About Sexual Difficulties

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the official classification system for sexual dysfunctions.  The 5th edition (DSM-5) was published in May 2013 and it contains diagnostic criteria for:  Delayed Ejaculation, Early (Premature) Ejaculation, Erectile Dysfunction, Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, Male Hypoactive Sexual Desire Disorder, Sexual Dysfunction Not Elsewhere Classified, and Substance/Medication-Induced Sexual Dysfunction. This is a heterogeneous group of conditions that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure. Many people  have a variety of sexual concerns, as a difficulty in one domain can impact other aspects of sexual function (e.g., in the case where sexual pain can have a dampening effect on sexual interest and/or arousal).

What is not a “sexual dysfunction”

The medical community often uses the term “sexual dysfunction” to refer to cases in which a person experiences great difficulty in a particular aspect of sexual functioning. It is important to know, however, that sometimes sexual difficulties are the result of inadequate sexual stimulation or lacking education/information on how sexual response is triggered. In these instances, that person should not be diagnosed as having a sexual dysfunction, and education on the sexual response to an individual or couple can go a long way in terms of helping people to experience (or regain) sexual pleasure.

It is also imperative to remember that sometimes changes in one’s sexuality occur simply as a function of aging or being in a long-term relationship.  Because we are so heavily influenced by society’s messages about what is “normal” and “abnormal”, this can result in one feeling inadequate if their sexual response declines. This is a very unfortunate but quite common experience.  Only in cases where the sexual symptoms persist for a minimum duration of six months, and if they interfere in a person’s life in some significant way would one consider making a diagnosis of a sexual “dysfunction”. Most people experience sexual difficulties at some point in their lives.

In the case of low sexual interest, motivation, or desire, sometimes this may be the result of one identifying as asexual, and is not a Sexual Interest/Arousal Disorder. For more information about asexuality, www.asexuality.org is an excellent resource.

Subtypes

For some individuals, they have experienced a sexual difficulty since they started to be sexually active (in other words, for many years), whereas for others, the difficulties are more recent (in other words, after a period in their lives where they experienced normal sexual functioning). “Lifelong” subtype refers to a sexual problem that has been present from early sexual experiences and “Acquired” subtype applies to sexual disorders that develop after a period of normal sexual function.

Specifiers

For most individuals with sexual concerns, there may be many different causes. As clinicians, we use “specifiers” to help understand what some of these causes may be so that a treatment plan can be tailored to meet the needs of the individual.  Some common specifers assessed by clinicians are:

1)    Partner factors:  These include a partner’s own sexual problems, a partner’s health status, and other factors in the partner’s own sexual and general health that may directly or indirectly impact a person’s sexual health.

2)    Relationship factors: These include factors in the relationship, such as difficulties with good communication, relationship discord, differences in partner’s level of sexual interest/desire, such as the case where one partner desires sex much more frequently than the other partner

3)    Individual vulnerability factors: This would include factor’s in the person’s own mental well-being such as having a poor body image, having a history of sexual or emotional or physical abuse), mental health concerns such as depression or anxiety, or other general life stressors

4)    Cultural or religious factors: Sometimes sexual complaints are influenced by a person’s ethnicity, culture, religion, or society generally.

5)    Medical factors: One’s medical health, hormone and menopausal status, chronic conditions, medications, surgeries, or other physical factors can contribute to the sexual concerns.