Diagnosing Sexual Dysfunction

Posted on Oct 3, 2016

Diagnosing Sexual Dysfunction

By Maria Glowacka

Are you wondering if your sexual problem is a sexual dysfunction?

First, if you’re wondering whether you should go talk to a health professional about a sexual problem you have been experiencing, the answer is YES if it is distressing to you and/or your partner. A health professional will likely ask you some questions about the problem and whether it developed in the context of a health condition or taking certain medications. For a sexual problem to be considered a sexual dysfunction, it must meet the diagnostic criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; [1]). The DSM-5 has classifications for seven sexual dysfunctions (described below). To be diagnosed with a sexual dysfunction, the symptoms must be present for at least six months, cause you significant distress, and cannot be caused exclusively by a non-sexual mental disorder, significant relationship distress, medical illness, or medication.

Male Sexual Dysfunction

The DSM-5 provides diagnostic criteria for four sexual dysfunctions that are specific to biological males (i.e., individuals who are born with male genitalia). Delayed Ejaculation is delayed, infrequent, or absent ejaculation in at least 75% of partnered sexual activity occasions. In the previous version of the DSM (DSM-IV-TR; [2]), this sexual dysfunction was referred to as Male Orgasmic Disorder. According to the current DSM, Erectile Disorder is diagnosed when a male has (1) difficulty getting an erection, (2) difficulty maintaining an erection, or (3) a decrease in how rigid the erection is during 75 to 100% of sexual activity encounters. Male Hypoactive Sexual Desire Disorder is a lack of or recurrent decrease in sexual thoughts, fantasies, and desire for sexual activity. It is the responsibility of the diagnosing clinician to determine that desire is not only perceived as low in comparison to the desire of one’s partner (which would be a desire discrepancy between partners and maybe not a sexual dysfunction). Premature (Early) Ejaculation is diagnosed when ejaculation occurs within one minute following vaginal penetration and before the person wishes it on at least 75% of partnered sexual activity occasions. It is important to note that this diagnosis is applicable to men who engage in non-vaginal sexual activity, but unfortunately the specific duration criteria remain unknown.

Female Sexual Dysfunction

There are three sexual dysfunctions in the DSM 5 that are specific to biological females (i.e., individuals who are born with female genitalia). Female Orgasmic Disorder is a delay in, infrequency of, or absence of orgasm, or a reduced intensity of orgasmic sensations during 75 to 100% of sexual activity encounters. Since there is lots of variation in the type or intensity of stimulation that triggers orgasm, clinicians are left to judge if a female’s ability to orgasm is less than expected for her age, sexual experience, and stimulation received. Female Sexual Interest/Arousal Disorder is absent or reduced sexual interest/arousal. This is determined by meeting three or more of the following criteria: (1) reduced/absent interest in sexual activity, (2) reduced/absent sexual thoughts/fantasies, (3) reduced/no initiations of sexual activity or not responding to partner initiations, (4) reduced/absent excitement or pleasure during 75 to 100% of sexual activity events, (5) reduced/absent interest/arousal in the context of any sexual cues, or (6) reduced/absent genital or non-genital sensations during 75 to 100% of sexual activity events. As with Male Hypoactive Sexual Desire Disorder, these symptoms must not only be a desire discrepancy between partners. The diagnosis of Female Sexual Interest/Arousal Disorder is a combination of Female Hypoactive Desire Disorder and Female Arousal Disorder from the DSM-IV-TR. Finally, the DSM 5 (American Psychiatric Association, 2013) characterizes Genito-Pelvic Pain/Penetration Disorder as constant or repeated difficulties with (1) vaginal penetration during intercourse, (2) vaginal or pelvic pain during penetration, (3) significant fear/anxiety about vaginal or pelvic pain, or (4) tensing of pelvic floor muscles during penetration attempts. Genito-Pelvic Pain/Penetration Disorder is a combination of the diagnostic criteria of Dyspareunia and Vaginismus in the DSM-IV-TR. Male genital pain has been removed from the current version of the DSM because of insufficient research, even though there is growing evidence of men experiencing pain during erection, ejaculation, and receptive anal intercourse [3].

Each of the sexual dysfunctions could be lifelong (present since becoming sexually active) or acquired (developed overtime), generalized (present in a variety of situations) or situational (only present with certain stimulation, situations, or partners), and clinicians could specify whether distress over symptoms is mild, moderate, or severe. Note that not everyone agrees on the diagnostic criteria for all of these sexual dysfunctions. There is a variety of ways that people can experience a distressing sexual problem. That being said, you might find yourself suffering from a sexual problem that doesn’t quite meet the criteria above to be considered a “sexual dysfunction”. If you’re distressed by this problem and/or it’s negatively impacting your relationship, you should go talk to a health professional. They can still help you out or point you in the right direction.

Sources:

[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

[2] American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.

[3] Bergeron, S., Rosen, N. O., & Pukall, C. P. (2014). Genital pain in women and men: It can hurt more than your sex life. In Y. M. Binik & K. S. K. Hall (Eds.), Principles and practice of sex therapy, fifth edition (pp. 159-176). New York: Guilford Press.