Classifying Female Sexual Dysfunction

Although the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (1994) is the currently accepted system for classifying women's sexual dysfunction, there have been criticisms of that system. In particular, the criticism stems from the fact that it is based on a model of sexual response that assumes women first experience sexual desire, then move on to the experience of sexual arousal, followed by orgasm. This linear step-by-step progression through sexual response is challenged by the finding that many women engage in sexual activity despite not experiencing sexual desire at the outset. Instead, they may experience sexual desire after the sexual encounter has begun. Some have termed this type of desire as "responsive desire".

Although there have been numerous challenges to the current DSM taxonomy and some have proposed alternative classification schemes from which to understand women's sexual complaints, one system that resulted from meetings of an international classification committee, sponsored by the American Foundation for Urologic Diseases in 2003, retained the general 4-category system of the DSM while making revisions to the individual diagnoses within each category. It is noteworthy that these are not adopted by the DSM, which is currently revising its manual and is expected to be published in 2012.

The four catagories are:

• Sexual Desire Disorders
• Sexual Arousal Disorders
• Orgasmic Disorder
• Sexual Pain Disorder

One proposed change for the Female Sexual Dysfunction is the possible merging of sexual desire and sexual arousal disorder into “Sexual Arousability Disorder” or “Sexual Interest/Arousal Disorder”. To view Dr Brotto’s presentation on this at the 2009 meeting of the Society for Sex Therapy and Research (SSTAR), please click here (DSM Criteria for Hypoactive Sexual Desire Disorder)