Treatment of Sexual Dysfunctions

Abstract

Impairments of sexual functioning, the dysfunctions, are classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) in seven categories. Sexual Desire Disorders include Hypoactive Sexual Desire involving deficient (or absent) sexual fantasies and desire for sexual activity, and Sexual Aversion, involving extreme aversion to and avoidance of all or almost all genital sexual contact with a partner. Sexual Arousal Disorders include Female Sexual Arousal Disorder, an inability to attain or maintain an adequate genital lubrication-swelling response of sexual excitement until completion of the sexual activity, and Male Erectile Disorder, an inability to attain or maintain an adequate erection until completion of the sexual activity. Orgasm Disorders include Female and Male Orgasmic Disorders and Premature Ejaculation. Female Orgasmic Disorder is delay or absence of orgasm following a normal sexual-excitement phase. It is pointed out that women vary widely in the type or intensity of stimulation that triggers orgasm and that the diagnosis should be based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives. Presumably, such absence of orgasmic capacity would not be accepted as a disorder in such women as those who reported in many surveys that they enjoyed intercourse very much, although they did not reach orgasm (McConaghy, 1993), provided it did not cause marked distress or interpersonal difficulty (Criterion B).