Hypoactive Sexual Desire Disorder - Criticism

Criticism

HSDD, as currently defined by the DSM has come under criticism of the social function of the diagnosis.

• HSDD could be seen a part of a history of the medicalization of sexuality by the medical profession to define normal sexuality. It may also over pathologize normal variation in sexuality because the parameters of normality are unclear. This lack of clarity is partly due to the fact that the terms "persistent" and "recurrent" do not have clear operational definitions.
• HSDD may function to pathologize asexuals, though their lack of sexual desire may not be maladaptive. Because of this, some members of the asexual community are lobbying the mental health community working on the DSM-V to regard asexuality as a legitimate sexual orientation rather than a mental disorder.

Other criticisms focus more on scientific and clinical issues.

• HSDD is such a diverse group etiologically that it functions as little more than a starting place for clinicians to assess people.
• Research indicates a high degree of comorbidity between HSDD and female sexual arousal disorder. Therefore, a diagnosis combining the two might be more appropriate.
• The requirement that low sexual desire causes distress or interpersonal difficulty has been criticized. It has been claimed that it is not clinically useful because if it is not causing any problems, the person will not seek out a clinician. One could claim that this criterion (for all of the sexual dysfunctions, including HSDD) decreases the scientific validity of the diagnoses or is a cover-up for a lack of data on what constitutes normal sexual function.
• The distress requirement is also criticized because the term "distress" lacks a clear definition.
• It is suggested that a duration criterion should be added because lack of interest in sex over the past month is significantly more common than lack of interest lasting six months. Similarly, a frequency criterion (i.e., the symptoms of low desire be present in 75% or more of sexual encounters) has been suggested.

The current framework for HSDD is based on a linear model of human sexual response, developed by Masters and Johnson and modified by Kaplan consisting of desire, arousal, orgasm. The sexual dysfunctions in the DSM are based around problems at any one or more of these stages. Many of the criticisms of the present DSM framework for sexual dysfunction in general, and HSDD in particular, claim that this models ignores the differences between male and female sexuality. Several criticisms are based on inadequacy of the current framework for dealing with women's sexual problems.

• Increasingly, evidence shows that there are significant differences between male and female sexuality. Level of desire is highly variable from woman to woman and there are some women who are considered sexually functional who have no active desire for sex, but they can erotically respond well in contexts they find acceptable. This has been termed "responsive desire" as opposed to spontaneous desire.
• The focus on merely the physiological ignores the social, economic and political factors including sexual violence and lack of access to sexual medicine or education throughout the world affecting women and their sexual health.
• The focus on the physiological ignores the relationship context of sexuality despite the fact that these are often the cause of sexual problems.
• The focus on discrepancy in desire between two partners may result in the partner with the lower level of desire being labeled as "dysfunctional," but the problem really sits with difference between the two partners. However, within couples the assessment of desire tends to be relative. That is, individuals make judgments by comparing their levels of desire to that of their partner.
• The sexual problems that women complain of often do not fit well into the current DSM framework for sexual dysfunctions.
• The current system of sub-typing may be more applicable to one gender than the other.