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If You're Unhappy with Your Sex Life You Suffer From Female Sexual Dysfunction?

Thu, 07/21/2011 - 09:09
Submitted by LilithLand

Currently, there are two popular ways of thinking about female sexual dysfunction: the traditional DSM-IV perspective that sees it as a medical disorder and a New View approach (which I will be looking at in a later post) that takes into consideration psychosocial factors.

In my last post in this series, Female Sexual Dysfunction: A DSM-IV Perspective, I gave an overview of the disorder, according to the DSM-IV. Now, I will talk about the the various kinds of disorders that are available for your displeasure.

The DSM-IV, the primary diagnostic tool for mental health professionals, sees female sexual dysfunction as a failure to make it through the phases of the sexual response cycle, which consists of desire, excitement, orgasm, and resolution. Somewhere between the first quivers of early desire and that post-coital cigarette, a dysfunctional woman hits a roadblock.

If she stalls right out of the gate (i.e., no sexual interest), she is diagnosed with a desire disorder. If she stalls at the excitement phase and never makes it to the finish line (i.e.,doesn't come), she is diagnosed with an orgasm disorder. Sexual dysfunction is largely looked at as a matter of faulty physiology.

A woman's emotional needs or feelings about her sex life - whether she experiences joy, bliss, boredom, or a desire to hide whenever her husband whips out that Viagra-sized boner- isn't included in the diagnostic criteria. To be perfectly fair, the DSM-IV does take into consideration personal distress.

If a woman doesn't care about her lousy sex drive, she is perfectly fine - no dysfunction; if she does, she has a diagnosable condition. And, some would cynically argue, Big Pharma has a potential customer. Here is a list of the basic sexual dysfunctions (female variety) in the DSM-IV-TR.

Hypoactive Desire Disorder

Diagnostic criteria for 302.71 Hypoactive Sexual Desire Disorder

A. Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person's life.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Sexual Aversion Disorder

Diagnostic criteria for 302.79 Sexual Aversion Disorder

A. Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction).

Diagnostic criteria for 302.72 Female Sexual Arousal Disorder

A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Diagnostic criteria for 302.73 Female Orgasmic Disorder

A. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis of Female Orgasmic Disorder should be based on the clinician's judgment that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Sexual Pain Disorders

Diagnostic criteria for 302.76 Dyspareunia

A. Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The disturbance is not caused exclusively by Vaginismus or lack of lubrication, is not better accounted for by another Axis I disorder (except another Sexual Dysfunction), and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Diagnostic criteria for 306.51 Vaginismus

A. Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The disturbance is not better accounted for by another Axis I disorder (e.g., Somatization Disorder) and is not due exclusively to the direct physiological effects of a general medical condition.

If you are a woman who is unhappy with your love life, and you went to a mental health professional, this is how your issue would be conceptualized and treated. I know some of you may be thinking that my series thus far is rather boring and technical (and for those of you who are still awake, God bless you), but I believe to understand this issue beyond the simplistic, black and white generalizations so prevalent in the media's treatment of sexual dysfunction requires some knowledge of the particular animal we're dealing with here.

So, bear with me. I promise to burn the DSM-IV eventually.

We Suggest: 
Learn to Orgasm in Four Acts (eBook)
What is Female Sexual Dysfunction & How Do You Get Rid of It?
There is No Pink Viagra - Here are Your Options
Betty Dodson's Bodysex Workshop
Women, Sex, Culture & Relationships
http://www.lilithland.net/

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As a mental health

Thu, 07/21/2011 - 11:23
lsjb (not verified)

As a mental health practitioner, marital and sex therapist precisely, i do not ever diagnose a patient with a sexual dysfunction.  Well, if there is a specific physiological reason, like pain or vascular insufficiency for a guy, for instance, i will.  Otherwise, and  only if the patient is distressed (herself and not her partner)will i speak to the complaint directly.  Sometimes a woman might not be distressed that she has no desire or no orgasm, but that is also deserving of more discussion.

Most importantly tho, and i think my colleagues would agree, we always see problems in what's called a "bio-psycho-social" framework. That means we see it in a context -- a person's whole life story and in particular what's happening in the moment.
Many sexual problems are often problems of education, miseducation or lack of -- and partners. 
Additionally, I never put a sexual dysfunction on an insurance form, its just too dramatic and never the only or primary  reason for therapy.  Of course, the patient might present it that way, then its my job to go exploring.

I've often wondered if a person went to a sex coach and learned to have a great sexual experience  would it continue after the session.  I still think the experience would be valuable but one's "other" issues will reemerge if never treated -- in my opinion. While I don't do" hands on" sex coaching, I do "hands on" relationship coaching.  I use talk therapy, books, videos, homework assignments and good old psychodynamic relationship skills. I'd love to see someone contact past clients and find out where they are 6mos later.  Same of course for psychotherapy, outcome studies, which we are in the process of researching.

Hi Isjb, thank you for your

LilithLand's picture
Thu, 07/21/2011 - 15:25
LilithLand

Hi Isjb, thank you for your valuable feedback. I'm always looking to learn. I am curious about why you never diagnosis someone with sexual dysfunction. What if that is their presenting problem? Say you have a client who is upset about her vaginismus, and she came to you wanting some help. Would you diagnosis her with vaginismus?

I agree sexual issues are so multifauceted, and it just seems that so much of human sexuality isn't really looked at in serious research. I personally would like to see more studies done on middle aged and older people who are single. Talk about a totally ignored group! I also would like more follow up studies on the results of sex therapy. 

When I was being taught

Thu, 07/21/2011 - 22:37
Narurin (not verified)

When I was being taught mental disorders (including sexual ones) in my psychology degree we were taught that the person is more important than the disorder. For example if a client was presenting with a hypoactive desire disorder, they wouldn't be conceptualised as 'the hypoactive client' but as Lucy (or whatever their name is). ISJB is right, when psychs diagnose a client they look at the disorder in the context of the individual's life. Sometimes the reason behind why that person has the disorder is more important than the disorder itself for example.
The DSM-IV is definately flawed as most people who use it regularly will tell you. However, you've missed the caveat which comes with any mental illness diagnosis - for something to be called a disorder the symptoms must interfere significantly with the functioning of that person's life or the functioning of people around them. This is the most important part of diagnosis. If an individual has no sexual desire and is fine with that, they do not have hypoactive desire disorder. And the diagnosis criteria do say this: "The disturbance causes marked distress or interpersonal difficulty."

Question from a layperson

Fri, 07/22/2011 - 20:09
Heylin

What if I'm unhappy with my partner sex life because of the following:
1. 80% of the time when I initiate sex, I get a lukewarm response or just rejected.
2. My sex partner has gained enough weight around his abdominal region that certain positions are uncomfortable or not as good as they used to be.
3. My partner seems to always have aches and pains that make it difficult for him to continue intercourse.
I'm no spring chicken either and I also have extra pounds, but right now I'm not feeling sexually compatible with my husband. I don't feel like there is anything wrong with my sex drive, just that there is not a good fit with my current partner right now. I would hate for big pharma to think I needed fixing unless they wanted to provide me with some new clean sex partners to play with.

Answered my own question

Sat, 07/23/2011 - 20:36
Heylin

Treat sex like exercise meaning you'll feel better when you're doing it. This obviously won't work for everyone, but in my case, it didn't hurt anything to try. Also helps that he doesn't mind when I run the show and we can both just laugh and change things when something's not working for us. It also helped for me to focus on simple affection and touching with him.  I was really starting to get worried because for a long time the sex was really bad and I didn't want to go back to that. He's still got to lose some weight (me too, but I'm working on it) because it's hard to hug now. I wonder how much obesity affects people sexually.

Hi Heylin, What you have

LilithLand's picture
Sun, 07/24/2011 - 20:43
LilithLand

Hi Heylin,
What you have mentioned is one of the criticisms of the DSM it tends to ignore relationship, and sociocultural factors in its criteria. That's not to say most therapists don't take these factors into consideration while working with clients, as Isjb points out. Its just that these issues are not factored into the criteria. 

I think both sexual compatability and attraction are huge factors in how well things go in the bedroom. As for obestity, that is also a huge deal. Obesity is assoicated with increased risk for diabetes and high blood pressure. Both of these health issues are very strongly correlated with sexual problems. Not to mention the fact that the drugs used to treat these conditions can do a number on your sexual functioning. Men with protruding guts (listen up guys) often have lower levels of testosterone - which is basically our "horny" hormone. And as you mentioned, a big gut just flat out gets in the way sometimes. 

Thanks Lilithland

Mon, 07/25/2011 - 20:17
Heylin

I was really getting in the downy dumps over this and when I mentioned it to him, he said, "Why? Because we had a little fight?" I'm happy we're both working on proper diet and exercise because higher testosterone will be a happy side effect along with better health.

Good luck Heylin, Diet and

LilithLand's picture
Sun, 07/31/2011 - 15:37
LilithLand

Good luck Heylin,
Diet and exercise leads to good health and that has a host of benfits including sexual.

Thank you Lilithland

Sun, 07/31/2011 - 15:42
Heylin

It seems to be working so far. We've been busy fixing up the house but it seems like we're more affectionate and energetic.

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