Sexual arousal disorder refers to the difficulty patients have in generating or maintaining the normal physiological responses required for satisfactory sexual intercourse. In men, it manifests as erectile dysfunction (impotence), while in women, it presents as vaginal dryness or lack of lubrication (lack of external genital response in women). Impotence refers to the absence of an erectile response in the male genitalia—there is a desire for intercourse, but the penis fails to erect, lacks sufficient firmness, or cannot sustain erection long enough, making it difficult to initiate or maintain satisfactory intercourse. Impotence is categorized as primary or secondary. Primary impotence describes individuals who have never experienced genital erection and thus cannot engage in intercourse. Secondary impotence refers to those who previously could engage in normal intercourse but later develop erectile dysfunction, or those who can achieve normal erection with certain partners or in specific situations but fail in others. Women with a lack of external genital response seek medical attention less frequently, as the absence of vaginal lubrication often stems from a lack of sexual interest.

bubble_chart Etiology

The causes of sexual arousal disorder can be categorized as organic, psychological, and mixed factors. 30–50% of erectile dysfunction cases are caused by organic sexually transmitted diseases, while 85–90% of patients are influenced by psychological factors, many of whom experience exacerbated sexual arousal disorders due to underlying physical or metabolic conditions. The psychological causes of sexual arousal disorder can be summarized into four aspects: developmental influences (e.g., parental control, emotional conflicts with parents, a family’s negative attitude toward sexuality, childhood psychological trauma related to sex, difficulty in gender identity formation, traumatic first sexual experiences); interpersonal relationship issues (e.g., loneliness, hostility or distrust toward the opposite sex, lack of attraction from the opposite sex, abnormal sexual preferences or beliefs); emotional disorders (e.g., anxiety, depression, fear of pregnancy, fear of contracting sexually transmitted diseases); and cognitive factors (e.g., sexual ignorance, credulity toward certain myths).

Sexual arousal disorders can be judged based on their conceptual framework. During differential diagnosis, the first step is to determine whether the patient experiences sexual arousal dysfunction under any circumstances and to assess whether it is caused by psychological or organic factors. Generally, psychological sexual arousal disorders often have a sudden onset and may be temporarily linked to a specific psychological trauma. In males, spontaneous erections occur during REM sleep; if erections are possible under certain conditions but not others, the cause is likely psychological. Organic sexual arousal disorders are usually accompanied by decreased libido, whereas psychological ones may not necessarily involve a reduction in sexual desire.

bubble_chart Treatment Measures

The treatment principles for this disease should primarily focus on disease cause therapy, supplemented by necessary psychological therapy and pharmacological treatment.

(1) Disease cause therapy: For cases caused by disorders of the genitourinary system, endocrine system, medications, or nervous system, active treatment of the primary disease should be pursued.

(2) Psychological therapy: Treatment should involve sensate focus training and systematic desensitization methods conducted with the mutual consent of both spouses, aiming to alleviate the patient's anxiety and gradually restore normal sexual response function.

(3) Pharmacological treatment: Patients with erectile dysfunction may be administered tonics and male hormones to enhance constitution and relieve fatigue. It is noteworthy that prolonged and excessive use of such medications is harmful rather than beneficial. Sildenafil, recently introduced into clinical practice, has shown efficacy for erectile dysfunction of various etiologies, with an overall effectiveness rate of 40-80%, and an 80% efficacy rate for psychogenic erectile dysfunction. Its side effects include nausea, stuffy nose, rash, headache, and transient visual disturbances. Currently, the most alarming concern is the reported deaths of 69 individuals associated with sildenafil use. Therefore, it must be used strictly under medical supervision.