Abnormal Psychology

496 CHAPTER 11

Sexual Dysfunctions According to DSM-IV-TR

The DSM-IV-TR categories of disorders of sexual dysfunction were partly inspired

by Masters and Johnson’s sexual response cycle. Disorders of sexual dysfunction

are divided into four categories: sexual desire disorders,sexual arousal disorders,

orgasmic disorders, and sexual pain disorders. These disorders can arise in individu-

als of various sexual orientations: heterosexuals, lesbians, gay men, or bisexuals.

Someone can have more than one kind of sexual dysfunction, as when a man

with premature ejaculation becomes nervous about having sexual relations and so

develops a dysfunction of desire or arousal. Moreover, sexual dysfunction may have

existed for an individual’s entire adult life or been acquired after a period of normal

sexual functioning, as happened to Laura. In addition, the dysfunction may occur in

all circumstances (generalized) or only in certain situations, with specifi c partners or

types of stimulation (situational). DSM-IV-TR also allows clinicians and researchers

to note whether the sexual dysfunction is thought to be due to psychological rather

than medical factors or due to a combination of psychological and medical factors.

Table 11.5 lists the sexual dysfunctions and their diagnostic criteria.

As noted in Table 11.5, for a sexual dysfunction to be considered a disorder, the

specifi c sexual symptoms must cause signifi cant distress or relationship problems

Type of Sexual Dysfunction Female Male

General Criteria A. The sexual dysfunction causes signifi cant distress or interpersonal diffi culties.

B. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction)

and is not due exclusively to the direct physiological effects of a substance (such as a drug of abuse, a medication) or a

general medical condition.

Desire Hypoactive sexual desire disorder: A. Persistently or recurrently defi cient (or absent) sexual fantasies and desire for

sexual activity. The judgment of defi ciency or absence is made by the clinician, taking into account factors that affect

sexual functioning, such as age and the context of the person’s life.

Sexual aversion disorder: A. Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital

sexual contact with a sexual partner.

Arousal Female sexual arousal disorder: A. Persistent

or recurrent inability to attain, or to maintain

until completion of the sexual activity, adequate

lubrication or swelling during sexual excitement.

Male erectile disorder: A. Persistent or recurrent diffi culty

attaining or maintaining an adequate erection until sexual

activity is completed.

Orgasm Female orgasmic disorder: A. Persistent or recurrent

delay in, or absence of, orgasm following a normal

sexual excitement phase. Women exhibit wide

variability in the type or intensity of stimulation that

triggers orgasm. The diagnosis of Female Orgasmic

Disorder should be based on the clinician’s judgment

that the woman’s orgasmic capacity is less than

would be reasonable for her age, sexual experience,

and the adequacy of sexual stimulation she receives.

Male orgasmic disorder: A. Persistent or recurrent delay in, or

absence of, orgasm following a normal sexual excitement phase

during sexual activity that the clinician (taking into account the

person’s age) judges to be adequate in focus, intensity, and

duration.

Premature ejaculation: A. Persistent or recurrent ejaculation

with minimal sexual stimulation before, on, or shortly after

penetration and before the person wishes it. The clinician must

take into account factors that affect duration of the excitement

phase, such as age, novelty of the sexual partner or situation,

and recent frequency of sexual activity.

Pain Dyspareunia: A. Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female.

B. The disturbance is not caused exclusively by a lack of lubrication.

Vaginismus: A. Recurrent or persistent involuntary

spasm of the musculature of the outer third of the

vagina that interferes with sexual intercourse.

Note: To be diagnosed with a sexual dysfunction, the person must meet both the criteria for the specifi c sexual dysfunction and the general criteria.

Source: Reprinted with permission from the DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision,

(Copyright 2002) American Psychiatric Association.

Table 11.5 • DSM-IV-TR Diagnostic Criteria for Sexual Dysfunctions