498 CHAPTER 11
in Case 11.8. In addition, as women age, decreased desire is probably related
to women’s hormonal shift with menopause: Women who have gone through
menopause tend to report diminished desire more so than other women (Eplov
et al., 2007). In fact, women who enter menopause abruptly and at an earlier
age because of the surgical removal of their uterus and ovaries are more likely to
report low sexual desire than are their same-age counterparts who have not yet
entered menopause (Dennerstein et al., 2006).
In addition, psychological and social factors account for a given woman’s
distress about decreased desire, and women in different European countries report
different levels of distress in response to decreased desire (Graziottin, 2007).Table 11.6 • Sexual Dysfunctions Facts at a Glance
Prevalence- According to one survey of 1065 female and 447 male patients in a general medical practice,
22% of the men and 40% of the women had a “sexual dysfunction” in the preceding 4 weeks
(Nazareth, Boynton, & King, 2003). However, the true prevalence of sexual dysfunctions is dif-
fi cult to determine: Many surveys either equate sexual dissatisfaction—for any reason—with
sexual dysfunction or use criteria that are different from those in DSM-IV-TR. - In another survey, 35% of men and 54% of women who had at least one heterosexual part-
ner in the previous year reported at least one sexual problem lasting 1 month (Mercer et al.,
2003). Note, however, that this is not long enough for a diagnosis of sexual dysfunction. - Only a small minority of respondents (6% of men, 16% of women) had persistent sexual prob-
lems that lasted more than 6 months (Mercer et al., 2003). - According to one survey, although 40% of women reported sexual problems, only 12% re-
ported distress about their problems (Shifren et al., 2008). Without distress (or impaired
functioning), the diagnosis of a sexual dysfunction would not be made.
Comorbidity- People with sexual dysfunctions may also have a co-occurring mood or anxiety disorder.
Onset- A sexual dysfunction may arise from specifi c circumstances, or it may be lifelong.
Course- As women age, sexual problems other than desire problems tend to decrease, except for hor-
monally induced lubrication problems. - The opposite is true for men: As they age, their sexual problems tend to increase, usually
because of erectile diffi culties that are associated with prostate problems, cardiovascular
problems, or other medical causes (Hackett, 2008; Heiman, 2002b).
Gender Differences- In one study, the most common problems among men were lack of interest, premature or-
gasm, and performance anxiety. - Among women the most common problems were failure to achieve orgasm and painful
intercourse.
Cultural Differences- Cultural norms about sexuality affect the extent to which a sexual problem leads to enough
distress or relationship diffi culties for it to be considered a disorder (Hartley, 2006). For
example, Japanese women have a low prevalence of problems with sexual desire, per-
haps because Japanese women do not consider no or little sexual desire to be a problem
(Kameya, 2001).
Source: Unless otherwise noted, the source for the table material is American Psychiatric Association, 2000.