Sexual dysfunction is difficulty experienced by an individual or partners during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. A diagnosis of sexual dysfunction under DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months (except for substance- or medication-induced sexual dysfunction). Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.