Sexual dysfunction refers to a variety of problems that people can experience, that prevents them from experiencing satisfaction during or around sex. This includes issues with desire and low libido, arousal (such as erectile dysfunction or premature ejaculation), problems that affect a person’s ability to achieve orgasm or climax, and pain during sex.
The causes of sexual dysfunction are diverse, and ageing is associated with several changes that can impact sexual function. These include reductions in sex hormone levels, testosterone and oestrogen, a reduced frequency and quality of erections, reductions in the sensitivity of the sexual organs and nipples.
Medical illnesses can influence sexual function, by changing the blood flow or nerve function of the sexual organs, including heart and vascular disease, cancer, diabetes, neurological problems, drug and alcohol use. Some medications can also contribute to sexual dysfunction. Additionally, psychological factors, including existing mental health conditions and treatments, work, financial or relationship stressors can also contribute to difficulties with sexual performance.
Importance for PLHIV50+
Sexual dysfunction is common, affecting approximately 1 in 3 men, and 1 in 2 women. It increases with age, with up to 75% of people over the age of 70 reporting some form of sexual dysfunction. Although being on antiviral medication with and undetectable HIV viral load prevents HIV transmission, a concern which previously may have contributed to anxiety around sex, up to 50% of people living with HIV report being dissatisfied with sex.
The diagnosis of sexual dysfunction comes about when a person alerts their clinician to a concern around their own or partner’s enjoyment of sex. To explore this, the healthcare provider may ask a series of questions to try to work out the cause and contributing factors, and conduct a thorough physical examination. Sometimes, blood tests can be helpful to identify other medical problems that might be contributing.