Sexual health is a core component of overall well-being and depends on tightly coordinated signaling between the brain, endocrine organs, and peripheral autonomic pathways. This review synthesizes a neurochemical framework for understanding sexual desire, arousal, orgasm, and satisfaction, with a particular focus on how acute and chronic stress disrupt these processes. Dopamine-driven reward and motivation circuits support sexual interest and approach behavior, while serotonergic pathways often exert inhibitory control that can delay orgasm and reduce arousal effects commonly observed with serotonergic medications. Oxytocin contributes to intimacy, trust, and bonding, shaping relational closeness and post-sex “afterglow” experiences, whereas sustained activation of the stress response system and prolonged cortisol exposure can suppress libido and dysregulate downstream neuroendocrine balance. Orgasmic pleasure is further explained by the distinction between motivational “wanting” and hedonic “liking,” in which endogenous opioid signaling plays a central role in the subjective euphoria of orgasm and contributes to analgesia, satiety, and refractoriness. Clinically, this integrative model highlights why sexual dysfunction frequently co-occurs with anxiety, depression, chronic stress states, and medication effects, and it supports comprehensive management that combines psychosocial interventions, stress reduction strategies, and individualized pharmacologic review. The review also outlines translational directions, including scalable biomarker approaches to quantify chronic stress load and better stratify sexual dysfunction phenotypes in future research.
Ravish et al. (2026) studied this question.