Women's sexual dysfunction: revised and expanded definitions

Abstract

Acceptance of an evidence-based conceptualization of women's sexual response combining interpersonal, contextual, personal psychological and biological factors has led to recently published recommendations for revision of definitions of women's sexual disorders found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV-TR). DSM-IV definitions have focused on absence of sexual fantasies and sexual desire prior to sexual activity and arousal, even though the frequency of this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The revised definitions consider the many reasons women agree to or instigate sexual activity, and reflect the importance of subjective sexual arousal. The underlying conceptualization of a circular sex-response cycle of overlapping phases in a variable order may facilitate not only the assessment but also the management of dysfunction, the principles of which are briefly recounted.

Fig. 1: Sex response cycle, showing responsive desire experienced during the sexual experience as well as variable initial (spontaneous) desire. At the “initial” stage (left) there is sexual neutrality, but with positive motivation. A woman's reasons for instigating or agreeing to sex include a desire to express love, to receive and share physical pleasure, to feel emotionally closer, to please the partner and to increase her own well-being. This leads to a willingness to find and consciously focus on sexual stimuli. These stimuli are processed in the mind, influenced by biological and psychological factors. The resulting state is one of subjective sexual arousal. Continued stimulation allows sexual excitement and pleasure to become more intense, triggering desire for sex itself: sexual desire, absent initially, is now present. Sexual satisfaction, with or without orgasm, results when the stimulation continues sufficiently long and the woman can stay focused, enjoys the sensation of sexual arousal and is free from any negative outcome such as pain. (Modified from Basson 2001, and published with the permission of the American College of Obstetricians and Gynecologists.)

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