Definitions of women's sexual dysfunction reconsidered: Advocating expansion and revision

Abstract

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's sexual response. It is apparent that fullfilment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Função sexual e fatores associados à disfunção sexual em mulheres no climatério

“…Alguns estudos concordam que um problema sexual somente deve ser considerado como disfunção sexual quando causar aflição da mulher, incômodo refletido, portanto, na insatisfação com a vida sexual 4,18 .…”

Disgust and Contamination Sensitivity in Vaginismus and Dyspareunia

“…However, since relevant studies could not demonstrate the presence of vaginal spasms, it appears that the hallmark of vaginismus is more accurately defined as a problem with penetration which extends to sexual intercourse (e.g., Binik et al, 2002). In line with this, it has been proposed to modify and extend the original diagnosis of vaginismus into: ''persistent or recurrent difficulties to allow vaginal entry of a penis, a finger, and/or any object, despite the women's expressed wish to do so, whereas structural or physical abnormalities were ruled out during the physical examination'' (Basson et al, 2003). In this study, the diagnosis of vaginismus was made on the basis of these criteria formulated by Basson et al The women with dyspareunia were characterized by persistent or recurrent pain with attempted or complete vaginal entry and/or penile vaginal intercourse.…”

“…The vaginistic complaints are characterized by persistent difficulties in allowing vaginal entry of the penis, a finger, and/or object, despite the woman's expressed wish to do so (Basson et al, 2003). These complaints often have a chronic course and may result in considerable emotional distress (e.g., ter Kuile et al, 2007).…”

The DSM Diagnostic Criteria for Female Sexual Arousal Disorder

“…There is now robust evidence indicating a high degree of comorbidity between FSAD and other sexual disorders, particularly Hypoactive Sexual Desire Disorder (HSDD) (Basson et al, 2003;Fugl-Meyer & Fugl-Meyer, 2002;Laumann et al, 1999;Rosen, Taylor, Leiblum, & Bachmann, 1993;Segraves & Segraves, 1991a). In one study of patients with HSDD, 41% of the women had at least one other sexual dysfunction and 18% had diagnoses in all three categories i.e.…”