Sexual Dysfunction

Psychosexual disorders were listed for the first time in 1980 in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), a handbook used by almost all mental health professionals. This listing has led to an increasing medicalization of sexual problems that can allow individuals to avoid examining their own attitudes and experiences that could have contributed to their dysfunction. If the source of the problem is "medical," the individuals may not see the need to take responsibility for their problems. If the problem is a lack of desire, the medical diagnosis can be used as a rationale to continue to avoid sexual activity.

The DSM-IV (the fourth edition of the DSM, published in 1994) classifies sexual dysfunctions as primary or secondary. A primary dysfunction occurs when an individual has never experienced one of the phases of the sexual response cycle. A secondary dysfunction refers to a situation in which a person has been able to respond in the past to one of the phases but is not responsive at the current time, or can experience one of the phases only in certain circumstances.

It is important to remember that many people do not neatly fit into any of the diagnostic categories described. In many cases, problems with desire, excitement, and orgasm overlap. (Everaerd and Laan 2000)

There has been very little systematic survey information on the prevalence of sexual dysfunction. Robert Francouer (1977) edited three volumes that covered 170 countries and cultures. Almost all of the accounts were anecdotal or based on data collected in various types of clinics. In those countries that did have information based on representative samples of their population (Czech Republic, Slovakia, Denmark, Finland, France, Iceland, and Sweden), it is difficult to make comparisons because of methodological differences in how these studies were carried out.

An overview of the National Health and Social Life Survey (NHSLS), which was the first to question a nationally representative sample of U.S. adults about their sexual attitudes and behaviors, reveals that sexual problems are most common among young women and older men (Laumann, Park, and Rosen 1999). Low sexual interest and problems with erection tend to become more common as men age probably due to the physiological changes that occur over time. Young women "are more likely to be single, their sexual activities involve higher rates of partner turnover as well as periodic spells of sexual inactivity. This instability, coupled with inexperience, generates stressful sexual encounters, providing the basis for sexual pain and anxiety"(p. 9).

The effects of race and ethnicity on the prevalences of sexual dysfunction are fairly modest. Hispanic women report lower prevalence of sexual dysfunction than do African-American or white women. White women are more likely to experience sexual pain then are African-American women, whereas African-American women report experiencing less pleasure with sexual experience and sexual desire more frequently than white women. Differences between men roughly follow those among women but the differences are not as large. Generally, Hispanics are less likely to report sexual problems whereas African Americans report more sexual problems across the spectrum of sexual dysfunction (Laumann, Park, and Rosen 1999).