Women’s Views of their Sexual Difficulties: Agreement and Disagreement with Clinical Diagnoses

Abstract

There is controversy about how to conceptualize sexual problems in women. Our purpose in this study was to compare ICD-10 diagnoses of sexual dysfunction in women with whether or not the woman perceived she had a sexual problem, her views on its origins, and its impact on her life. Participants (N = 401, M age, 37.8 years) were consecutive attendees to general practices in London, England. Our main measures were an ICD-10 diagnosis of sexual dysfunction and the woman's own perception of a sexual problem. Based on reported symptoms and behavior, 38% of women had at least one ICD-10 diagnosis of sexual dysfunction. Prevalence fell to 18% in women who also perceived they had a problem and to 6% in women who regarded the problem as moderate or severe. A total of 73 (18%) women were assigned an ICD-10 diagnosis and agreed that they had a problem, 80 (20%) were assigned a diagnosis but reported no problem, 78 (19%) had no diagnosis but reported a sexual problem, and 170 (42%) had no diagnosis and reported no problem. For women with sexual partners, reported sexual satisfaction was lowest in those assigned an ICD-10 diagnosis who also perceived they had a problem and highest in those with no diagnosis and no perceived problem. Relationship and emotional difficulties were the most common perceived causes of sexual difficulties, whether or not an ICD-10 diagnosis was assigned. There were three aspects to sexual difficulties in women. The first concerned symptoms and behavior that clinicians used to make a diagnosis, the second was the woman's own perception that she had a sexual difficulty, and the third was her level of sexual satisfaction. All three appear to be important and may explain why published prevalence rates of sexual dysfunction and associated factors are so conflicting.

Sexuality in Older Adults (65+)—An Overview of the Literature, Part 1: Sexual Function and its Difficulties

“…Thus, for a diagnosis of a sexual disorder the DSM-5 requires that sexual problems have been experienced for at least six months and is associated with "clinically significant distress in the individual" (American Psychiatric Association, 2013). We know that some women meet the symptom criteria for a sexual disorder but report no associated distress (Ferenidou, Kapoteli, Moisidis, Koutsogiannis, et al, 2008;King, Holt, & Nazareth, 2007). In fact, because the criteria required for a clinical diagnosis of sexual dysfunction are difficult to impossible to assess in large, 9 population-based surveys (Graham & Bancroft, 2005), we can likely only determine prevalence estimates of sexual "difficulties" and not sexual "dysfunctions".…”

Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being

“…Recently, a growing body of research has been produced that demonstrates the important role of the relational context in understanding the different aspects of couples' sexual well-being. For instance, various studies have shown that relationship problems are associated with a decline in sexual satisfaction (e.g., Sprecher & Cate, 2004) and -especially among women -with sexual dysfunctions and sexual distress (Bodenmann et al, 2007;King, Holt, & Nazareth, 2007;Stephenson & Meston, 2010). Given this strong interdependence between sex and intimate relationships, it is plausible to assume that lifetime experiences with tensed and discordant relationships, characterized by negative affect and negative behavioral patterns in the relationship, interfere with current positive sexual interactions.…”

The DSM Diagnostic Criteria for Female Sexual Arousal Disorder

“…A number of recent studies have assessed personal distress (Criterion B) associated with sexual arousal difficulties (e.g., Bancroft et al, 2003;Hayes et al, 2008;King, Holt, & Nazareth, 2007;Oberg et al, 2004;Shifren et al, 2008;Witting et al, 2008). A consistent finding across these studies has been that sexual problems, even if moderate/severe, do not always cause distress.…”

“…Some have argued that personal or interpersonal distress should not be included in the symptom criteria for the diagnosis of sexual dysfunction (Althof, 2001;Segraves et al, 2007). The issue of distress is acknowledged to be a difficult one (Mitchell & Graham, 2008); on the one hand, logically it seems that lack of distress should not preclude a diagnosis from being made (and, as discussed above, we know that some women meet diagnostic criteria for a sexual disorder but report no distress about it [King et al, 2007]). On the other hand, without assessing distress, prevalence rates for sexual problems are markedly higher.…”