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Posted by on Nov 8, 2013 in Health, Mental Health, Psychology, Teaching | 2 comments

Changes to the Sexual Dysfunction Disorders in DSM-5

This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.

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Changes to the Sexual Dysfunction Disorders in DSM-5 by Ann O. Nonymous

With the release of the DSM-5 (Diagnostic and Statistical Manual), several changes have been made to classifications and criterion.  Along with these changes come great debate on the topics.  In this blog, we will examine changes made to the classifications and criterion for Sexual Dysfunctions in the DSM-5.   We will specifically look at the following disorders: Genito-Pelvic Pain/Penetration Disorder, Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Male Hypoactive Sexual Desire Disorder, and Premature Ejaculation.

Overall, the DSM-V has created gender specific dysfunctions and has either combined or deleted some of the previous diagnoses listed in the DSM-IV for sexual dysfunctions.  Sexual dysfunctions in the DSM-5 now requires a period of approximately 6 months of symptoms to meet the criteria for diagnosis of sexual dysfunctions.  The DSM-5 also requires more exact severity of the criteria to reduce over-diagnosis of sexual dysfunctions.  Subtypes for sexual dysfunctions in the DSM-5 include only “lifelong versus acquired” and “generalized versus situational.”  The DSM-5 deleted two subtypes: “sexual dysfunction due to a general medical condition” and “due to psychological versus combined factors.”

One sexual dysfunction, Genito-Pelvic Pain/Penetration Disorder, was previously called Sexual Pain Disorders [Dyspareunia].  The DSM-5 merged DSM-IV categories of vaginismus and dyspareunia since the disorders were highly comorbid and difficult to differentiate.  By renaming the disorder, DSM-V hopes to better represent the nature of the problem.  The DSM-5 defines Criterion A for this disorder, vaginal penetration during intercourse, in more detail and more concretely.  Symptoms related to problems with penetration, fear or anxiety, and muscle tension have been added to the previous DSM-IV list of pain symptoms.  The symptoms in Criterion A must cause clinically significant distress to the individual.  The DSM-5 places the previous listed “interpersonal difficulty” from the DSM-IV under the label of “clinically significant distress.”  The DSM-5 also considers nonsexual mental disorders, severe relationship distress, and other stressors as potential conditions for exclusion from this diagnosis, which was not presented in the DSM-IV.  (Explore more thoughts on pelvic/genital pain within articles discussing factors contributing to pain.)

Female Orgasmic Disorder is another “new” disorder listed in the DSM-5, which was previously known as Orgasmic Disorder in the DSM-IV.  With the release of the DSM-5, this diagnosis was made specifically exclusive to females.  In DSM-5, Criterion A (marked delay in, marked infrequency of, or absence of orgasm) is more streamlined and more exact concerning the severity of symptoms.  Whether the disorder is due to psychological factors has been eliminated in DSM-5, but added the specifier, “if a female has never experienced an orgasm under any situation.”  This article discussing criteria from DSM-IV is a good comparison to the changes mentioned in Female Orgasmic Disorder and helps explain more about the disorder.  Another disorder, Female Sexual Interest/Arousal Disorder is a combination of two previous disorders, Sexual Aversion Disorders and Sexual Arousal Disorders.  Like Female Orgasmic Disorder, this disorder was also made specific to females in the DSM-5.  In the DSM-5, Criterion A (absent/reduced interest in sexual activity) has been defined in greater detail.  Symptoms are more focused on reduction of sexual interest and arousal and psychological and physiological symptoms.  The DSM-5 considers severe relationship distress and other stressors as potential conditions for exclusion from this diagnosis, which was not discussed in the DSM-IV.

In changes made from the DSM-IV to the DSM-5, Male Hypoactive Sexual Desire Disorder was made specific to males.  This disorder was previously known as Hypoactive Sexual Desire Disorder.  For this disorder, “general and socio-cultural contexts” have been added to the list of contextual factors to be considered for diagnosis.  In order to be diagnosed in the DSM-5, symptoms must cause clinically significant distress to the individual.  The DSM-5 lists severe relationship distress and other stressors as potential conditions for exclusion from this diagnosis, which was not presented in the DSM-IV.  Premature ejaculation also has some changes in the DSM-5.  Nonsexual mental disorders, severe relationship distress, and other stressors as potential exclusionary conditions are included in the DSM-5 for premature ejaculation, which was no present in the DSM-IV.  The DSM-5 also places stricter criterion on this disorder by clarifying premature ejaculation as “within approximately 1 minute following vaginal penetration.”  With premature ejaculation, details concerning whether the disorder is due to psychological factors have been eliminated in DSM-5.  In order to be diagnosed in either of these conditions, the DSM-5 states that symptoms must cause clinically significant distress to the individual.  The DSM-5 also considers nonsexual mental disorders, severe relationship distress and other stressors as potential conditions for exclusion from this diagnosis, which was not presented in the DSM-IV.

Some feel there was a need for a change for the criteria in Sexual Dysfunction. With all the comments being tossed around, you will always hear the pros and cons to sexual dysfunction criterion for the DSM-IV and the DSM-V.  In the future, we will continue to progress in our understanding of various mental and behavioral difficulties. but we will always have our own opinions and thoughts, as we are all individuals and a very opinionated species.