Doctors dropped 'frigidity' and 'impotence' for more precise, less judgmental terms
Medicine once lumped sexual problems under blunt labels: impotence for men, frigidity for women. Modern classification splits them into four families, desire, arousal, orgasm and pain, and a formal DSM-5 diagnosis requires marked distress lasting at least six months. Around 152 million men worldwide are estimated to have erectile dysfunction alone.
The World Health Organization's definition is deliberately broad: being unable to take part in a sexual relationship the way one would like. Much of the modern framework rests on the human sexual response cycle described by William Masters and Virginia Johnson and later adjusted by Helen Singer Kaplan. Because these difficulties often travel with mood, anxiety and eating disorders, clinicians are expected to take a full sexual and general health history, including stress, guilt and performance worries.
Low desire can stem from falling oestrogen or testosterone, ageing, fatigue, pregnancy, depression, or medication such as SSRI antidepressants, though only a handful of proposed causes have been studied rigorously. Erectile dysfunction has causes ranging from psychological strain to cardiovascular disease, diabetes, multiple sclerosis, spinal injury and drugs, and many are treatable. The estimated 30 million affected men in the United States is probably an undercount, since stigma and taboo discourage reporting. Hormone deficiency is a relatively rare culprit.
Orgasm problems include anorgasmia, defined as delay or absence in at least 75 percent of encounters; after menopause, one in three women report difficulty. Premature ejaculation, long blamed on the mind, may have a neurobiological basis. Some conditions are strikingly obscure. Post-orgasmic illness syndrome brings flu-like aches, palpitations and fatigue lasting up to a week; its cause is unknown, suspected to involve the immune or autonomic nervous system, and it has no known cure. Post-coital tristesse, a wave of sadness after sex, lasts up to two hours.
Pain disorders include vaginismus, an involuntary muscle spasm, and in men Peyronie's disease, where fibrous bands curve the penis; its incidence is put at between 1 and 20 percent of men, most often aged 40 to 70. Research keeps widening the picture: a study of 100 women with chronic obstructive pulmonary disease linked sexual dysfunction to heavier symptoms, fatigue and depression.
Source: Sexual dysfunction
