Sexual Dysfunctions: A Comprehensive Review of Diagnostic Classification, Clinical Features, and Current Treatment Approaches

Abstract

Sexual dysfunctions (SDs) are clinical conditions characterized by disturbances in one or more phases of the sexual response cycle, leading to significant psychological distress and impairment in functioning. The sexual response cycle involves complex interactions among hormonal, neurological, vascular, and psychosocial factors. The four-phase model proposed by Masters and Johnson and the three-phase model introduced by Kaplan form the theoretical basis of current diagnostic frameworks. Over time, the classification of SDs has evolved, and DSM-5 introduced significant modifications, including the merging and restructuring of certain diagnostic categories. Epidemiological studies indicate that the prevalence of SDs varies depending on diagnostic criteria and assessment methods; recent meta-analyses suggest rates of approximately 31% in men and 41% in women. Premature ejaculation and erectile disorder are among the most commonly reported SDs in men, whereas female sexual interest/arousal disorder and female orgasmic disorder are more prevalent among women. SDs may present as lifelong or acquired, generalized or situational. A comprehensive diagnostic evaluation includes detailed sexual history, physical and neurological examination, and assessment of medical conditions and substance or medication use. Treatment approaches include psychoeducation, cognitive-behavioral sex therapy, couple therapy, and pharmacological interventions. Behavioral and cognitive-based sex therapy approaches have been shown to contribute significantly to clinical improvement, particularly in premature ejaculation and genito-pelvic pain/penetration disorder. This review provides a comprehensive and integrative overview of the diagnostic framework, epidemiology, clinical subtypes, and current treatment approaches in SDs.