Classification and Etiology

Organic causes, pharmacological impact and lifestyle habits.

To understand sexual difficulties, it is imperative to first distinguish between biological and psychogenic factors.

Organic causes encompass medical conditions that alter the physiology of sexual response, such as cardiovascular disease, endocrine imbalances, or infections.

A significant external factor is substance use; for example, excessive alcohol or tobacco use can directly inhibit erectile response or lubrication.

Also, certain pharmacological treatments, such as antihypertensives or psychotropics (antidepressants, antipsychotics), have known side effects that decrease libido or hinder orgasm.

Finally, the natural aging process entails anatomical and hormonal changes that, while to be expected, may require an adaptation in the sexual dynamics of the couple.

Psychological factors and educational influence

The psychological dimension plays a preponderant role, often more determinant than the biological dimension in certain disorders such as premature ejaculation.

Negative thoughts, anxiety and work or relationship stress act as pleasure blockers.

A restrictive or fear-based sexual education ("sex is dirty" or "dangerous") can install limiting beliefs that persist into adulthood, generating guilt or inhibition.

Personality also plays a role; individuals with low self-esteem, body shame or fear of rejection are more predisposed to develop dysfunction.

In addition, previous traumatic experiences, such as abuse or unsatisfactory first relationships, may condition an anxious response to the current intimate encounter.

Typologies: Primary vs. Secondary and Situational vs. Generalized

Clinically, we classify dysfunctions according to their history and context of onset.

A dysfunction is "primary" or lifelong if the individual has always experienced the difficulty from the beginning of his or her sexual life.

Conversely, it is "secondary" or acquired if it appears after a period of normal functioning. This distinction is crucial for prognosis.

In addition, we assess whether the problem is "generalized" (occurs in all situations and with all partners) or "situational" (occurs only in specific contexts).

For example, a man might have a normal erectile response during masturbation or with a casual partner, but experience dysfunc