Sexual Interest/Arousal Disorder in Men
Sexual Interest/Arousal Disorder in Men32
The Sexual Dysfunction subworkgroup is currently exploring three possible options for the diagnostic criteria in men. Option 1 is to preserve the DSM-IV-TR title and criteria for Hypoactive Sexual Desire Disorder but add “in Men” to the title. Option 2 is a parallel proposal to what is presented earlier for women (i.e., the individual requires X of 6 criteria to be met). If this option is selected, “in men” will be deleted from the disorder’s name and Sexual Interest/Arousal Disorder will be a gender-neutral diagnostic category applying to men and women. Option 3 is to require X of 5 symptoms (instead of X of 6 symptoms as in Option 2). This would involve the removal of criterion A6 from the list.
Our workgroup plans to come to a conclusion as to the best possible option on the basis of field trial results. In the event that Option 2 or Option 3 are chosen, the results of field trials will also be used to determine the required number of symptoms necessary in order to meet criteria for the disorder.
A. Lack of sexual interest/arousal of at least 6 months duration as manifested by at least X of the following indicators:
(1) Absent/reduced interest in sexual activity
(2) Absent/reduced sexual/erotic thoughts or fantasies
(3) No initiation of sexual activity and is not receptive to a partner’s attempts to initiate
(4) Absent/reduced sexual excitement/pleasure during sexual activity (on at least 75% or more of sexual encounters)
(5) Desire is not triggered by any sexual/erotic stimulus (e.g., written, verbal, visual, etc.)
(6) Absent/reduced genital and/or nongenital physical changes during sexual activity (on at least 75% or more of sexual encounters)
B. The problem causes clinically significant distress or impairment.
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
Specifiers:
1) Lifelong (since the onset of sexual activity) or acquired
2) Generalized or situational
3) Partner factors (partner’s sexual problems, partner’s health status)
4) Relationship factors (e.g., poor communication, relationship discord, discrepancies in desire for sexual activity)
5) Individual vulnerability factors (e.g., depression or anxiety, poor body image, history of abuse experience)
6) Cultural/religious factors (e.g., inhibitions related to prohibitions against sexual activity)
7) Medical factors (e.g., illness/medications)
31This specifier presumes knowledge of etiology, which often does not exist.
32Compared to the available literature on HSDD in women, much less empirical data exist on HSDD in men. Most of the available literature has focused on low desire in hypogonadal men or in men with Erectile Dysfunction. Thus, we have proposed three possible options for DSM-V. Option 1 is to retain the DSM-IV-TR criteria for HSDD, and to rename the disorder as “HSDD in men”. This is the most conservative option in light of the sparse available data. Thus, low desire in men and women would have different disorder names and a different set of criteria. Option 2 is to adopt the proposed criteria for Sexual Interest/Arousal Disorder, as per recommendations by Brotto (2009) and Graham (2009), for both men and women. This reflects the findings that desire is expressed in a multitude of ways in men, just as in women (e.g., desire for sex, frequency of fantasizing, frequency of initiating sex, frequency of being receptive to sex) (Dworkin et al., 2005; Meston and Buss, 2007), the overlap men report in sexual desire and subjective sexual arousal (Corona et al., 2004; Janssen et al., 2000; Janssen et al., 2008), and findings from the Incentive Motivation model that sexual desire/arousal is a “triggered” experience in response to sexually competent stimuli for both men and women (Everaerd and Laan, 1995; Janssen et al., 2000; Toates, 2009). How many of the six criteria would be required would be determined on the basis of field trials. The sixth criterion (A6) indicates difficulty with genital or non-genital physical arousal. There is limited support, however, for A6. What is available shows that there is a high level of comorbidity between low sexual desire and impaired arousal in men. However, there are also data indicating that a host of physiological and physical parameters tested may not significantly differentiate men with and without low desire. If this option was retained and A6 was included, this would need to be clearly differentiated from difficulties in erectile functioning. Thus, criterion A6 might refer to reductions in skin sensitivity or signs of autonomic arousal; however, recurrent episodes of erectile failure causing distress would qualify this symptom for a full diagnosis of ED. Given that criterion A6 presents some confusion about the boundary between impairments in genital or non-genital response and erectile dysfunction, Option 3 is to adopt the proposed Sexual Interest/Arousal Disorder criteria but then delete A6 and require that only X of five symptoms of low desire/subjective arousal be met. The number of criteria from this list of five required for a diagnosis would be decided on the basis of field trial results. This would result in male and female-specific forms of Sexual Interest/Arousal Disorder.
References
Brotto, L. A. (2009). The DSM diagnostic criteria for Hypoactive Sexual Desire Disorder. Archives of Sexual Behavior. Online first. DOI 10.1007/s10508-009-9543-1
Corona, G., Mannucci, E., Petrone, L., Giommi, R., Mansani, R., Fei, L., et al. (2004). Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. International Journal of Impotence Research, 16(3), 275-281.
Dworkin, S. L., & O'Sullivan, L. (2005). Actual versus desired initiation patterns among a sample of college men: Tapping disjunctures within traditional male sexual scripts. Journal of Sex Research, 42, 150-158.
Everaerd, W., & Laan, E. (1995). Desire for passion: Energetics of sexual response. Journal of Sex and Marital Therapy, 21, 255-263.
Graham, C. A. (2009). Review of the DSM diagnostic criteria for Female Sexual Arousal Disorder Archives of Sexual Behavior, doi 10.1007/s10508-009-9542-2.
Janssen, E., Everaerd, W., Spiering, M., & Janssen, J. (2000). Automatic processes and the appraisal of sexual stimuli: Toward an information processing model of sexual arousal. Journal of Sex Research, 37(1), 8-23.
Janssen, E., McBride, K., Yarber, W., Hill, B., & Butler, S. (2008). Factors that influence sexual arousal in men: A focus group study. Archives of Sexual Behavior, 37(2), 252-265.
Meston, C. M., & Buss, D. M. (2007). Why humans have sex. Archives of Sexual Behavior, 36(4), 477-507.
Toates, F. (2009). An integrative theoretical framework for understanding sexual motivation, arousal, and behavior.Journal of Sex Research, 46(2-3), 168-193.
Dimensional Assessment Instrument for Sexual Interest/Arousal Disorder
in Men and Women
1. Over the past six months, have you experienced absent or reduced interest in sexual activity?
0 = Never
1 = Mild
2 = Moderate
3 = Severe
4 = Extreme
2. Over the past six months, have you experienced absent or reduced sexual or erotic thoughts or fantasies?
0 = Never
1 = Mild
2 = Moderate
3 = Severe
4 = Extreme
3. Over the past six months, have you been less receptive to your partner’s attempts to initiate sexual activity and/or less likely to initiate sexual activity with your partner?
0 = Never
1 = Mild
2 = Moderate
3 = Severe
4 = Extreme
4. Over the past six months, have you experienced absent or reduced sexual excitement or pleasure during sexual activity (on at least 75% or more of sexual encounters)?
0 = Never
1 = Mild
2 = Moderate
3 = Severe
4 = Extreme
5. Over the past six months, has any form of sexual or erotic stimulus (e.g., whether written, verbal, visual, or other types) been effective in triggering your sexual interest?
0 = Never
1 = Mild
2 = Moderate
3 = Severe
4 = Extreme
6. Over the past six months, have you experienced absent or reduced genital and/or non-genital physical changes during sexual activity (on at least 75% or more of sexual encounters)?
0 = Never
1 = Mild
2 = Moderate
3 = Severe
4 = Extreme
This disorder is not listed in DSM-IV; therefore, DSM-IV criteria for this disorder do not exist. The Work Group is recommending as an option that the diagnosis of Sexual Interest/Arousal Disorder in Men subsume the previous diagnosis of Hypoactive Sexual Desire Disorder (DSM-IV code 302.71). |
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