Verified by Sexual Disorders
Healthy sexual activity can include a wide range of desires and activities, which, when fantasized about or experienced between consenting adults as part of a fulfilling relationship, bring people pleasure, even if others may prefer to live their sex lives in a different way.
Some sexual behavior, however, indicates the presence of sexual disorder, because the practice leads to significant personal distress, involves harming others, or becomes compulsive.
For more information, see the Diagnosis Dictionary.
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When individuals are unable to enjoy fulfilling sex lives because of lack of desire, struggles with arousal, physical pain during sexual activity, or an inability to reach orgasm, their relationships, self-esteem, and overall quality of life can suffer. Such conditions may be chronic or temporary, but in either case, therapy and education may go a long way toward alleviating discomfort.
Erectile disorder (ED), also known as erectile dysfunction or impotence, is the inability to get or maintain an erection firm enough for sexual intercourse or other satisfying sexual activity. It is normal for men occasionally to lose an erection, but ED is a chronic problem, and it affects at least 12 million American men. ED becomes more common as men age but generally only becomes a cause of concern for an individual when it causes stress or a loss of self-confidence, affects a relationship, or is discovered to be an indication of an underlying serious health condition. ED can have physical, neurological, or psychological causes, and is generally treated with lifestyle changes before a prescription of medication.
Many women do not experience orgasm through intercourse alone. But orgasmic disorder, or female orgasmic disorder, refers to a woman’s general difficulty or inability to reach orgasm during sexual stimulation. A diagnosis is made when the disturbance causes clinically significant distress, and generally not when the experience can be linked to external factors such as severe relationship distress, intimate partner violence, or other significant stressors. A doctor would also ask a women reporting struggles with orgasm whether the situation may be a result of inadequate sexual stimulation. Sex or relationship counseling is typically recommended for women experiencing orgasmic disorder. Hormone supplementation may be tried, but the treatment is controversial and the long-term effects are unclear.
An estimated 15 percent of women in North America experience frequent pain during sexual intercourse, especially during penetration. The condition, known as genito-pelvic pain or penetration disorder, or sexual pain disorder, can reduce sexual desire, disrupt relationships, and make a sufferer feel less feminine, a challenge to her identity and self-esteem. For some women, the pain is limited to vaginal intercourse while others may also experience pain inserting tampons. The condition may be lifelong or acquired, and treatment varies based on the type and severity of the pain, but may include sex or relationship counseling and/or dilation exercises. For women in long-term relationships, clinicians suggest that counseling should include both partners.
Sexual desire disorder refers to an extended period during which an individual feels no desire for sexual activity over a prolonged period. Men and women can both experience low sexual interest, typically resulting in a failure to initiate or respond to bids for sexual intimacy, as well as an absence of sexual thoughts or fantasies. The condition is not diagnosed unless symptoms have been present for at least six months and have caused clinically significant distress. The condition can be generalized or situational, and is usually treated with psychotherapy before considering a course of medication. (The disorder is distinct from asexuality, which is not a clinical condition.)
For some people, sexual arousal or gratification depends on fantasizing about and/or taking part in sexual practices that most would consider atypical or extreme. These conditions, known as paraphilias, are considered disorders when they cause the individual significant distress or when engaging in such behavior causes harm or distress to others. Paraphilias can center on particular objects (children, animals, underwear) or behaviors (inflicting pain, exposing oneself) but are characterized by sexual preoccupation to the point of dependency. Most paraphilias are very specific and unchanging and they are far more common in men than in women.
Exhibitionistic disorder involves the urge, fantasy, or act of exposing one’s genitals to others without their consent, particularly strangers. Subtypes of the disorder include a compulsion to show one’s genitals to prepubescent children, adults, or both. Exhibitionism is believed to affect around 2-4 percent of the male population, and an unknown but smaller number of women.
An intense sexual attraction to either inanimate objects or to body parts not traditionally viewed as sexual, such as feet, when coupled with clinically significant distress or impairment, is known as fetishistic disorder. Many people find certain nongenital bodily features attractive or arousing, but fetishistic arousal interferes with normal sexual or social functioning, and often sexual arousal is impossible without the presence of the fetish object. Many people may have fetishes as a part of sex lives but a diagnosis of fetishistic disorder requires significant personal distress or disruption of social, occupational, or other areas of functioning. The disorder is believed to occur almost exclusively in men.
Voyeuristic disorder is a paraphilia that involves spying intentionally on unsuspecting people, often when they are disrobing, naked, or engaging in sexual activities, for the purpose of sexual arousal. A voyeur, or “Peeping Tom,” may employ binoculars, mirrors, or recording devices in their pursuit. A diagnosis of voyeuristic disorder requires experiencing persistent, intense arousal from the activity for at least six months. A smaller number of voyeurs find arousal in watching people defecate or from eavesdropping on erotic conversations. A voyeur will often masturbate or have sexual fantasies while watching a target but is generally not interested in having sex with the person. Males are more likely to engage in voyeurism, which, for adults, is a criminal act.
The paraphilia known as frotteurism involves the act of touching or rubbing one's genitals against another person in a sexual manner without their consent, to derive sexual pleasure or reach orgasm. Frotteurs seek a private sexual experience in a public setting. The condition most often occurs in young men roughly between the ages of 15 and 25 and is rare among women.
Cross-dressing is not a clinical disorder, but the paraphilia known as transvestism can be. The condition involves an individual experiencing recurrent, intense sexual arousal from dressing as the opposite gender, especially when the urge to do so causes them significant distress or impairment in his or her daily life. An individual with transvestic disorder may feel anxiety, depression, guilt, or shame because of their urge, often because of partner disapproval or their own concern about negative social or professional ramifications.
For some people, a fulfilling sex life involves bondage, dominance, submission, or similar practices, often referred to as BDSM or kink, conducted between consenting adults in a safe environment. For others, however, the infliction or experiencing of pain becomes obsessive or causes disruption to their personal lives. In these cases, the individual may be living with sexual masochism disorder or sexual sadism disorder.
People living with the paraphilia known as sexual masochism disorder engage in or fantasize about being beaten, bound, humiliated, or otherwise made to suffer, resulting in sexual satisfaction. Many healthy individuals have made kink a part of their sex lives, but when individuals with this sexual preference also report psychological or social problems as a result, including obsessive thoughts or overwhelming anxiety, shame, or guilt, they may be diagnosed with the disorder.
One specific type of sexual masochism is asphyxiophilia; when one tries this practice while alone, accidental death may result. Sexually masochistic behavior is usually evident by early adulthood, and the condition is treated with psychotherapy and medication.
Sexual sadism disorder involves inflicting pain, humiliation, fear, or other form of physical or mental harm on another person to achieve sexual gratification. Sadistic acts can include restraint (such as with ropes, chains, or handcuffs), imprisonment, biting, spanking, whipping, or beating. Individuals for whom these practices are a part of a consenting relationship, who experience no distress or dysfunction from them—and who do no harm to consenting others—would not be considered to have the disorder. When someone repeatedly practices sadistic sexual acts without a partner’s consent, or when their fantasies or behaviors cause social, professional, or other functional problems, the disorder may be diagnosed. Some acts of sexual sadism are criminal, and lead to serious harm or even the death of another person.
Sexual attraction to young children is an especially disturbing and potentially dangerous paraphilia, but those who live with it rarely seek help or treatment, primarily because of the criminal aspect of many pedophilic acts, as well as extensive public disapproval and the intense shame the condition may cause.
Pedophilia is an ongoing sexual attraction to pre-pubertal children. The condition is diagnosed when the presence of sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a child or children, generally age 13 years or younger, persists over a period of at least six months. Pedophilia is often a lifetime condition, and it is more common in men and can involve attraction to either boys or girls. The highest possible prevalence of pedophilia in the male population is theorized to be approximately three to five percent, and the condition is rarer in women. It is not clear why some people become pedophiles. There is some evidence that it may run in families, either through genetics or learned behavior. A history of childhood sexual abuse appears to be a potential factor in the development of pedophilias, although this has not been proven.
