Major changes are proposed for definitions of female sexual dysfunctionBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c830 (Published 09 February 2010) Cite this as: BMJ 2010;340:c830
The definitions of female sexual dysfunction and its disorders of desire, arousal, orgasm, and pain are facing a major overhaul as part of the current revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM).
A working group for the American Psychiatric Association, which produces the manual, has proposed new definitions that give greater acknowledgment to the relationship context of women’s sexual difficulties and new criteria to raise the threshold for diagnosis.
Describing current criteria for “hypoactive sexual desire disorder” as being “highly problematic,” a member of the working group, Lori Brotto, a psychologist and assistant professor at the University of British Columbia, wrote that a woman’s lack of sexual desire may sometimes be a “normal reaction to a problematic context and therefore should not be pathologized” (Archives of Sexual Behavior, doi:10.1007/s10508-009-9543-1)
Writing in the same journal, another working group member, Cynthia Graham, of the Isis Education Centre, Warneford Hospital, Oxford, stated that in order “to avoid pathologizing normal variation in sexual experiences” women’s mild and passing sexual problems should not be regarded as symptoms of a medical dysfunction (doi:10.1007/s10508-009-9535-1).
The group has proposed abandoning the two existing disorders of desire and arousal and merging them into a new entity potentially labelled “sexual arousability disorder.” Under its proposals, symptoms may have to be of a certain severity and to present for more than six months before a woman qualifies for a diagnosis.
It is unclear how the proposal to move away from the label “hypoactive sexual desire disorder” will affect drug companies—including Boehringer Ingelheim—that are currently testing products to treat the condition. Boehringer Ingelheim recently released abstracts suggesting that its drug flibanserin could offer woman an extra 0.7 “satisfying sexual events” per month, over and above the effects of a placebo.
For more than a decade some researchers have claimed that the condition called female sexual dysfunction affects 43% of women, though others believe the true prevalence is far less.
An adviser to the working group, Ellen Laan, a psychologist at the University of Amsterdam, told the BMJ that under the proposed new definitions the prevalence of these sexual disorders would be “much lower” and that the 43% figure is going to “go out the window.”
The American Psychiatric Association is posting all the proposed revisions on the DSM website on Wednesday 10 February (www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx).
The fifth edition is not expected to be finalised until 2013, but it is already being strongly criticised. Last June Allen Frances, chairman of the task force for the fourth edition, strongly attacked plans to create new categories in the manual for people with mild problems believed to be at risk (Psychiatric Times, www.psychiatrictimes.com/display/article/10168/1425378).
Dr Frances wrote that he feared that the new categories could result in widespread “medicalization of normality,” leading to a “deluge of unneeded medication,” and would create a “bonanza” for the drug industry.
A task force member, William Carpenter, said that a “risk syndrome category” is being considered and acknowledges concerns about how to avoid “excessive” drug treatment.
Cite this as: BMJ 2010;340:c830
Competing interest: RM has written a book about female sexual dysfunction, scheduled for publication in North America and Australia in 2010.