Psychological and interpersonal dimensions of sexual function and dysfunction
Abstract
ABSTRACT Introduction Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term. Aim To focus on psychological and interpersonal aspects of sexual functioning in women and men after a critical review of the literature from 2010 to the present. Methods This report is part 1 of 2 of our collaborative work during the 2015 International Consultation on Sexual Medicine for Committee 2. Main Outcome Measures Systematic review of the literature with a focus on publications since 2010. Results Our work as sexual medicine clinicians is essentially transdisciplinary, which involves not only the collaboration of multidisciplinary professionals but also the integration and application of new knowledge and evaluation and subsequent revision of our practices to ensure the highest level of care provided. There is scant literature on gender non-conforming children and adolescents to clarify specific developmental factors that shape the development of gender identity, orientation, and sexuality. Conversely, studies consistently have demonstrated the interdependence of sexual function between partners, with dysfunction in one partner often contributing to problems in sexual functioning and/or sexual satisfaction for the other. We recommend that clinicians explore attachment styles of patients, childhood experiences (including sexual abuse), onset of sexual activity, personality, cognitive schemas, infertility concerns, and sexual expectations. Assessment of depression, anxiety, stress, substance use and post-traumatic stress (and their medical treatments) should be carried out as part of the initial evaluation. Clinicians should attempt to ascertain whether the anxiety and/or depression is a consequence or a cause of the sexual complaint, and treatment should be administered accordingly. Cognitive distraction is a significant contributor to sexual response problems in men and women and is observed more consistently for genital arousal than for subjective arousal. Assessment of physical and mental illnesses that commonly occur in later life should be included as part of the initial evaluation in middle-aged and older persons presenting with sexual complaints. Menopausal status has an independent effect on reported changes in sex life and difficulties with intercourse. There is strong support for the use of psychological treatment for sexual desire and orgasm difficulties in women (but not in men). Combination therapies should be provided to men, whenever possible. Conclusion Overall, research strongly supports the routine clinical investigation of psychological factors, partner-related factors, context, and life stressors. A biopsychosocial model to understand how these factors predispose to sexual dysfunction is recommended.
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Few papers provide a comprehensive and exclusive overview of the psychological and relational/social aspects underlying ED.
“Although increasingly more clinicians have started to integrate psychological assessment and advices in ED protocols, there are only few papers available that provide a comprehensive and exclusive overview of the psychological and relational/social aspects underlying ED.7,14”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [14]
ED and its treatment involve a shared stressor that is challenging for both partners.
“Not only does ED and its treatment involve a shared stressor that is challenging for both partners, but it is also common that sexual changes in 1 partner go along with sexual changes in the other partner.14,51,52”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [14]
Sexual changes in one partner go along with sexual changes in the other partner.
“Not only does ED and its treatment involve a shared stressor that is challenging for both partners, but it is also common that sexual changes in 1 partner go along with sexual changes in the other partner.14,51,52”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [14]
ED may cause partners to feel sexually unattractive, induce feelings of guilt and rejection, generate relational distress, and interfere with their own sexual function.
“Furthermore, sexual partners may need counselling too because the ED may cause them to feel sexually unattractive, induce feelings of guilt and rejection, generate relational distress, and interfere with their own sexual function.14,54,55”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [14]
A narrow focus on genital function or performance disregards the broader relational context and psychological variables that constitute a patient and partner's sexual satisfaction and quality of life.
“A narrow focus on genital function or performance disregards the broader relational context and psychological variables that constitute a patient and partner's sexual satisfaction and quality of life.14,124,140”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [14]
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- Authors
- Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Byers, E. S., Graham, C., Nobre, P., & Wylie, K.
- Affiliations
- University of British Columbia (CA)
- Clinique du Levant , Beirut, , Lebanon
- Obstetrics and Gynecology , Phoenix, AZ , USA
- Haziporen 10bet , Bet Shemesh, , Israel
- Universidade de São Paulo (BR)
- University of New Brunswick (CA)
- University of Southampton (GB)
- University of Aveiro (PT)
- Porter Brook Medical Centre (GB)
- Corresponding author
- Brotto, Lori
- ORCID
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-04-01
- Volume
- 13
- Issue
- 4
- Pages
- 538-571
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W3080181030
- Cited by
- 439
- References
- 359
- Citations by year
- 2026: 28 · 2025: 58 · 2024: 44 · 2023: 57 · 2022: 44 · 2021: 64 · 2020: 55 · 2019: 29 · 2018: 29 · 2017: 23 · 2016: 6 · 2015: 1
- FWCI
- 4.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Social Sciences › Sociology and Political Science › Marriage and Sexual Relationships
- Keywords
- sexual dysfunction, sexual function, psychological factors, interpersonal factors, biopsychosocial model, sexual satisfaction, attachment styles, child sexual abuse, cognitive schemas, cognitive distraction, anxiety and depression, substance use, post-traumatic stress, menopause, sexual desire disorders, orgasm disorders, sexual medicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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