relates to sexual health in both males and females. sexual medicine specialists take into consideration unhealthy lifestyle habits that may contribute to the sexual quality of life of individuals who are experiencing sexual dysfunction. obesity, tobacco smoking, alcohol, substance abuse, and chronic stress are all lifestyle factors that may have negative impacts on sexual health and can lead to the development of sexual dysfunctions. both obesity and tobacco smoking have negative impacts on cardiovascular and metabolic function, which contributes to the development of sexual dysfunctions. chronic smoking causes erectile dysfunction in men due to a decrease in vasodilation of vascular endothelial tissue. alcohol dependence can lead to erectile dysfunction in mend and reduced vaginal lubrication in women. long term substance abuse of multiple recreational drugs (mdma, cocaine, heroin, amphetamine), leads to a decrease in sexual desire, inability to achieve orgasm, and a reduction of sexual satisfaction. chronic stress may potentially contribute to sexual dysfunction, as it can induce high levels of cortisol, which may cause harmful effects in if it remains altered long term. high levels of cortisol have been shown to cause a reduction in gonadic steroids and adrenal androgens. studies have shown that these steroids and adrenal androgens have effects on genital arousal as well as sexual desire. sexual medicine experts are responsible for promoting healthy lifestyle habits in order to help prevent sexual dissatisfaction. adoption of healthy lifestyle routines include: avoiding drugs, smoke, and excessive alcohol, as well as incorporating regular physical activity accompanied by a balanced diet and use of stress-management strategies. these habits can be proposed before trying to incorporate pharmacological therapies and/or psychiatric therapies. sexual dysfunction in transgender persons limited research has been performed on sexual dysfunction in those who are transgender, but preliminary research suggests that initiating a sexual relationship is difficult for some. one recent study published in the journal of sexual medicine surveyed 518 transgender individuals about sexual dysfunction and disturbances and reported that difficulty initiating sexual encounters and difficulties achieving orgasm were the most prevalent sexual dysfunctions experienced in the study sample. challenges while the awareness of sexual health importance has increased in regards to individuals' general health and well-being, there is still a taboo that follows sexual health. the perception of sexual health varies among different cultures, as the notion is tied with many cultural norms, religion, laws, traditions, and many more. sexual medicine is a unique component of the medical practice that has its own challenges. the main obstacle that stands between these discussions have been reported as the lack of education regarding sexual issues in individuals. the discussion of sexual health and taking a sexual history faces barriers as physicians infrequently address these topics in visits, and individuals are reluctant to discuss openly due to the perception that it is the physician's duty to initiate the topic and fears that the conversation will make the physician uncomfortable. another challenge in sexual medicine is that in a standard process of drug discovery and development, human tissue and cells are not used in testing the candidate drug. instead, animal models are often used to study sexual function, pathophysiology of diseases that cause sexual dysfunction, and new drugs. pharmacokinetic and pharmacodynamic relationships are studied in animal models to test the safety and efficacy of candidate drugs. with animal models, there is a limitation to understanding sexual dysfunction and sexual medicine, as the results achieved can only mount to predictions. identification and treatment of female sexual dysfunctions are also a challenge as women often encounter difficulty within multiple disorders and sexual phases. the various sexual phases that are encompassed within female sexual dysfunctions (fsd) include hypoactive sexual desire disorder (hsdd), female sexual arousal disorder (fsad), female orgasmic disorder (fod) and female sexual pain disorders (fpd). because many of these domains overlap, it is difficult to identify the target of treatment and many limitations are placed in the approach for research. risk factors for female sexual dysfunctions were observed to be embedded with biopsychosocial aspects in epidemiological studies such as depression, urinary tract symptoms, cancer and cancer treatment, relationship problems, and menopausal transition. as a result, a multidimensional approach must be taken in the identification and treatment of female sexual dysfunctions. the issue of psychological dilemmas that are associated with sexual dysfunctions is another challenge that is faced in sexual medicine. there are many psychological aspects that are tied in with sexual dysfunctions. despite much of sex therapy originating from psychological and cognitive-behavioral practices, many of the psychological dynamics have been lost in the sexual medicine protocols. approaching from a psychological and existential perspective helps link the understanding between sexual function and sexual dysfunction in the individual. because the psychological aspects underneath the sexual distress are not being addressed within sexual therapy and treatments are mostly focused on the specific symptoms in sexual medicine, there are many situations where individuals still experience disappointment and dissatisfaction within sexual activities despite the dysfunction being resolved.