11.2 Causes and risk factors for sexual dysfunction

Sexual dysfunction can stem from various biological, psychological, and social factors. From hormonal imbalances to relationship issues, these causes often intertwine, creating complex challenges for individuals and couples.

Medical conditions, medications, and mental health play significant roles in sexual health. Age-related changes, lifestyle choices, and substance use can also impact sexual function. Understanding these factors is crucial for effective treatment and support.

Factors in Sexual Dysfunction

Biopsychosocial Model

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• Biological factors that can contribute to sexual dysfunction include hormonal imbalances, neurological disorders, cardiovascular disease, diabetes, and chronic pain conditions
• Psychological factors such as anxiety, depression, low self-esteem, body image issues, and past sexual trauma can significantly impact sexual functioning
• Social and cultural factors, including relationship problems, lack of sexual education, religious beliefs, and societal stigmas surrounding sexuality, can influence the development of sexual dysfunctions
• The biopsychosocial model suggests that sexual dysfunctions often result from a complex interplay of biological, psychological, and social factors rather than a single cause, emphasizing the importance of considering multiple domains when assessing and treating sexual dysfunctions

Medical Causes of Dysfunction

Chronic Diseases and Conditions

• Cardiovascular diseases, such as hypertension and atherosclerosis, can impair blood flow to the genitals, leading to erectile dysfunction in men and arousal disorders in women
• Neurological conditions, including multiple sclerosis, Parkinson's disease, and spinal cord injuries, can disrupt nerve pathways involved in sexual response, causing difficulties with arousal, sensation, and orgasm
• Hormonal imbalances, particularly low testosterone levels in men and estrogen deficiencies in women, can contribute to sexual dysfunctions like decreased libido and vaginal dryness
• Chronic pain conditions (fibromyalgia, endometriosis) can make sexual activity uncomfortable or painful, leading to avoidance and loss of desire

Medications and Treatments

• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can cause sexual side effects such as reduced desire, delayed orgasm, and erectile dysfunction by altering neurotransmitter levels in the brain
• Other medications, such as antihypertensives, antiandrogens, and chemotherapy drugs, can also have negative impacts on sexual functioning through various mechanisms (lowering blood pressure, reducing testosterone, damaging nerves and blood vessels)
• Surgical treatments for conditions like prostate cancer or gynecological disorders can result in sexual dysfunctions due to nerve damage, scar tissue formation, or changes in anatomy
• Radiation therapy for cancers in the pelvic region can cause sexual side effects by damaging blood vessels, nerves, and tissues involved in sexual response

Relationship and Mental Health Influences

Interpersonal and Psychological Factors

• Relationship problems, such as poor communication, unresolved conflicts, and lack of emotional intimacy, can contribute to the development and persistence of sexual dysfunctions by creating stress, resentment, and emotional distance between partners
• Chronic stress, whether from personal, professional, or financial sources, can lead to decreased sexual desire and difficulties with arousal and orgasm by activating the body's stress response and diverting focus away from sexual stimuli
• Anxiety disorders, particularly performance anxiety and sexual aversion disorder, can significantly impact sexual functioning by causing fear, avoidance, and physical symptoms (rapid heartbeat, muscle tension) that interfere with sexual response
• Depression can lead to a loss of interest in sexual activity, decreased sexual desire, and difficulty achieving orgasm, which can further exacerbate the underlying mental health condition and create a negative feedback loop

Trauma and Abuse History

• Trauma-related disorders, such as post-traumatic stress disorder (PTSD) resulting from sexual abuse or assault, can cause sexual dysfunctions through a combination of psychological distress, fear, and physical symptoms (flashbacks, dissociation)
• Childhood sexual abuse can lead to long-term difficulties with trust, intimacy, and sexual functioning in adulthood by shaping negative beliefs about sexuality and relationships
• Domestic violence and intimate partner abuse can contribute to sexual dysfunctions by creating an environment of fear, control, and trauma that inhibits sexual expression and enjoyment
• Survivors of sexual trauma may experience triggers during sexual activity that elicit anxiety, panic, or dissociation, making it difficult to engage in and enjoy sexual experiences

Age, Lifestyle, and Substance Use

Aging and Hormonal Changes

• Age-related changes, such as decreased hormone levels, reduced blood flow, and changes in neurotransmitter function, can contribute to the development of sexual dysfunctions in older adults by impacting desire, arousal, and orgasm
• Menopause in women can lead to vaginal dryness, decreased libido, and pain during intercourse due to hormonal changes, particularly the decline in estrogen production
• Andropause in men, characterized by a gradual decrease in testosterone levels with age, can result in reduced sexual desire, erectile difficulties, and changes in sexual response
• Age-related chronic health conditions (arthritis, diabetes) can indirectly impact sexual functioning by causing pain, fatigue, or mobility issues that make sexual activity challenging

Health Behaviors and Substance Use

• Lifestyle factors, such as obesity, lack of physical activity, and poor diet, can negatively impact sexual functioning by contributing to cardiovascular disease, hormonal imbalances, and decreased energy levels
• Cigarette smoking can impair sexual functioning by reducing blood flow to the genitals and increasing the risk of cardiovascular disease, leading to difficulties with arousal and orgasm
• Alcohol and drug abuse can lead to sexual dysfunctions by altering brain chemistry, impairing judgment, and causing physical health problems that interfere with sexual response (liver disease, nerve damage)
• Chronic use of substances like alcohol, opioids, and stimulants can cause long-term damage to the nervous system and hormonal balance, leading to persistent sexual dysfunctions even after substance use is discontinued