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Archive for the ‘Sexual’ Category

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.

Disorders of sexual desire are frequently encountered in psychiatric practice. These disorders may be part of the presentation of common psychiatric disorders such as depression and anxiety disorders, a drug side effect, secondary to relationship discord or idiopathic. Understanding the etiology of problems of low sexual desire is also complicated because of the interplay of biological, psychological and interpersonal influences. Because these disorders can have a multitude of etiologies, diagnosis is often complicated and most often imprecise. Because sexuality is such an important part of one’s self-identity and plays a significant role in intimate relationships, low sexual desire can have a multitude of unfortunate consequences and obviously should be a focus of psychiatric interventions.

The goal of this chapter is to review current evidence concerning the diagnosis, epidemiology, etiology and treatment of hypoactive sexual desire disorders. Masters and Johnson and the DSM-IV-TR  regard male and female sexual disorders as symmetrical.

However, there appear to be sex differences in the strength of sexual desire, its covariates, its sequencing in the sexual response cycle, and its response to relationship discord. In this chapter, female disorders of desire will be considered separately from male disorders of desire as they may represent different diagnostic entities.