Female Sexual Dysfunction: Mental Disorder

One of three installments of our Female Sexual Dysfunction series in which we explore the disorder from a clinical, cultural and current global  perspective

Clinically, Female Sexual Dysfunction (FSD) is defined as “the persistent and recurring decrease in sexual desire or arousal, the difficulty or inability to achieve orgasm and or the feeling of pain during sexual intercourse”. These symptoms, especially a difficulty achieving orgasm, seem fairly common and yet  FSD remains widely off our radar. While 43% of women suffer from FSD compared to 31% of men who suffer from Erectile Dysfunction (ED), pharmaceutical options for women are slim. This reality is frustrating, especially considering the overwhelming research and treatment of erectile dysfunction in males, specifically the development of phosphodiesterase type 5 inhibitors to treat ED.

FDS is a multifaceted disorder which encompasses physical, psychological and social-interpersonal components, making it more difficult to categorize and treat. There is often stigma surrounding various aspects of female sexuality, however, FSD is subjected to the stigma of mental health as well because it is treated through sexual therapy and is categorized within the Diagnostic and Statistical Manual of Mental Disorders (DSM).

In the first edition of DSM, sexual dysfunctions both male and female were categorized as a psychophysiological autonomic and visceral disorder. In DSM-III, which is noted as a categorical switch from psychoanalytic to biological psychology, the language became Psychosexual Dysfunctions. For women, this included inhibited sexual desire and excitement, inhibited female orgasm, functional dyspareunia, vaginismus, and atypical psychosexual dysfunction. Psychosexual Dysfunctions was changed to Sexual Dysfunctions in  DSM-III-R, along with additional changes in language to the types of dysfunctions within this category. Another change was made in DSM-IV, in which dysfunctions included female hypoactive desire disorder, female arousal disorder, female orgasmic disorder, dyspareunia, and vaginismus.

In the current DSM, DSM-V of 2013, the Sexual Dysfunction classification became more simplified reducing the five Sexual Dysfunctions to three. This was done to reflect the current state of research within the field of sexual disorders, as well as increase the validity and clinical usefulness of the DSM-V. Female hypoactive desire disorder and female arousal disorder was merged into Female Sexual Interest/Arousal Disorder, Dyspareunia and Vaginismus merged into Genito-Pelvic Pain/Penetration disorder, and Female Orgasmic Disorder was unchanged. Critics have argued that the inclusion of Female Sexual Dysfunction within the DSM is harmful in that it ignores other cultural and personal factors shaping sexuality and its difficulties. This is true historically, as female sexuality was only acceptable within a heteronormative context.

The World Health Organization defines Female Sexual Dysfunction as “the various ways in which a woman is unable to participate in a sexual relationship as she would wish”, a definition that has more implications then WHO may have intended. In the 20th century, FSD could have been any woman who was unable to peruse pleasures that did not conform to traditional, heterosexual gender roles. Women were shamed for being both too sexual and not sexual enough; wanting clitoral stimulation was considered taboo. Each of these offenses was punishable by hospitalization! This resulted in the marginalization and demonization of women who wish to explore their sexuality freely. We still feel the effects of this today, despite the cultural shifts that have begun to validate the importance of the female sexuality. For even the most privileged of us, there are still so many ways in which the society we live in prevents women from all walks of life from participating in our sexual relationships as we would wish.

xoxo

Rose Hill

Part two in which we explore the historical context of female sexual dysfunction coming soon!

Publications that made this post possible:

Allahdadi, Kyan J, et al. “Female Sexual Dysfunction: Therapeutic Options and Experimental Challenges.” Cardiovascular and Hematological Agents in Medicinal Chemistry, vol. 7, no. 4, 2009, pp. 260-269. 

Angel, Katherine. “The History of Female Sexual Dysfunction as a Mental Disorder in the 20th Century.” Current Opinion in Psychiatry, vol. 23, no. 6, pp. 536-541.

IsHak, WW, and Gabriel Tobia. “DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions.” OMICS International Online, 2013. https://www.omicsonline.org/dsm-5-changes-in-diagnostic-criteria-of-sexual-dysfunctions-2161-038X.1000122.php?aid=18508. Accessed 15 August 2018.