CRITICISMS
Human Sex Response Cycle
DSM classification
• M &J based data only on observed physiological
responses
• Biased sample
• Desire often occurs after arousal, and not often
present at first
• Sexual stimuli are integral
• The outcome strongly influences future motivation
• Doesn’t account for individual variability, relationship
duration
• Does not capture subjective sexual excitement
• Evidence does not support DSM criteria
Alternative diagnostic systems for
female sexual dysfunction
• A New View of Women’s Sexual Problems
(Kaschak & Tiefer, 2001) – in textbook
• New Definitions of Women’s Sexual
Dysfunction (Basson et al., 2003)
reasons or
Incentives for
sexual activity
Willingness to
find / be receptive
Sexual stimuli
with appropriate
context
Arousal
More intense
arousal &
responsive
desire
Emotional &
physical
satisfaction
biological
psychological
+
Spontaneous
sexual desire
+
+
Information
Processing
Basson 2001; 2002
2
DSM-IV-TR
Sexual
Disorders,
2000
1. Sexual Desire Disorders
– Hypoactive Sexual Desire
– Sexual Aversion
2. Disorders of Sexual Arousal
– Female Sexual Arousal Disorder
– Male Erectile Disorder
3. Disorders of Orgasm
– Female Orgasmic Disorder
– Male Orgasmic Disorder
– Premature Ejaculation
4. Sexual Pain Disorders
– Dyspareunia
– Vaginismus
Sexual Disorders:
Diagnosis & Classification
• Must cause marked distress or interpersonal difficulty
• Specifiers:
– Lifelong (primary) vs. acquired (secondary)
– Global vs. Situational
– Gradual vs. Sudden onset
• Differentiate if secondary to a medical or psychiatric
condition
– Physical disease
– Substance abuse
– Other Axis I disorder
– Medication
Predisposing
Factors
Perpetuating
Factors
Precipitating
Factors
TIME
Early
Development
Current
Functioning
How do
sexual problems develop?
Laumann 2005
Sexual problems among women and men aged 40-80y: Prevalence and
correlates identified in the Global Study of Sexual Attitudes and Behaviors
• n = 29 countries
• (sampled): n=13,882 women; n=13,618 men
• (eligible*): n = 9,000 women; n = 11,205 men *based on having at least 1
intercourse in past year
• During the last 12 months have you ever experienced any of the following
for a period of 2 months or more when you:
– Lacked interest in having sex
– Were unable to reach climax (experience orgasm)
– Reached climax (experienced orgasm) too quickly
– Experienced physical pain during sex
– Did not find sex pleasurable
– Had trouble achieving or maintaining an erection (men)
– Had trouble becoming adequately lubricated (women)
• Answered yes/no
If yes…
• Severity assessed with: “for each of these
experiences, how often would you say this
has occurred during the last 12 months?”
– Occasionally / sometimes / frequently
– “Occasionally” treated as “no problem” in
analyses
Correlates (predictors)
assessed
• Demographics: age, education, financial problems,
• Health: general health status, physical activity, vascular
condition, depression, prostate disease, hysterectomy,
smoking
• Relationships: divorce in past 3 years, expected length
of current relationship, are you exclusive?
• General satisfaction with life
• Individual sexual behaviour: sex & foreplay frequency
• Sexual practices: frequency of thinking about sex?
• Sexual attitudes
• Sexual beliefs: do you think aging reduces sexual
desire? Does your religion affect your sexuality?
3
Statistical Analyses
• Logistic regression (odds ratio)
= odds of having a particular problem
compared to a reference group
• Possible range of odds ratios:
– < 1 = less likely to have the problem
– 1 = no difference in likelihood from reference
group
– > 1 = more likely to have the problem
Women
• Sexual Desire Disorders

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