Etiology

Biological/Medical Causes

 Diabetes: This condition can lead to autonomic neuropathy and vascular disease,
affecting sexual performance in males by causing erectile difficulties and early
markers of cardiovascular disease. Diabetes can also lead to complications like penile
microangiopathy, which directly impacts erectile function .15

 Cardiovascular Disease: Conditions such as hypertension, myocardial infarction, and

peripheral vascular disease can impact sexual function by affecting blood flow,
potentially leading to erectile dysfunction. The presence of ED has been shown to be
a major risk factor for cardiovascular disease, highlighting the interconnectedness of
these health issues . 5

 Neurological Disorders: Parkinson's disease, for example, can affect sexual desire and
response. Other neurological conditions can also lead to sexual dysfunction,
emphasizing the importance of a comprehensive evaluation to identify underlying
causes .
1

 Menopause: Hormonal changes in women can cause vaginal dryness and dyspareunia,
affecting sexual function. This is a clear example of how endocrine conditions can
directly impact sexual health .
1

 Chronic Diseases: Kidney or liver failure can indirectly impact sexual function due to
the overall health status of the individual. These conditions can lead to a variety of
symptoms that affect sexual performance and satisfaction .1

 Endocrine Conditions: Besides diabetes, hyperthyroidism, and Addison's disease can

directly or indirectly affect sexual function. These conditions can lead to a range of
symptoms, from hormonal imbalances to metabolic issues that impact sexual health . 1

 Gynecological Conditions: Vaginitis, endometriosis, and pelvic infections can lead to

sexual dysfunction. These conditions can cause pain, discomfort, and a lack of sexual
desire, affecting the sexual response cycle .
1

 Respiratory Conditions: Asthma and obstructive airways disease can indirectly affect
sexual function by causing sleep disturbances and other health issues that impact
sexual health . 1

 Other Conditions: Prostate cancer, arthritis, renal failure, pelvic autonomic

neuropathy, spinal cord lesions, and stroke can also contribute to sexual dysfunction.
These conditions can lead to a variety of symptoms that affect sexual performance
and satisfaction . 1

 Medication Side Effects: Certain medications, including antidepressants,

antipsychotics, and antihistamines, can impair sexual function. This highlights the
importance of considering medication side effects when evaluating sexual
dysfunction .
1
Psychological Causes

 Negative Body Image and Performance Anxiety: Fear of rejection, negative self-
perception, and performance anxiety can significantly impact sexual function. These
psychological factors can lead to a lack of interest in sex or a fear of sexual
performance, affecting sexual satisfaction .
1

 Depression: There is a strong relationship between depression and sexual dysfunction,

with rates estimated at up to 50%. Depression can lead to a lack of interest in sex,
difficulty achieving orgasm, and other symptoms that affect sexual health .1

 Work-Related Stress and Anxiety: Concerns about sexual performance, marital or

relationship problems, and past sexual trauma can contribute to dysfunction. These
psychological factors can lead to a variety of symptoms that affect sexual
satisfaction .
1

Sociocultural Causes

 Social Contact and Environmental Circumstances: Communication and relationship

inequalities, sociocultural influences like sex-role or religious proscriptions, and
environmental factors such as lack of privacy and disparate work schedules can
contribute to sexual dysfunction. These factors can create stress and anxiety that
impact sexual health .
1

 Cultural and Societal Myths: Misconceptions about sex, expectations, and the natural
part of aging can lead to sexual dysfunction. These societal beliefs can create
unrealistic expectations and fears that affect sexual satisfaction .
1

Understanding these causes in detail is crucial for diagnosing and treating sexual dysfunction
effectively. It's important to consider both biological and psychological factors alongside
sociocultural and medical influences to provide a comprehensive approach to sexual health.
Several neurotransmitters play a role in sexual function and dysfunction
1. Dopamine: Involved in reward and pleasure, dopamine plays a role in sexual
arousal and motivation. Dysregulation of dopamine levels can contribute to
sexual dysfunction, such as in hypoactive sexual desire disorder.

2. Serotonin: Known for its role in mood regulation, serotonin also influences
sexual desire and arousal. Medications that increase serotonin levels, like
selective serotonin reuptake inhibitors (SSRIs), can sometimes lead to sexual
side effects.

3. Norepinephrine: Involved in the body's stress response. Dysregulation of

norepinephrine levels can impact sexual function, such as in erectile
dysfunction.

4. Oxytocin: Often referred to as the "love hormone," oxytocin is associated

with bonding and social behaviors. It also plays a role in sexual arousal,
orgasm, and satisfaction.

Imbalances or dysregulation of these neurotransmitters can contribute to

various forms of sexual dysfunction, including erectile dysfunction, premature
ejaculation, and hypoactive sexual desire disorder. Additionally, medications
that affect neurotransmitter levels, such as antidepressants, can also influence
sexual function.
Several brain areas are implicated in sexual function and dysfunction in both
males and females. Here are some key regions:

1. Hypothalamus: Regulates sexual behavior and arousal by integrating

hormonal and neural signals. It plays a central role in initiating and
coordinating sexual responses.

2. Limbic system: Includes structures such as the amygdala and hippocampus,

which are involved in emotional processing and memory. Emotional
responses to sexual stimuli are mediated by the limbic system.

3. Cerebral cortex: Responsible for higher cognitive functions, including sexual

arousal, desire, and perception. Areas such as the prefrontal cortex and
parietal cortex are involved in processing sexual stimuli and initiating sexual
responses.

4. Spinal cord: Transmits sensory and motor signals related to sexual arousal
and response between the brain and the genitals. Dysfunction in spinal cord
pathways can lead to erectile dysfunction or problems with orgasm and
ejaculation.

5. Anterior cingulate cortex (ACC): Plays a role in monitoring and regulating

emotional and cognitive processes. Dysfunction in the ACC can contribute to
sexual dysfunctions such as erectile dysfunction and decreased sexual
motivation.

6. Hypothalamic-pituitary-adrenal (HPA) axis: Regulates the body's stress

response and can impact sexual function. Chronic stress and dysregulation of
the HPA axis can lead to sexual dysfunction.
These brain areas interact and communicate with each other to facilitate sexual
arousal, desire, and response. Dysfunction or alterations in these regions can
contribute to various forms of sexual dysfunction in both males and females.