Latent Structures of Female Sexual Functioning

Abstract

For the last three decades, male and female sexual responses have been conceptualized as similar, based on separated and sequential phases as proposed by the models of Masters and Johnson (1966) and Kaplan (1979) model. However, there is a growing debate around the need to conceptualize female sexual response and the classification of sexual dysfunction in women, in view of the upcoming editions of the DSM and ICD. The aim of this study was to test, using structural equation modeling, five conceptual, alternative models of female sexual function, using a sample of women with sexual difficulties and a sample of women without sexual problems. A total of 1993 Portuguese women participated in the study and completed a modified version of the Female Sexual Function Index. Findings suggested a four-factor solution as the model that best fit the data regarding women presenting sexual difficulties: (1) desire/arousal; (2) lubrication; (3) orgasm; (4) pain/vaginismus. In relation to sexually healthy women, the best model was a five-factor solution comprising of (1) desire; (2) arousal; (3) lubrication; (4) orgasm; and (5) pain/vaginismus. Discriminant validity between factors was supported, suggesting that these dimensions measure distinct phenomena. Model fit to the data significantly decreased in both samples, as models began to successively consider greater levels of overlap among phases of sexual function, towards a single-factor solution. By suggesting the overlap between pain and vaginismus, results partially support the new classification that is currently being discussed regarding DSM-5. Additionally, results on the relationship between sexual desire and arousal were inconclusive as sexually healthy women were better characterized by a five-factor model that considered the structural independence among these factors, whereas women with sexual difficulties better fit with a four-factor model merging sexual desire and subjective sexual arousal.

DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions

“…Kaplan even describes it as «phobic avoidance» [6]. Carvalho et al, after testing five alternative models of female sexual function, concluded that the diagnoses vaginismus and dyspareunia overlapped to a great degree [19]. One consequence of the collapse of the two diagnoses is male dyspareunia which, because it was deemed exceedingly rare, was scrapped completely from the nomenclature [20].…”

A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology

“…In contrast, within the literature more broadly, the results of some factor analytic studies suggest that there may in fact be similarities between men and women who experience low sexual function, and between men and women who do not. The sexual response cycle has been found to have distinct desire, arousal, and orgasm phases for men and women without low sexual function (Carvalho, Vieria & Nobre, 2011; Giles & McCabe, 2009), whereas sexual desire, arousal, and orgasm tend to overlap for men and women experiencing low sexual function (Carvalho, Vieira & Nobre, 2012; Carvalho et al, 2011; Corona et al, 2015; Giles & McCabe, 2009). These findings are consistent with the notion of higher symptom severity being associated with greater comorbidity (Kessler et al, 2005; Krueger, 1999), and with the similar dimensional findings for men and women across Forbes et al’s (2015a, 2015b) later studies in particular.…”

“…This is important because sexual function is continuous (i.e., it does not naturally separate into discrete categories of ‘function’ and ‘dysfunction’), and phases of sexual response often overlap (Carvalho et al, 2012; Carvalho et al, 2011; Corona et al, 2015; Giles & McCabe, 2009). In contrast, the DSM deems sexual dysfunctions as either present or absent, and implies that low levels of arousal (e.g., Female Sexual Interest/Arousal Disorder, or Erectile Disorder) are categorically distinct from orgasmic function (e.g., Female Orgasmic Disorder, Premature [Early] Ejaculation, or Delayed Ejaculation).…”

“…In order to extend this research to efficacious interventions, it will be essential to combine this approach with a focus on how the shared spectra manifest in specific cognitive, affective, and behavioral mechanisms (Harvey, Watkins, Mansell & Shafran, 2004). The shared characteristics found across internalizing disorders and low sexual function (e.g., distraction, worry, guilt, negative automatic thoughts, emotion dysregulation, rigid assumptions, avoidance; Carvalho et al, 2012; Nobre & Pinto-Gouveia, 2009) have been researched extensively in depression and anxiety, and Nobre and colleagues have begun research into these characteristics in sexual dysfunctions. However, the role of these characteristics has not been examined in comorbid disorder presentation.…”

Wenn Geschlechtsverkehr nicht möglich ist: Vorstellung eines internetbasierten Behandlungsprogramms für Genito-Pelvine Schmerz-Penetrationsstörung mit Falldarstellung

“…Edition des Diagnostischen und Statistischen Manuals Psychischer Störungen (DSM-5) und vereint die revidierten Diagnosen von Dyspareunie und Vaginismus. Die Zusammenführung beider Störungsbilder in der GPSPS-Diagnose resultierte aus großen Überschneidungen der Symptombilder und Schwierigkeiten ihrer differenzialdiagnostischen Abgrenzung [Carvalho et al, 2012].…”