Classifying Female Sexual Dysfunction:

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Classifying Female Sexual Dysfunction:

Although the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (1994) is the currently accepted system for classifying women’s sexual dysfunction, there have been criticisms of that system. Thus, the Definitions committee, sponsored by the American Foundation for Urologic Diseases in 2003 revised and expanded upon the definitions of women’s sexual dysfunctions as described below.  The 4 general categories of women’s sexual dysfunctions were maintained:

Sexual Desire Disorders

Women’s Sexual Interest/Desire Disorder

  • Absent or diminished feelings of sexual interest or desire, absent sexual thoughts or fantasies and a lack of responsive desire.  Motivations (here defined as reasons/incentives), for attempting to have sexual arousal are scarce or absent.  The lack of interest is considered to be beyond the normative lessening with life cycle and relationship duration.

Sexual Aversion Disorder

  • Extreme anxiety and/or disgust at the anticipation of/or attempt to have any sexual activity.

Sexual Arousal Disorders

Subjective Sexual Arousal Disorder

  • Absence of or markedly diminished feelings of sexual arousal (sexual excitement and sexual pleasure) from any type of sexual stimulation.  Vaginal lubrication or other signs of physical response still occur.

Genital Sexual Arousal Disorder

  • Absent or impaired genital sexual arousal.  Self report may include minimal vulval swelling or vaginal lubrication from any type of sexual stimulation and reduced sexual sensations from caressing genitalia.  Subjective sexual excitement still occurs from nongenital stimuli.

Combined Genital and Subjective Arousal Disorder

  • Absence of or markedly diminished feelings of sexual arousal (sexual excitement and sexual pleasure) from any type of sexual stimulation as well as complaints of absent or impaired genital sexual arousal (vulval swelling, lubrication)

In addition, there is a newly proposed condition, not currently in the DSM-IV, that has been described.  There is insufficient scientific research on this condition but it has been described as:

Persistent Sexual Arousal Disorder

  • Spontaneous intrusive and unwanted genital arousal (e.g. tingling, throbbing, pulsating) in the absence of sexual interest and desire.  Any awareness of subjective arousal is typically but not invariably unpleasant.  The arousal is unrelieved by one or more orgasms and the feelings of arousal persist for hours or days.

Orgasmic Disorder

Women’s Orgasmic Disorder

  • Despite the self-report of high sexual arousal/excitement, there is either a lack of orgasm, markedly diminished intensity of orgasmic sensations or marked delay of orgasm from any kind of stimulation.

Sexual Pain Disorders

Vaginismus

  • the persistent or recurrent difficulties of the women to allow vaginal entry of a penis, a finger, and/or any object, despite the women’s expressed wish to do so.  There is often (phobic) avoidance and anticipation/fear/experience of pain, along with variable involuntary pelvic muscle contraction.  Structural or other physical abnormalities must be ruled out/addressed.


Dyspareunia

  • the persistent or recurrent pain with attempted or complete vaginal entry and/or penile vaginal intercourse.

Prevalence

Sexual difficulties in women are extremely common.  There have been a number of large-scale studies on women of various age ranges in an attempt to document the precise prevalence of such difficulties.  An important factor to keep in mind when looking at the prevalence of sexual difficulties is that having a difficulty does not imply that the person is necessarily bothered by it.  In other words, having a sexual difficulty does not necessarily imply sexual dysfunction.  Transient sexual concerns in women are common, and may be affected by temporary stressors, life changes, fatigue, medications, medical conditions, and relationship changes.

The “Boston Area Community Health” (BACH) survey studied a random sample of 3,205 women aged 30-79 living in the Boston, USA region.  The study found that 38.4% of sexually active women reported sexual problems in their life.  However, only third of that group, or in other words 13.7% of the total sample of women, stated that they had sexual problems and that the problems were distressing and interfered in their life. 

Sexual problems were more common as women aged, and were associated with depression, sexual and physical abuse, overall mental health, and use of alcohol.

In a different study in which the prevalence of sexual concerns was studied in 13,882 women aged 40-80 from 29 countries, significant cross-cultural differences were found in how common various sexual problems are.  Lack of interest in sex (26-43%) and difficulties reaching orgasm (18-41%) were the most common sexual concerns.  Difficulties with genital lubrication were found in 16-38% of women.  Negative expectations about sex, depression, and negative feelings about the partner, were all significantly associated with all of the female sexual dysfunctions.

Note:  Data taken from the following sources:
Lutfey KE, Link CL, Rosen RC, Wiegel M, McKinlay JB.  Prevalence and Correlates of Sexual Activity and Function in Women: Results from the Boston Area Community Health (BACH) Survey.  Archives of Sexual Behavior 2008.

Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moiera E, Wang T.  Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors.  International Journal of Impotence Research 2005;17:  39-57.

Treatment

Various treatments exist for helping women with sexual difficulties. These include, but are not limited to:

  • Sex Therapy
  • Biofeedback
  • Pelvic Muscle Physiotherapy
  • Vasoactive Medications
  • Hormone Replacement therapy
  • Clitoral Therapy Device
  • Natural Herbal Supplements

Sex therapy is increasingly being combined with pharmaceutical products for the treatment of female sexual dysfunction. Though large scale, controlled empirical studies are still in progress, there is preliminary evidence of a positive outcome when these methods are combined.