Insufficient pleasure derived from sexual activities may lead to sexual deviation or violence, marriage and family breakdown, sexual exploitation, and prostitution. It may be covert or even unconscious and other causes of unhappiness may be blamed, or it may be a source of guilt feelings. Of all sexual activities, coitus is of paramount psychophysical importance. Obstacles to satisfactory love-making may be physical, environmental, or psychological, with the latter caused by a range of factors.
Lack of sexual satisfaction becomes more obvious in a permissive society where it may be discussed openly and action taken to alleviate it; although such action may sometimes seem immoral to those of traditional views. Elsewhere lack of sexual satisfaction may not be admitted if it puts the person's social prestige in question, or it may take the form of finding new wives or concubines to add to a harem; homosexuality may be an accepted substitute in some cultures.
A survey in 1993 in France indicated that 12% of French women and 6% of men aged between 18 and 45 had not had sex within the previous year.