Causes

Many different factors may contribute to sexual dissatisfaction or dysfunction. They are often connected. Sex requires the mind and body to work together.

Physical causes

• Diabetes. Diabetes is one of the most common causes of erectile dysfunction. Diabetes can damage nerves and blood supply to the penis and vagina.
• Physical impairments. A back injury, stroke, surgery in the pelvic area, arthritis or certain birth defects can affect how well you can move and control your body
• Hormonal imbalances. Low levels of estrogen in women and low levels of testosterone in men and women. Lower estrogen levels after menopause lead to thinning and decreased elasticity of the lining of the vagina. The swelling and lubrication during arousal are slowed down. This can lead to uncomfortable or painful intercourse and achieving orgasm may take longer.
• Pregnancy and breast-feeding. Both may change the hormonal balance temporarily.
• Medications. Medications that lower blood pressure can interfere with the blood flow to the genitals. A side effect of certain antidepressants may include lack of lubrication or lack of interest. This side effect may not go away. Antihistamines and chemotherapy drugs can decrease libido and the ability to achieve orgasm.
• Chronic disease, such as kidney or liver failure.
• Alcoholism and drug abuse.
• Smoking.
• Cancer. Cancer can affect hormone production of an organ such as the prostate, penis, ovaries, cervix or vagina. Patients often have side effects such as fatigue or nausea.
• Surgical treatment for benign prostatic hyperplasia. Enlarged prostate gland
• Contraceptive creams and foams. They can irritate a woman's vagina and cause dryness.
• Peyronie's disease. Some researcher believe it is caused by an injury to the penis shaft (hitting or bending) that causes localized bleeding inside the penis, which then fails to heal properly. This theory does not explain why Peyronie's disease is found in men who have not experienced penile trauma nor does it explain why. The condition often disappears on its own. Another theory is that Peyronie's disease is an autoimmune disorder.

Psychological and social causes

Emotional factors affecting sex include both psychological problems of one partner and interpersonal problems:

• Untreated depression and stress.
• Anxiety. After a traumatic event such as a heart attack or stroke, a person may be afraid that sex may trigger another episode.
• History of sexual abuse. Feelings coming from sexual trauma earlier in life may interfere with a satisfying experience.
• Cultural and religious issues. Guilt about sexual pleasure or fear of intimacy.
• Relationship problems. Lack of trust, inability to communicate desires and preferences to the partner, boredom and unhappiness in a longstanding relationship or anxiety about sexual performance may interfere with sexual function.
• Self-image. Hair loss, weight gain, skin problems, removal of a breast or testicle during surgery for cancer can all affect a person's sexual self-image.

More on Sexual Problems

In the Encyclopedia:

This article was reviewed and updated June 2007.