514 CHAPTER 11
Key Concepts and Facts About Sexual Dysfunctions
- Sexual dysfunctions are psychological disorders marked by
problems in the human sexual response cycle. The response cy-
cle traditionally has been regarded as having four parts: excite-
ment, plateau, orgasm, and resolution––but it is now commonly
regarded as beginning with sexual attraction and desire. - Sexual dysfunctions fall into one of four categories: disorders of
desire, arousal, orgasm, and pain. The dysfunctions may be situ-
ational or generalized and may arise from neurological (and other
biological) factors, psychological factors, or a combination of fac-
tors. However, to be classifi ed as dysfunctions they must cause
signifi cant distress or problems in the person’s relationships. - Sexual desire disorders involve three components: cognitive,
emotional, and, to a lesser extent, neurological (and other bi-
ological). Problems with any of these components can lead to
hypoactive sexual desire or sexual aversion disorder. Both of
these disorders may be diagnosed in men or women. - Sexual arousal disorders arise when the normal progression
through the excitement phase is disrupted. Arousal disorders in-
volve neurological (or other biological), cognitive, and emotional
components, although DSM-IV-TR focuses solely on the neuro-
logical (or other biological) component. The two disorders per-
taining to arousal are female sexual arousal disorder and male
erectile disorder. - Sexual orgasmic disorders are characterized by persistent
problems with the orgasmic response after experiencing a
normal excitement phase and adequate stimulation. These
disorders may involve neurological (and other biological), cog-
nitive, and emotional components. DSM-IV-TR includes three
disorders in this category. Two of these involve an absence
or delay of orgasmic response: female orgasmic disorder and
male orgasmic disorder. Typically, men with orgasmic disorder
are able to climax with masturbation but not with vaginal in-
tercourse. The third disorder, premature ejaculation, involves
orgasm that occurs persistently with minimal sexual stimula-
tion and before the man wishes it.- Sexual pain disorders hinge on pain with sexual intercourse.
There are two disorders: dyspareunia, which can occur in both
men and women, and vaginismus, which occurs only in women. - Criticisms of the DSM-IV-TR sexual dysfunction disorders in-
clude the following: (1) The sexual response cycle may not
apply equally well to women; (2) the criteria focus almost
exclusively on the neurological (and other biological) com-
ponents; (3) the end goal is orgasm, not satisfaction; (4) the
criteria rest on a particular defi nition of normal sexual func-
tioning that doesn’t encompass normal aging; (5) there are no
duration criteria; (6) the defi nition of distress or interpersonal
diffi culty caused by the sexual dysfunction is vague; (7) the
DSM-IV-TR defi nitions of the sexual dysfunctions for women
aren’t necessarily the ones used by specialists in human sexu-
ality; (8) dyspareunia should be considered a pain disorder,
not a sexual disorder.
desire problem. Yet she might explain that when her husband had diffi culty with his
erections, he was much more affectionate, sexually attentive to her, and creative in
their sexual interactions. Now he is goal-directed, focusing almost exclusively on
intercourse. Solving his erectile dysfunction led to changes in the couple’s sexual re-
lations that were not viewed as positive by his wife. Treatments that directly target
only one type of factor, such as medication, may seem to resolve the problem for the
patient, but instead can—via feedback loops among the three types of factors—have
unexpected negative consequences for the couple.Targeting only a neurological
(or other biological) factor in
one partner may not improve the
overall sexual functioning and
Steve Kelley/Cartoonist Group satisfaction of the couple.