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Numerous individuals and groups have criticized the DSM-IV-TR criteria for sexual disorders. Major suggestions for revision have been made by an international consensus group funded by the American Urological Association. This group met on four occasions and has published a number of manuscripts detailing recommended changes. This group specifically suggested that the criteria sets for hypoactive sexual desire disorder be modified.

Data indicating that many sexually responsive women do not report sexual fantasies was cited as well as evidence that some sexually responsive women do not experience desire for sexual activity but respond to sexual stimuli once involved in a sexual situation. It was recommended that lack of responsive desire be substituted for absence of desire for sexual activity. This group also noted evidence that interest in sexual activity appears to lessen both with age and relationship duration for many women. Basson  specifically states that the linear sequencing of desire, arousal, orgasm as outlined in DSM-IV-TR is a model better suited to male than female sexuality. She posits that many women are unaware of desire for sexual activity at the onset of sexual activity and that emotional intimacy may be the most important factor influencing a woman’s initial sexual responsiveness. In this model, responsive desire and sexual arousal clearly overlap.

It should be noted that the DSM-IV-TR criteria and suggested revisions lack precise criteria sets designating severity or duration criteria. Also, the separation of sexual dysfunctions from relationship discord and adjustment disorders is imprecise. Many clinicians would not diagnose a sexual problem as a sexual dysfunction if it is clearly secondary to relationship discord. However, this is not clearly specified in the DSM-IV-TR text. Similarly, the distinction between an adjustment disorder influencing sexual function and a sexual dysfunction is not clearly specified. Precise operational criteria are necessary to define homogenous clinical groups for research and advancement of knowledge in the field.

Modern nomenclature for the sexual disorders can be traced to Masters and Johnson  who delineated premature ejaculation, ejaculatory incompetence, impotence, orgasmic dysfunction, vaginismus and dyspareunia. Except for vaginismus and dyspareunia,
the sexual dysfunctions were linked to the phases of the sexual response cycle (excitement, plateau, orgasm). The sexual response cycle and those disorders of sexual response were considered to be analogous in both sexes. This diagnostic scheme was initially adopted by most mental health clinicians. As more clinicians gained experience in the treatment of sexual disorders, it became increasingly obvious that the major problem of many patients was the absence of desire for sexual activity, a concept not included in the Masters and Johnson diagnostic schema. Harold Lief and Helen Singer Kaplan, both psychoanalysts, introduced this concept of the diagnosis of inhibited sexual desire.

The first official nomenclature for the sexual disorders was published in the DSM in 1980. In this system, inhibited sexual desire was defined as persistent and pervasive inhibition of sexual desire. The text also indicated that the diagnosis would rarely be made unless the lack of desire was a source of distress to either the individual or partner. In DSM-III-R the term inhibited was deleted as this was felt to imply a psychodynamic etiology and the somewhat awkward term, hypoactive sexual desire was substituted for inhibited sexual desire. The definition was also slightly modified. The new definition was persistently, or recurrently deficient or absent sexual fantasies and desire for sexual activity. In this edition, the following subtype modifiers were introduced: psychogenic only or psychogenic and biogenic, lifelong or acquired, generalized or situational. In DSM-IV, the definition of hypoactive sexual desire remained unchanged except for a new provision that the diagnosis could not be made unless the disturbance caused marked distress or interpersonal difficulty. This definition remained unchanged in DSM-IV-TR.