Sexual aversion versus hypoactive sexual desire: a diagnostic challenge

Abstract

Our work with women with sexual aversion documents the presence of marked sexual avoidance behaviors as specified in the DSM-III-R1 diagnostic criteria for this disorder. At the same time, we demonstrate the presence of normal sexual desire and capacity for orgasm in these women. These two findings offer support for a valid diagnostic differentiation between sexual aversion disorder and hypoactive sexual desire disorder. Inherent in the diagnosis and treatment of sexual aversion disorder is an appreciation by the clinician of the tremendous approach-avoidance conflict that exists in these patients. The behavioral and cognitive avoidance features, therefore, need to be elicited actively by the clinician during all phases of assessment and treatment. These features are not always offered readily by the patients for fear of having to relinquish these strategies and their related sense of control over the overwhelming anxiety that sexual intimacy can produce. Consequently, treatment is not always straightforward and successful.