Sexual Dysfunction

The DSM-IV divides desire disorders into two categories: hypoactive sexual desire disorders and sexual aversion disorders. The first of these, hypoactive sexual desire disorder, is defined as deficient or absent sexual fantasies and desire for sexual activity with anyone. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning such as age, sex, and the context of the person's life. The deficiency may be selective: a person may experience erection or lubrication and orgasm but derive little pleasure from the physical feelings and thus have little interest in sexual activity. In other cases, the individual's desire is at such a low ebb that he or she has no interest in self-stimulation or in participation in sexual interaction that might even lead to arousal. Some people can be described as asexual; in other words, they do not experience desire for any kind of sexual activity. This is not considered a dysfunction if the individual is satisfied with not engaging in sexual activity.

The sources of sexual desire disorder have not been well clarified. Most current knowledge of the causes of low sexual desire is based on clients who are seen in therapy and thus must be viewed with caution until more objective research has been conducted using nonclinical samples. With that caveat in mind, low sexual desire has been associated with such factors as anxiety, religious orthodoxy, depression, habituation to a sexual partner, fear of loss of control over sexual urges, sexual assault, side effects of medication, marital conflict, and fear of closeness. (Allgeier and Allgeier 2000).

In the general population, 16 percent of men and 33 percent of women aged eighteen to fifty-nine reported that they lacked interest in sex for a period of several months or more in the year before they were interviewed (Laumann et al. 1994). The suppression of sexual desire is, of course, not dysfunctional in and of itself. Most of us learn scripts to suppress sexual desire for inappropriate partners, such as parents, close relatives, and children, and in inappropriate situations.

Sexual aversion disorder is a persistent aversion to almost all genital sexual contact with a partner. Whereas individuals displaying hypoactive sexual desires are often indifferent about sexual interaction, sexual aversion reflects fear, disgust, or anxiety about sexual contact with a partner. An individual with sexual aversion disorder may still engage in autosexual behaviors such as masturbation and fantasy, while avoiding interpersonal sexual behavior.

Excessive sexual desire is often associated with paraphilias. Preliminary evidence indicates that men with paraphilic disorders are two to three times more sexually active than men in the general population (Kafka 1997).