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Sexual Dysfunctions and Asexuality in DSM-5

Part of the History, Philosophy and Theory of the Life Sciences book series (HPTL,volume 10)

Abstract

In the past 15 years or so, there has been a large increase in the amount of industry funding for sex research, as well as a backlash against the “medicalization” of female sexuality. During the same time, there has been a growing community of people identifying as “asexual,” which is often seen as a sexual orientation. This chapter considers the interaction of these in leading up to DSM-5, as well as concerns about clinical significance criteria and difficulties in distinguishing between “sexual dysfunctions” and “normal variation.”

Keywords

  • Asexuality
  • Harmful dysfunction
  • Sexual desire/arousal disorder
  • Sexual dysfunction

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Notes

  1. 1.

    Retrieved 8/30/2013 from http://en.wikipedia.org/wiki/Hypoactive_sexual_desire_disorder

  2. 2.

    DSM-5 has two chapters of sexual disorders. The paraphilias concern “deviant” sexual interests, and the ones currently listed are in the DSM largely because of their forensic history and it is in this group that homosexuality was previously included. The sexual dysfunctions include things like sexual pain disorders, erectile dysfunction, low/no sexual desire and/or arousal, etc.

  3. 3.

    The term “dysfunction” here is different than in the collocation “sexual dysfunction.” The collocation “sexual dysfunctions” generally entails being a disorder. “Sexual disorders” is often a superordinate term for the sexual dysfunctions and paraphilias.

  4. 4.

    This addition largely reflects part of a definition of (mental) disorder proposed by Culver and Gert (1982). Their approach also focuses on limiting relevant harms (see also Culver and Gert 2009), but has been less influential. Rather than a notion of “dysfunction,” they require that the condition be a “nondistinct sustaining cause” (Culver and Gert 1982, p. 72).

  5. 5.

    Spitzer and Wakefield (1999) had previously made similar comments about the sexual dysfunctions and paraphilias.

  6. 6.

    Meeting Criterion B presupposes meeting Criterion A, so “meeting B but not A” can be excluded.

  7. 7.

    In fact, they had difficulty finding asexual women, and so the asexual sample size was smaller than for other groups. The graph they show for physiological arousal (Figure 1, p. 705) suggests that, with increased power from a larger sample, they would likely find that asexual women do have lower levels of physiological sexual arousal in the condition they studied.

  8. 8.

    In a footnote in our report, I indicated that I neither endorsed nor opposed this option. We had not asked about this possibility in our interviews, and in the absence of any feedback from clinicians I did not want to support it.

  9. 9.

    By contrast, the chapter on the paraphilias appears to be quite up front about what is not normal in its definition of ‘paraphilia’, which it contrasts with ‘normophilia’: “The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” (APA 2013, p. 685). I have no idea what this means, but it does not give the impression of avoiding taking a position on what is normal.

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Hinderliter, A. (2015). Sexual Dysfunctions and Asexuality in DSM-5. In: Demazeux, S., Singy, P. (eds) The DSM-5 in Perspective. History, Philosophy and Theory of the Life Sciences, vol 10. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-9765-8_8

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