500 CHAPTER 11
can have an adequate erection but think that he is inadequate because he believes
that his penis is not hard enough. Similarly, a woman may respond to the biological
sensations of sexual arousal by being afraid of losing control (Malatesta & Adams,
2001). Despite the infl uence of cognitive and emotional components, the DSM-IV-
TR criteria for arousal disorders are exclusively biological (Malatesta & Adams,
2001). They focus on blood fl ow problems that interfere with sexual arousal.Female Sexual Arousal Disorder
Two arousal disorders are included in DSM-IV-TR, one for men and one for women.
The hallmark of female sexual arousal disorder (formerly known as frigidity)is
persistent or recurrent diffi culty attaining or maintaining engorged genital blood
vessels in response to adequate stimulation (see Table 11.5). Normally with arousal,
some of the fl uid in these blood vessels (not the blood itself; Giraldi & Levin, 2006)
is exuded into the genital area, serving as a lubricant. With female arousal disorder,
however, the less than normal engorgement leads to decreased lubrication.
Menopause can lead to vaginal dryness and inadequate lubrication during sex-
ual activity. In some sense, this makes female sexual arousal disorder a natural part
of aging for women. In fact, female arousal disorder is most likely to occur in those
who have been through menopause, particularly among women who have adequate
sexual desire and can attain orgasm (Heiman, 2002b; Laumann, Paik, & Rosen,
1999). When the arousal problem is not a result of menopause-related hormonal
changes, it frequently occurs along with desire and/or orgasm problems; this co-
morbidity means that it is rare for a woman to have only arousal problems that do
not arise from hormone-related dryness. Note that DSM-IV-TR focuses exclusively
on the neurological and other biological aspect of sexual arousal, not the subjective
experience—which may be more signifi cant for many women (Basson et al., 2001;
Rosen & Leiblum, 1995).
As with all sexual dysfunctions, the diagnosis of sexual arousal disorder
requires that the arousal problem cause distress or relationship diffi culties and not
be due exclusively to some other psychological disorder or to a medical disorder
(see Table 11.5).Male Erectile Disorder
The hallmark symptom of male erectile disorder (impotence, in nontechnical lan-
guage) is a persistent or recurrent inability to attain or maintain an adequate erec-
tion until the end of sexual activity (American Psychiatric Association, 2000; see
Table 11.5). Some men with male erectile disorder are able to have erections during
foreplay but not during actual penetration. Others are not able to obtain a full erec-
tion with a new partner or in some situations; still others, such as Harry, in Case
11.10, have the problem during any type of sexual activity. If the man is able to
have a full erection during masturbation, biological causes are unlikely. More than
half of men over 40 years old have at least some erection problem (Feldman et al.,
1994); thus, male erectile disorder, like its counterpart, female arousal disorder, can
be seen as a normal by-product of aging. It is estimated that 300 million men world-
wide will develop male erectile disorder by the year 2025, in part because of the
increased aging of the population (cited in Shabsigh et al., 2003).Clearly, psychological factors can contribute to male erectile disorder; it is not al-
ways a neurological or other biological problem or a consequence of normal aging.Clearly, psychologicalfactors can contribute to male erectiledisorder; it is not al-CASE 11.10 • FROM THE OUTSIDE: Male Erectile Disorder
Harry [had been married for 2 years when] he found out his wife had been involved in nu-
merous extramarital affairs and divorced her. He said his friends all knew but were reluctant
to tell him. Following the divorce he encountered erectile problems with all partners—even
those to whom he felt close.
(Althof, 2000, p. 261)Female sexual arousal disorder
A sexual dysfunction marked by a woman’s
persistent or recurrent diffi culty attaining or
maintaining engorged genital blood vessels
in response to adequate stimulation; formerly
referred to as frigidity.
Male erectile disorder
A sexual dysfunction characterized by a man’s
persistent or recurrent inability to attain or
maintain an adequate erection until the end
of sexual activity; sometimes referred to as
impotence.