Sexual dysfunction, Part I: Classification, etiology, and pathogenesis

The sexual dysfunctions are extremely common but are rarely recognized by primary care physicians. They represent inhibitions in the appetitive or psychophysiologic changes that characterize the complete adult sexual response and are classified into four major categories: (1) sexual desire disorders (hypoactive sexual desire, sexual aversion disorder), (2) sexual arousal disorders (female sexual arousal disorder, male erectile dysfunction), (3) orgasmic disorders (inhibited male or female orgasm, premature ejaculation), and (4) sexual pain disorders (dyspareunia, vaginismus).

Articles about the sexual dysfunctions were obtained from a search of MEDLINE files from 1966 to the present using the categories as key words, along with the general key word "sexual dysfunction." Additional articles came from the reference lists of dysfunction-specific reviews.

Cause and pathogenesis span a continuum from organic to psychogenic and most often include a mosaic of factors. Organic factors include chronic illness, pregnancy, pharmacologic agents, endocrine alterations, and a host of other medical, surgical, and traumatic factors. Psychogenic factors include an array of individual factors (e.g., depression, anxiety, fear, frustration, guilt hypochondria, intrapsychic conflict), interpersonal and relationship factors (e.g., poor communication, relationship conflict, diminished trust, fear of intimacy, poor relationship models, family system conflict), psychosexual factors (e.g., negative learning and attitudes, performance anxiety, prior sexual trauma, restrictive religiosity, intellectual defenses), and sexual enactment factors (e.g., skill and knowledge deficits, unrealistic performance expectations). Understanding the cause and pathophysiology of sexual disorders will help primary care physicians diagnose these problems accurately and manage them effectively.