Gender and Sexual Disorders 497
(American Psychiatric Association, 2000). This means that someone may have a
problem with any aspect of sexual response but would not be diagnosed as having
a sexual dysfunction disorder unless the problem caused the individual marked dis-
tress or led to problems in his or her relationships.
Many, if not most, problems in the sexual response cycle have psychologicalcauses rather than physical causes relating to the sex organs. This is true of both
Mike and Laura, and somewhat true for Sarah and Benjamin, in Case 11.7. Table
11.6 provides more information about sexual dysfunctions.
To understand better the problems Sarah and Benjamin were having, let’s examine
sexual dysfunctions in more detail.
Sexual Desire Disorders
Sexual desire is a multifaceted experience. It can be thought of as having at least
three components: (1) a neurological and other biological component (related to
hormones and brain activity, which lead to a genital response); (2) a cognitive com-
ponent (related to an inclination or desire to be sexual); and (3) an emotional and
relational component (related to being willing to engage in sex with a particular
person at a specifi c place and time) (Levine, 1988). Any of these components can
lead to either of two disorders, hypoactive sexual desire disorder or sexual aversion
disorder.
Hypoactive Sexual Desire Disorder
As specifi ed in DSM-IV-TR, one type of desire problem is hypoactive sexual de-
sire disorder, whose hallmark is a persistent or recurrent lack of sexual fantasies
or an absence of desire for sexual activity (see Table 11.5). This lack of desire
may be lifelong or more recently acquired, and it may occur in all situations
(generalized) or only in particular situations (such as with a specifi c person), but
it must cause distress or impair functioning. Laura seems to have such a lack
of sexual desire—a lack of any interest in sexual relations with Mike—but she
wishes to feel desire.
Hypoactive sexual desire focuses primarily on a person’s cognitive (fantasies)and emotional/relational (desire) state (Malatesta & Adams, 2001). People with
hypoactive sexual desire disorder may lack sexual desire and be unwilling to engage
in sexual behavior with a partner, or they may lack desire but still be willing to en-
gage in sexual behavior with a partner, as was Sarah in Case 11.7. However, some-
one who is depressed and, as part of the depression, has little or no sexual desire (a
symptom of depression) is not considered to have hypoactive sexual desire disorder
because the low desire is caused by another disorder.
Women are more likely than men to have hypoactive sexual desire disorder.This sex difference may arise in part because, for women, desire may be more
closely tied to the emotional nuances of a relationship than for men—as illustrated
Tdtdbttth bl ShdBji hilt’ i
CASE 11.7 • FROM THE OUTSIDE: Sexual Dysfunctions
More than a decade [earlier], Sarah had experienced a very traumatic childbirth, with
lacerations and ripping in the vaginal canal, which created extensive scarring and a lack of
sensation. Since then she had found it diffi cult to become aroused and reach orgasm with
intercourse. Before the delivery she had been fi ne.
Sarah had lost all interest in sex, but she was willing to be sexual for the sake of inti-
macy, which she still enjoyed. Her husband, Benjamin, however, had a hard time not taking it
personally that she couldn’t have an orgasm, and began to fi xate on the problem, bringing it
up in and out of the bedroom. But all the time and effort he was spending on her arousal only
made her more anxious and less likely to become aroused at all. He started to feel inadequate
as a result and began to fi nd it diffi cult to maintain his erection. They had gone on in this way
for years, and now were close to a separation.
(Berman et al., 2001, p. 168)Hypoactive sexual desire disorder
A sexual dysfunction characterized by
a persistent or recurrent lack of sexual
fantasies or an absence of desire for sexual
activity.