up or engage in heavy avoidance. 

Acknowledging it will help reduce the shame associated with the problem. Sexual dysfunctions can be crippling for people and so reducing shame and stigma is crucial. If your partner discloses a sexual dysfunction, it’s important to be supportive and understanding. 

ICYMI: Check out my post about how to talk about sex with your partner

Consult your doctor

Treatment is usually necessary for sexual dysfunctions whether that be medical or psychological treatment. The first step is to consult your doctor to assess for physical causes that may be treated medically. In cases where medication is unnecessary or not an option, seeing a therapist who is knowledgeable in this area can be beneficial.

Talk therapy

If medical issues are ruled out after a physical examination with a physician, then therapy is a good next step. If a medical condition is identified, therapy can still be beneficial to learn how to cope and deal with the identified issue. Individual therapy for the person experiencing the difficulty with a trained sex therapist plus couples therapy is ideal.

Connecting with a therapist may be difficult at first, but it has the potential to be extremely helpful, and healing even. Not only will you have a safe space to discuss the issue and how it affects you, but you’ll also learn techniques to help you better manage it. 

You’ll also learn strategies to communicate this to your partner(s) if that’s an area of struggle. If the issue is more chronic, then acceptance and coping skills will really help. Avoidance has a cost and will take a toll on the individual and their relationship(s), it’s just not worth it. 

Couples therapy with a therapist knowledgeable in this area or with a certified sex therapist can help the couple navigate the problem more effectively as a team. The partner(s) not experiencing the issue will learn how to be supportive. The couple will learn ways to improve the issue or how to work with the issue in ways that still promote a healthy sex life. If it’s not clear by now, communicating to improve sex is of utmost importance. 

A helpful way to cope with sexual dysfunctions is to zoom out from them. The tendency is to put so much emphasis on what’s not working properly that people forget they are sexual beings in spite of this. Men with erectile issues can still be great lovers, women who experience pain during intercourse can still be sexual goddesses. There is so much more to sex than just penetration. Deemphasizing the problem reduces individual pressure and the pressure to perform.

In summary, here’s what to expect in therapy for sexual dysfunction: 

• Tools to communicate/disclose dysfunctions to your partner(s) 
• Ways to offer (and receive) support to/from your partner(s)
• Coping skills to better manage the dysfunction
• Increase your sex education
• Strategies to get more in the mood (if needed)

One of the biggest benefits of therapy will be working on the shame that sexual dysfunctions cause. Shame is a common reaction to dysfunctions and is crippling. Societal messages around sex and sexual functioning are tied to concepts of masculinity and femininity. If something isn’t working well, that can be internalized into “there’s something wrong with me, I’m not enough.” Learning to decrease that shame will make it easier to want to engage sexually again and will help with overall confidence. 

The stigma and shame around sexual dysfunctions are the biggest barriers to treatment. These are not topics of conversation that people feel comfortable having and given the intimate nature, it’s understandable. Oftentimes, people avoid the issue altogether in hopes that it will resolve on its own, it rarely ever does. In therapy, participants will learn how to cope with the issue and how to improve it, if possible. 

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