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Chapter 18: Female Sexual Dysfunction

Christine M. Vaccaro; Rachel N. Pauls

DEFINITION

Female sexual dysfunction (FSD) is a common health problem that may affect up to 43% of women.1 Over past decades the definition of FSD has evolved. The World Health Organization’s International Classification of Diseases (ICD-10, 1980) emphasized physical factors that influence the sexual response, in contrast with the focus on psychological ones by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). More recently, the American Foundation for Urologic Disease (AFUD) defined FSD as disorders of libido, arousal, orgasm, and sexual pain that lead to personal distress or interpersonal difficulties.2

While the DSM-V due in 2012 is expected to make further adjustments to the current classification system, the most recent revision of the definition was generated at the Third International Consultation on Sexual Medicine (ICSM), published in 2010,3 and is a modification of the AFUD classification system. The ICSM definitions were formulated by an international panel of 21 experts in the field of female sexual medicine (Tables 18-1 and 18-2).3,4

Table 18-1

ICSM Definition3

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Table 18-1

ICSM Definition3
Disorder Definition
Sexual desire/interest disorder Diminished or absent feelings of sexual interest or desire, absent sexual thoughts or fantasies, and a lack of responsive desire. Motivation (here defined as reasons/incentives) for attempting to become sexually aroused is scarce or absent. The lack of interest is considered to be beyond the normative lessening with lifecycle and relationship duration.

  • Arousal disorder Subjective sexual arousal disorder

  • Genital sexual arousal disorder

  • Combined genital and subjective arousal disorder Persistent genital arousal disorder

 Sexual arousal disorders are divided into 4 subtypes:

  • Absence of or markedly diminished feelings of sexual arousal (sexual excitement and sexual pleasure) from any type of sexual stimulation. Vaginal lubrication or other signs of physical response still occur.

  • Complaints of impaired genital sexual arousal; self-report may include minimal vulvar swelling or vaginal lubrication from any type of sexual stimulation and reduced sexual sensation from caressing genitalia. Subjective sexual excitement still occurs from nongenital sexual stimuli.

  • Absence of or markedly diminished feelings of sexual arousal (sexual excitement and sexual pleasure) from any type of sexual stimulation as well as complaints of absent or impaired genital sexual arousal (vulvar swelling, lubrication).

  • Spontaneous, intrusive, and unwanted genital arousal (ie, tingling, throbbing, pulsating) in the absence of sexual interest and desire. Any awareness of subjective arousal is typically but not invariably unpleasant. The arousal is unrelieved by one or more orgasms and the feeling or arousal persists for hours or days.
Women’s orgasmic disorder Despite the self-report of high sexual arousal/excitement, there is a lack of orgasm, markedly diminished intensity of orgasmic sensations, or marked delay of orgasm from any kind of stimulation
Dyspareunia Persistent or recurrent pain with attempted or complete vaginal entry and/or penile vaginal intercourse.
Vaginismus Persistent or recurrent difficulties of the woman to allow vaginal entry of a ...

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