Sexual Disorders
On this page
Direct answer
Sexual disorders divide into sexual dysfunctions — clinically significant disturbance of desire, arousal, orgasm or sexual pain causing distress — and the paraphilias, intense atypical sexual interests involving non-consenting persons, suffering or objects. In men the classics are erectile disorder and premature ejaculation, the commonest male sexual dysfunction; in women, interest-arousal disorder, orgasmic disorder and genito-pelvic pain-penetration disorder (dyspareunia and vaginismus). Management begins with a detailed sexual history, treatment of medical, drug and relational causes, and sex therapy, with pharmacotherapy where specific — phosphodiesterase-5 inhibitors for erectile dysfunction (never with nitrates) and SSRIs or dapoxetine for premature ejaculation.
What you must remember
- Response cycle: Masters and Johnson described excitement, plateau, orgasm and resolution; Kaplan's triphasic model of desire, arousal and orgasm underlies the categories — the phase that fails names the disorder.
- Erectile disorder: failure to obtain or maintain erection in most attempts for six months or more; psychogenic dysfunction is sudden, situational and spares morning erections, while organic is gradual and global (diabetes, vascular disease, drugs); phosphodiesterase-5 inhibitors are first-line, contraindicated with nitrates.
- Premature ejaculation: ejaculation within about one minute of penetration with inability to delay, the commonest male sexual dysfunction; treated with squeeze (Semans) and stop-start techniques, SSRIs (paroxetine classically) or on-demand dapoxetine.
- Female dysfunctions: orgasmic disorder, interest-arousal disorder, and genito-pelvic pain-penetration disorder merging dyspareunia and vaginismus, treated with graduated dilators, pelvic floor physiotherapy and couple therapy.
- Evaluation essentials: full medical, drug and substance history with endocrine screen where indicated; distinguish lifelong from acquired and global from situational, and involve the partner.
- Paraphilias (disorders when causing distress or harm): exhibitionism (among the commonest clinically), voyeurism, frotteurism, masochism and sadism, fetishism, transvestic fetishism and pedophilic disorder; treated with cognitive behaviour therapy, relapse prevention and antiandrogens or SSRIs where indicated.
- Terminology evolution: ego-dystonic homosexuality was removed from classifications; gender identity disorder is now gender dysphoria in DSM-5 and gender incongruence in ICD-11 — an identity issue distinct from paraphilias.
Common confusion
Erectile dysfunction of psychogenic versus organic origin is the classic viva split: sudden, situational dysfunction with morning erections preserved points psychogenic; gradual, global loss with vascular or diabetic risk points organic. Among paraphilias, fetishism (arousal by objects), transvestic fetishism (cross-dressing for arousal) and gender dysphoria (identity, not arousal) sort many MCQs, and voyeurism versus exhibitionism — watching versus showing — is the most swapped pair.
Exam-focused takeaway
NEET-PG asks sexual medicine as phase-matching (the phase disturbed names the dysfunction), mechanism-drug pairing (sildenafil contra nitrates, paroxetine or dapoxetine for premature ejaculation, squeeze technique as the behavioural answer), and paraphilia matching from one-line scenarios. Expect organic-versus-psychogenic erectile dysfunction vignettes using morning erections as the clue and a vaginismus stem answered by graduated dilation.
Frequently asked questions
What are the phases of the human sexual response cycle?
Kaplan's triphasic model of desire, arousal and orgasm, refining Masters and Johnson's four-phase cycle — dysfunction is named by the phase affected.
How is psychogenic erectile dysfunction distinguished from organic?
Psychogenic is sudden and situational with morning erections preserved; organic is gradual and global, with vascular, diabetic, hormonal or drug causes.
Which drugs treat erectile dysfunction and what is the key contraindication?
Phosphodiesterase-5 inhibitors such as sildenafil — contraindicated with nitrates because of catastrophic hypotension.
What is the first-line approach to premature ejaculation?
Squeeze and stop-start behavioural techniques, plus SSRIs such as paroxetine or on-demand dapoxetine.
What is genito-pelvic pain-penetration disorder?
The DSM-5 merging of dyspareunia and vaginismus, treated with graduated dilators, pelvic floor therapy and couple work.
What is the difference between voyeurism and exhibitionism?
Voyeurism is arousal from watching unsuspecting persons; exhibitionism is arousal from exposing one's genitals to strangers.