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# The human sexual response and the sexual dysfunctions

- Disorder

How sexual desire, arousal, orgasm and resolution work, and the lasting problems with them that cause distress, often from medical causes or drugs.

Updated Nov 13, 2026

## Key points

- DSM-5-TR female dysfunctions are female sexual interest/arousal disorder, female orgasmic disorder and genito-pelvic pain/penetration disorder; in men the main problems are low desire, erectile dysfunction and premature or delayed ejaculation.
- Criteria need symptoms on at least 75 percent of occasions, for at least 6 months, with distress.
- SSRIs cause sexual dysfunction in more than half of patients, mainly trouble reaching orgasm, plus lower libido and erectile dysfunction; bupropion and mirtazapine lack these sexual effects.
- Other drug causes include antipsychotics, tricyclic antidepressants, some antihypertensives, 5-alpha-reductase inhibitors and antiandrogens.
- Medical causes include diabetes, neurological disease, low testosterone, high prolactin and low estrogen with vaginal dryness.
- In the circular model, desire can be responsive to stimulation and can build after arousal begins.

## What it is

The classic linear model describes the sexual response as spontaneous desire, then excitement and plateau, orgasm and resolution; the circular model of Rosemary Basson and colleagues adds that sexual activity often starts from emotional intimacy or other motives, and desire can be responsive, building once arousal begins. DSM-5-TR requires symptoms on at least 75 percent of occasions for at least 6 months, causing distress. Sexual problems are common: an estimated 30 to 50 in 100 women report them, but only about 12 in 100 are distressed, and distress is what makes a problem a disorder.

## Key facts

- Erection is mediated by a sacral parasympathetic reflex; emission begins with stimulation of alpha-adrenergic receptors.
- Premature ejaculation is usually caused by inexperience, anxiety and other psychological factors; SSRIs can contribute to delayed ejaculation.
- Female sexual interest/arousal disorder merged the former separate desire and arousal disorders.
- Genito-pelvic pain/penetration disorder combines pain with intercourse, fear of pain and pelvic floor muscle tightening; low estrogen with vaginal dryness can contribute.
- Depression, anxiety, past sexual trauma and conflict in the relationship all inhibit desire and arousal.

## Step by step

- Take a detailed sexual history, in private, including the relationship, mental health and any past trauma.
- Review every drug: SSRIs, antipsychotics, some antihypertensives, 5-alpha-reductase inhibitors and antiandrogens.
- Examine the patient and order tests such as testosterone, prolactin and thyroid function when the history suggests them.
- Treat the causes and offer psychological treatment such as cognitive behavioral therapy or mindfulness-based practices, with or without medicines.
- Refer for pelvic floor therapy when pain or musculoskeletal problems predominate.

## The DSM-5-TR sexual dysfunctions at a glance

| Dysfunction | Core feature | Common contributors | First approach |
| --- | --- | --- | --- |
| Male hypoactive sexual desire disorder | Persistently low or absent sexual thoughts and desire | Depression, drugs, relationship problems | Treat causes; couple or sex therapy |
| [Low desire from low testosterone](https://durgical.com/en/conditions/male-hypogonadism/) | Low desire with a low morning testosterone level | Hypogonadism | Measure morning testosterone |
| [Erectile disorder](https://durgical.com/en/conditions/erectile-dysfunction/) | Cannot get or keep an erection firm enough | Diabetes, neurological disease, drugs, anxiety | See the erectile dysfunction page |
| Premature (early) ejaculation | Ejaculation earlier than wished | Inexperience, anxiety | Stop-start and squeeze techniques |
| Delayed ejaculation | Marked delay or absence of ejaculation | SSRIs, psychological factors | Review drugs; psychological treatment |
| Female sexual interest/arousal disorder | Little interest or desire and/or low arousal | Depression, drugs, relationship conflict | Cognitive behavioral therapy or mindfulness; flibanserin or bremelanotide in premenopausal women |
| Female orgasmic disorder | Orgasm delayed, rare, absent or much less intense | Anxiety, SSRIs | Psychological treatment; review drugs |
| [Genito-pelvic pain/penetration disorder](https://durgical.com/en/conditions/menopause-and-climacteric-syndrome/) | Pain, fear of pain, pelvic floor tightening with penetration | Low estrogen with vaginal dryness, past trauma | Pelvic floor therapy, treat dryness |
| Substance/medication-induced dysfunction | Onset with starting or raising a drug | SSRIs, antipsychotics, some antihypertensives | Lower the dose or switch to a drug with fewer effects |
| [Paraphilic disorders (not a dysfunction)](https://durgical.com/en/conditions/paraphilic-disorders/) | Atypical sexual interests causing distress or harm | Different category | See the paraphilic disorders page |

## Clinical notes

- Take a sexual history routinely, in private and without assumptions about orientation or relationships; review every drug.
- Look for and treat medical causes, and check testosterone, prolactin and thyroid function when the history suggests them.
- Cognitive behavioral therapy and mindfulness-based practices are effective, with or without medicines.
- For SSRI-related problems, options include lowering the dose or switching to an antidepressant that impairs sexual response less, such as bupropion or mirtazapine; data on adding bupropion conflict.
- Flibanserin and bremelanotide are approved for low desire in premenopausal women; testosterone is not recommended in premenopausal women.

## Memory aid

A line, then a circle: in the linear model desire comes first; in Basson's circle, desire may arrive after arousal.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the key idea of Basson's circular model of sexual response?

Desire can be responsive: sexual activity may start from intimacy or other motives, and desire can build after arousal begins.

## Which antidepressant class commonly causes sexual dysfunction, and what does it cause?

SSRIs: in more than half of patients, mainly trouble reaching orgasm, plus lower libido and erectile dysfunction.

## Which antidepressants have the fewest sexual side effects?

Bupropion and mirtazapine, which lack the sexual adverse effects of SSRIs.

## What makes a sexual problem a DSM-5-TR sexual dysfunction?

Symptoms on at least 75 percent of occasions for at least 6 months that cause distress.

## What mediates erection, and what starts emission?

Erection: a sacral parasympathetic reflex; emission: stimulation of alpha-adrenergic receptors.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/behavioral-science/the-human-sexual-response-and-the-sexual-dysfunctions/)

## Elsewhere in DurgiPedia

- [Erection and ejaculation](https://durgical.com/en/physiology/erection-and-ejaculation/)
- [Menopause](https://durgical.com/en/physiology/menopause/)
- [Testosterone and its actions](https://durgical.com/en/physiology/testosterone-and-its-actions/)
- [Prolactin and its control by dopamine](https://durgical.com/en/physiology/prolactin-and-its-control-by-dopamine/)
- [Sexuality and sexual health in nursing care](https://durgical.com/en/nursing/sexuality-and-sexual-health-in-nursing-care/)

## Connections

## Related 5

- [Cognitive behavioral therapy and cognitive distortions](https://durgical.com/en/behavioral-science/cognitive-behavioral-therapy-and-cognitive-distortions/)
- [Family, group and interpersonal therapy](https://durgical.com/en/behavioral-science/family-group-and-interpersonal-therapy/)
- [Communication skills: open questions, empathy and teach-back](https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/)
- [Adulthood and middle age](https://durgical.com/en/behavioral-science/adulthood-and-middle-age/)
- [Normal psychological ageing vs dementia](https://durgical.com/en/behavioral-science/normal-psychological-ageing-vs-dementia/)

## Related conditions 8

- [Erectile dysfunction](https://durgical.com/en/conditions/erectile-dysfunction/)
- [Paraphilic disorders](https://durgical.com/en/conditions/paraphilic-disorders/)
- [Menopause and climacteric syndrome](https://durgical.com/en/conditions/menopause-and-climacteric-syndrome/)
- [Male hypogonadism](https://durgical.com/en/conditions/male-hypogonadism/)
- [Prolactinoma (hyperprolactinaemia)](https://durgical.com/en/conditions/prolactinoma/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Gender dysphoria](https://durgical.com/en/conditions/gender-dysphoria/)

## In Pharmacology 5

- [Selective serotonin reuptake inhibitors (SSRIs)](https://durgical.com/en/pharmacology/classes/selective-serotonin-reuptake-inhibitors/)
- [Bupropion](https://durgical.com/en/pharmacology/bupropion/)
- [Mirtazapine](https://durgical.com/en/pharmacology/mirtazapine/)
- [Flibanserin](https://durgical.com/en/pharmacology/flibanserin/)
- [Finasteride](https://durgical.com/en/pharmacology/finasteride/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Overview of Female Sexual Function and Dysfunction](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/overview-of-female-sexual-function-and-dysfunction) (MSD Manual Professional Edition, 2026); [Overview of Male Sexual Function and Dysfunction](https://www.msdmanuals.com/professional/genitourinary-disorders/male-sexual-function-and-dysfunction/overview-of-male-sexual-function-and-dysfunction) (MSD Manual Professional Edition, 2026); [Sexual Interest/Arousal Disorder](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/sexual-interest-arousal-disorder) (MSD Manual Professional Edition, 2026); [Drug Treatment of Depression](https://www.msdmanuals.com/professional/psychiatric-disorders/mood-disorders/drug-treatment-of-depression) (MSD Manual Professional Edition, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/behavioral-science/the-human-sexual-response-and-the-sexual-dysfunctions/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/the-human-sexual-response-and-the-sexual-dysfunctions/