Sexual Dysfunction in Depression: Assessing Pleasure Alongside Desire, Arousal, and Orgasm

Sexual dysfunction is closely tied to psychiatric illness because it involves many of the same brain processes and circuits as depression and anxiety, according to Anita Clayton, MD, the Wilfred W. Spradlin Professor in Psychiatry and Neurobehavioral Sciences and professor of clinical obstetrics and gynecology at the University of Virginia in Charlottesville.

In a video interview at the 2026 Jersey City Psychiatry Conference, Clayton said about 70% of people with a major depressive episode have 1 or more sexual dysfunctions. Research has documented high rates of sexual dysfunction in patients with untreated major depression, before any antidepressant is started.¹ This means sexual symptoms may come from the illness itself rather than only from treatment.

Overlap With Anhedonia

Clayton said sexual dysfunction in depression can involve loss of pleasure, but it often also involves the loss of specific sexual functions.

She pointed to low sexual desire as an example of the overlap. When a patient reports no longer being interested in an activity they used to enjoy, that is essentially anhedonia. Clinicians do not usually describe it that way in the context of sexual dysfunction, but Dr Clayton said the same questions remain important.

"If you lack desire, that in some ways sounds like, 'I'm not really interested in doing this thing I used to enjoy.' That's anhedonia, but we don't really say it that way in the context of sexual dysfunction," said Clayton.

Assessing Each Phase

When assessing sexual dysfunction, Clayton described working through the phases of sexual response: desire, arousal, orgasm, and sometimes pain. Pleasure is an additional area, and in many respects it maps directly onto anhedonia scales. Some of these scales include sex as an area in which a patient may have lost interest or pleasure.

Sexual dysfunction associated with depression can be made worse by antidepressant treatment, which can affect adherence and quality of life.² Asking about each phase of sexual response, and about pleasure specifically, can help clinicians tell whether a problem stems from the depressive illness or from the medication used to treat it.

References

1. Kennedy SH, Dickens SE, Eisfeld BS, Bagby RM. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56(2-3):201-208.

2. Clayton AH, El Haddad S, Iluonakhamhe JP, et al. Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf. 2014;13(10):1361-1374.