Sexual Dysfunction in Men and Women: Real Causes, Effects, and Therapy Solutions

Updated: October 2025 · Reviewed for accuracy and improved with current clinical context.

If you’ve ever struggled to get aroused, lost the mood halfway, felt pain during sex, or simply thought, “Why don’t I enjoy sex anymore?” – that’s sexual dysfunction. It’s far more common than most people admit, and it’s not just about the body. It affects how you see yourself, how you connect with your partner, and how safe intimacy feels in your relationship.

Globally, 31% of men and 43% of women will face some form of sexual dysfunction in their lifetime. In India, the numbers are even higher in many studies, between 22% and 76%, depending on the group studied. That means it’s not rare, and it’s not just happening to “other people.”

Here’s what that looks like in real life:

• Men in their 20s and 30s: erection problems, climaxing too quickly, or losing confidence after one “failure.”
  
• Women in their 20s to 40s: loss of desire, painful intercourse, or struggling to reach orgasm.
  
• Middle-aged couples: mismatched sex drives, stress from work or money, resentment creeping in.
  
• Older adults: hormonal changes, chronic illness, and feeling like intimacy has slipped away.

This guide is for you if you’re tired of wondering “what’s wrong with me,” or if you’re watching your relationship drift because of unspoken struggles in bed. 

What Is Sexual Dysfunction (and Sexual Distress)?

Sexual dysfunction is a repeated difficulty with sexual desire, arousal, orgasm, or pain during sex. It can affect both men and women at any age. Beyond physical problems, it often causes emotional distress, lowers confidence, and creates strain in relationships.

Sexual dysfunction isn’t about one off-night. It’s when sex repeatedly feels difficult, unsatisfying, or even painful. Over time, it stops being a source of connection and becomes a source of worry.

The most common forms include:

• Low sexual desire – little or no interest in sex
• Arousal issues – trouble getting or staying aroused
• Orgasm difficulties – delayed, absent, or unsatisfying climax
• Pain during sex – discomfort that makes intimacy stressful

But there’s more to it than physical challenges. Many people experience what therapists call sexual distress, the emotional suffering that comes with the problem. You might feel anxious, ashamed, guilty, or even “broken.” In many cases, the distress ends up damaging the relationship more than the dysfunction itself.

Whether you call it “sexual dysfunction,” “sex problems,” or “sexual difficulties,” the experience is real. And while silence makes it worse, support and therapy can help rebuild both sexual well-being and emotional closeness.

Sexual Dysfunction in Men and Women

Sexual dysfunction doesn’t look the same for everyone. Men and women experience it differently, and the impact often shifts with age, health, and life circumstances. Understanding this helps break the silence and shows you’re not alone if you’re facing it.

In Men

For men, the most common issues include:

• Erectile difficulties – trouble getting or maintaining an erection
• Premature ejaculation – climaxing earlier than desired
• Delayed or absent ejaculation – struggling to reach orgasm
• Low desire – a drop in sexual interest altogether

These problems are often linked to stress, anxiety, or medical conditions like diabetes and high blood pressure. Younger men may notice performance anxiety or porn-related expectations creeping in, while older men are more likely to face erectile issues due to health changes.

In Women

For women, sexual dysfunction usually shows up differently:

• Low sexual desire – reduced or absent interest in sex
• Arousal difficulties – difficulty becoming physically ready for sex
• Orgasmic problems – delayed or absent orgasm
• Pain during sex – discomfort or conditions like vaginismus or vaginal dryness

Women often face unique triggers such as hormonal shifts (postpartum, perimenopause, menopause), stress from family or work, and in some cases, unresolved trauma. 

Unlike men, where performance is often the focus, women tend to carry distress quietly, feeling guilt or self-blame when sex becomes difficult.

Shared Struggles

Despite the differences, one thing is common: the emotional impact. Men may feel “less masculine,” while women may feel “undesirable.” Both can lead to avoidance, silence, and distance in the relationship.

Sexual Dysfunction Across Age Ranges

Sexual dysfunction doesn’t look the same for everyone. At different stages of life, it can appear in different ways, sometimes physical, sometimes emotional, sometimes both. The details may vary, but the feelings of frustration, worry, and silence are universal.

In Your 20s

At this age, many people expect sex to feel natural and effortless. But for some, anxiety takes over – erections don’t last, climax comes too quickly, or sex feels tense instead of enjoyable. 

For women, it may mean pain during sex, struggling to let go, or guilt about desire. Not everyone goes through this, but if you do, it can feel isolating because few people talk about it.

In Your 30s

Responsibilities grow heavier – careers, marriages, and parenting. You might notice desire fading, or sex slipping into routine. For some, exhaustion, work stress, or family pressure overshadow intimacy. 

New parents may find sex painful or feel disconnected from their partner. Not every couple faces this, but when it happens, it often feels like a hidden burden.

In Your 40s

This is a stage where health and hormones start to shift. Some men find erections less reliable, while some women notice changes in arousal or comfort during sex. 

Others may feel emotionally distant because life is so full of demands – children, ageing parents, financial worries. The form may differ, but the impact is often the same: sex feels harder to talk about.

In Your 50s and Beyond

Here, physical changes are more common – menopause for women, erectile changes for men. But the deeper struggle is often emotional: worrying about desirability, feeling that “sex is over,” or missing closeness with a partner. 

Yet many couples also find this stage brings a chance to reconnect and explore intimacy in new, less pressured ways.

Causes of Sexual Dysfunction for Both Men and Women

Causes of Sexual Dysfunction in Men

In Your 20s

At this age, the body is usually healthy, but the mind often becomes the biggest barrier.

• Performance anxiety: A single failed erection can spiral into fear the next time. Many young men start avoiding sex altogether because they don’t want to “fail again.”
  
• Porn and unrealistic expectations: Porn trains the brain to expect instant arousal and endless stamina. Real sex feels different, and men panic when their body doesn’t “keep up.”
  
• Guilt or early trauma: Some carry scars from inappropriate childhood experiences or strict family environments that taught them sex is “wrong.” Those messages don’t vanish overnight.
  
• Lifestyle habits: Late nights, drinking, smoking, or endless gaming all take their toll  but when erections fail, men usually blame themselves, not their lifestyle.
  

👉 In your 20s, dysfunction is rarely a medical issue. It’s more about stress, self-image, and silence.

In Your 30s

Now the weight of responsibility shows up in the bedroom.

• Work and financial pressure: It’s hard to focus on sex when your mind is stuck on deadlines or bills. Many men describe “losing interest” not because they don’t want sex, but because they’re mentally exhausted.
  
• Premature ejaculation and erection issues: Stress hormones like cortisol directly interfere with arousal. Some men climax too quickly, others can’t stay hard. Both situations fuel shame.
  
• Family dynamics: Trying for children can turn sex into a scheduled chore. Arguments or resentment with a partner often translate into avoidance.
  
• Hidden guilt or affairs: Affairs, pornography secrecy, or unspoken conflict may quietly erode desire, even if love for the partner remains.

👉 In your 30s, dysfunction is usually the product of stress colliding with intimacy.

In Your 40s

The physical body starts to demand attention here.

• Medical conditions: Diabetes, high blood pressure, and cholesterol often show up now, all of which affect erections. Many men ignore these until sexual problems force them to notice.
  
• Testosterone decline: Even a gradual drop can reduce desire, energy, and confidence.
  
• Midlife stress: Parenting teenagers, workplace competition, or caring for ageing parents adds emotional weight that follows into the bedroom.
  
• Distance in marriage: By this stage, unresolved arguments or years of mismatched expectations often surface as a loss of sexual connection.
  

👉 Dysfunction here is usually a mix of health, hormones, and emotional disconnection.

In Your 50s and Beyond

Here, the changes are more visible and harder to ignore.

• Chronic illness and medications: Heart conditions, arthritis, prostate problems, or the side effects of medication all influence erections and desire.
  
• Reliance on pills: Many men use Viagra or similar drugs, but without therapy, the fear of “not performing” never goes away.
  
• Masculinity fears: When sex changes, many men secretly feel “less of a man,” even if their partner is understanding.
  
• Years of silence: The longer sex has been avoided or minimised, the harder it feels to bring it up again, not because of the body, but because of the emotional wall.
  

👉 In your 50s and beyond, dysfunction is often less about performance itself and more about identity, confidence, and connection.

Causes of Sexual Dysfunction in Women

In Your 20s

Sex in your twenties is often painted as adventurous and carefree, but the reality can be very different.

• Pain during sex: Conditions like vaginismus, vaginal dryness, or even lack of comfort with your partner can make sex physically painful.
  
• Early trauma or inappropriate experiences: Unwanted advances or childhood experiences may resurface, making it hard to relax.
  
• Shame and guilt: Growing up in families where sex is taboo often leaves women struggling to feel “allowed” to enjoy it.
  
• Pressure to perform: Comparing yourself to friends or worrying about “body count” can create anxiety that blocks arousal.
  

👉 In your 20s, dysfunction often comes from emotional scars and performance pressure, not physical decline.

In Your 30s

This stage brings both new joys and new pressures.

• Pregnancy and childbirth: Hormonal changes, body image shifts, and painful postpartum sex are common but rarely spoken about.
  
• Exhaustion: Balancing kids, work, and home leaves little energy for sex. Desire fades not because of lack of love, but lack of rest.
  
• Emotional overload: Women often carry the heavier share of parenting and household responsibilities, leading to silent resentment that shows up in the bedroom.
  
• Relationship stress: Arguments, lack of help from a partner, or even subtle power struggles can make sex feel like another duty instead of something to look forward to.
  

👉 In your 30s, dysfunction often reflects the collision of physical changes and emotional weight.

In Your 40s

Here, hormonal changes and emotional shifts often overlap.

• Perimenopause: Dryness, irregular cycles, hot flashes, and mood swings can lower desire and make sex physically uncomfortable.
  
• Arousal difficulties: It may take longer to feel ready, which can create frustration if the partner doesn’t understand.
  
• Stress sandwich: Many women are caring for children and ageing parents while also juggling careers. Stress leaves little space for desire.
  
• Relationship distance: If emotional connection has been neglected, sex feels harder to initiate and easier to avoid.
  

👉 Dysfunction here is usually a mix of hormones, stress, and long-standing emotional patterns.

In Your 50s and Beyond

Menopause reshapes the body, but the emotional impact often feels heavier.

• Pain and dryness: Declining oestrogen can make sex uncomfortable or even unbearable without support.
  
• Loss of desire: Hormonal shifts can reduce libido, but social beliefs (“sex is for younger people”) make it worse.
  
• Feeling undesirable: Many women describe feeling invisible or unwanted, even when their partner hasn’t said anything.
  
• Years of silence: If sex has been avoided for long, initiating again feels almost impossible.
  

👉 In your 50s and beyond, dysfunction is less about biology alone and more about confidence, self-image, and communication.

Symptoms and Warning Signs of Sexual Dysfunction

Sexual dysfunction often starts with small, frustrating changes that build up over time. Recognising the signs of sexual dysfunction early can help you seek support before it begins to harm your confidence or relationship.

Symptoms of Sexual Dysfunction in Men

For men, the body often gives clear signals:

• Erectile problems – difficulty getting or maintaining an erection regularly
• Premature ejaculation – climaxing sooner than desired
• Delayed or absent ejaculation – struggling to orgasm even with stimulation
• Low libido – a sudden or ongoing drop in sexual desire
• Avoidance – staying away from sex out of fear of failure

👉 Many men with sexual dysfunction describe feeling anxious or “less masculine,” even though these problems are common and treatable.

Symptoms of Sexual Dysfunction in Women

In women, sexual dysfunction often shows up more quietly but can be just as distressing:

• Low sexual desire – lack of interest in sex despite wanting closeness
• Arousal issues – difficulty becoming physically ready for sex
• Orgasmic dysfunction – delayed, absent, or unsatisfying orgasms
• Pain during sex – dryness, discomfort, or conditions like vaginismus
• Emotional distress – guilt, shame, or frustration instead of pleasure

👉 Many women don’t report these symptoms of sexual dysfunction, worried about being judged or letting their partner down.

Emotional and Relationship Signs of Sexual Dysfunction

Sexual dysfunction doesn’t stop at physical symptoms. The emotional impact is just as real:

• Anxiety before sex – worrying if things will “work”
• Loss of intimacy – avoiding touch, affection, or closeness
• Relationship strain – fights, resentment, or silence replacing connection
• Feeling “broken” – carrying guilt or shame in silence

The Impact of Sexual Dysfunction on Life and Relationships

The impact of sexual dysfunction isn’t just about sex itself. It sneaks into how you feel about yourself, how you look at your partner, and even how you carry yourself at work or with friends. What begins in the bedroom slowly shows up everywhere else.

Impact on Confidence and Mental Health

When your body doesn’t respond the way you expect, self-doubt creeps in fast.

• Many men quietly wonder, “Am I still a man if I can’t keep an erection?”
• Many women think, “What’s wrong with me if I don’t want sex or if it hurts every time?”

Over time, these thoughts don’t stay limited to sex. They spill into everyday life, you may feel distracted, less confident in social situations, or simply “off” in your skin. 

Anxiety and depression often follow, and sometimes the fear of the next sexual encounter becomes more stressful than the dysfunction itself.

Impact on Relationships

The effects of sexual dysfunction in relationships are rarely talked about, yet almost every couple feels them.

• One partner avoids sex because they fear failure or pain.
• The other feels rejected and unwanted.
• Small touches – a hug, a kiss, sitting close – start disappearing because both are nervous about “where it might lead.”

Arguments may not even be about sex at all, they erupt over chores, money, or parenting but underneath, the sexual distance fuels the tension. Some couples start living more like flatmates than lovers, and neither knows how to break the silence.

Impact on Daily Life

Sexual dysfunction can change the rhythm of your whole day.

• You might avoid situations that could lead to intimacy.
• At work, your mind drifts because of the stress you’re carrying.
• Socially, you may pull back from friends or gatherings because you don’t feel like yourself.
• Some people overcompensate, taking pills in secret, relying more on porn, or chasing casual encounters to “prove” they can still perform.

These coping strategies don’t heal the problem, they often deepen the loneliness.

Treatment Options and Solutions for Sexual Dysfunction

Most people start with quick fixes – pills, supplements, or late-night Google searches — because it feels easier than saying the words out loud. 

But while these may help for a moment, they rarely solve the real problem. Lasting recovery usually means looking at both body and mind.

Therapy and Counselling

For many, therapy is the missing piece.

• Individual therapy helps unpack performance anxiety, past trauma, or self-esteem issues that block desire.
  
• Couples counselling creates a safe space to talk about what’s been unsaid – guilt, rejection, or distance.
  
• Sex therapy offers guided techniques like sensate focus (non-sexual touch to rebuild comfort) or communication tools that rebuild confidence step by step.

Research shows that psychological and relational therapies are often more effective than medication alone, especially for problems rooted in stress, anxiety, or relationship conflict.

Medical Support

Sometimes the cause is physical, and medical help makes a difference.

• Men: medications for erectile dysfunction, testosterone therapy if levels are low, or treatment for underlying conditions like diabetes or heart disease.
  
• Women: hormonal therapies, lubricants, or vaginal oestrogen for dryness and pain during or after menopause.

Medical treatment works best when paired with emotional support, not as a replacement for it.

Lifestyle Adjustments

Small, everyday changes often make a big difference in sexual health.

• Regular exercise improves blood flow and boosts mood.
• Reducing alcohol, smoking, or drugs can improve arousal and desire.
• Better sleep lowers stress hormones that interfere with sex.
• Mindfulness and relaxation practices calm racing thoughts that block arousal.

These aren’t “cures,” but they help the body and mind stay ready for intimacy.

The treatment of sexual dysfunction is not one-size-fits-all. For some, it’s therapy. For others, medical support. Most often, it’s a mix of both. 

What matters most is that you don’t ignore it because sexual dysfunction is treatable, and closeness can be rebuilt.

Why Therapy Is the Key to Treating Sexual Dysfunction

Pills may help the body, but they don’t fix the fear, guilt, or silence that drive sexual dysfunction. That’s why therapy is often the most effective treatment.

• Talk therapy helps release shame, cultural pressure, and unspoken conflicts.
  
• Cognitive Behavioural Therapy (CBT) teaches you to challenge anxious thoughts like “I’ll fail again” and replace them with calm, realistic ones.
  
• Sensate focus therapy guides couples to rebuild comfort through touch without pressure to “perform.”
  
• Trauma-focused therapy supports people whose past experiences resurface as fear or avoidance.
  
• Couples counselling helps partners talk about sex openly, resolve mismatched drives, and repair closeness.

Unlike quick fixes, therapy works on the mind, emotions, and relationships, the real roots of sexual dysfunction.

Final Thoughts

Sexual dysfunction can make you feel isolated, ashamed, or even “broken.” But here’s the truth: sex is not a luxury, it’s part of being human. You have the right to enjoy it, to feel close to your partner, and to experience pleasure without fear or pain.

Too many people settle for silence or quick fixes. Pills may mask the problem, but they don’t bring back confidence, desire, or the warmth of feeling wanted. Real change happens when you look at the roots – stress, past experiences, health, or relationship strain and work through them with the right support.

At PsychiCare, we believe no one should have to suffer in silence. Our team of trained sexologists and psychologists has already helped more than 5,000 people worldwide both men and women, singles and married couples to reclaim their sexual wellbeing. Backed by 200+ positive reviews, we’ve seen time and again that when you give yourself permission to talk, to seek therapy, and to heal, sex can stop being stressful and start becoming joyful again.

Sexual dysfunction is treatable. More importantly, intimacy, closeness, and sexual happiness are your right, and with the right support, you can have them back.

FAQs on Sexual Dysfunction

1. Why can’t I enjoy sex even in my 20s?

For some women, painful or anxious sex comes from early experiences – unwanted touching, strict families, or fear around sex. For some men, it’s smoking, drinking, or stress at home. Even in your 20s, these things can block desire or arousal.

2. Why do I get hard alone but not with my partner?

This is usually not a body problem – it’s anxiety. When you’re with a partner, pressure takes over and your body shuts down. Many men in their 20s and 30s describe this. Therapy helps calm the fear so sex feels natural again.

3. Why does sex feel like pressure instead of fun?

When sex feels like another job, it’s often because of stress, fights, or exhaustion. For women, carrying too many responsibilities kills desire. For men, work or financial stress often lowers performance. Therapy helps couples shift from pressure back to play.

4. Why do I avoid sex after one bad experience?

A single “failure” – losing an erection, finishing too fast, or painful sex can make you panic about the next time. Many people then avoid sex completely. Therapy breaks this cycle and rebuilds confidence one step at a time.

5. Can family stress affect sex?

Yes. Growing up in chaotic or critical families often leaves hidden stress that shows up later in relationships. Some people carry guilt, some carry anger, and both can block desire or performance. Therapy helps untangle family patterns from your sex life.

6. Why does sex hurt even when I want it?

For women, pain can come from dryness, vaginismus, or past trauma. It feels confusing when the mind says yes but the body says no. It’s not weakness. Therapy and medical care together make sex safer and more comfortable.

7. Can alcohol or smoking cause problems in bed?

Yes. Many young men in forums share how heavy drinking, smoking, or late-night partying made erections or desire weaker. What feels fun at first can create long-term dysfunction. Cutting back, alongside therapy, usually brings things back on track.

8. Why do I feel guilty after sex?

Guilt often comes from upbringing – being told sex is “wrong” or dirty. Even when you want it, the old messages create shame. Therapy helps replace guilt with acceptance, so sex feels natural and happy instead of heavy.