“Althof et al. (2017). Opinion paper: On the diagnosis/classification of sexual arousal concerns in women.” – Article summary

In the earliest diagnostic manuals, only inhibited sexual excitement was used to denote psychosexual disorders. However, this was indicated by a lack of a physiological response. In later diagnostic manuals, the FSAD diagnosis was added. However, the subjective arousal subtype was removed from this diagnosis in the DSM-4. This was done to make sure that the male-female similarity in sexual dysfunctions diagnoses could be maintained. The FSAD diagnosis only represents genital arousal and sees subjective arousal and sexual desire as the same thing while it is not.

Desire refers to the motivation to engage in and/or be receptive to a sexual event for sexual or non-sexual gratification. Genital arousal refers to genital changes in response to sexual stimuli. These changes may be associated with other bodily reactions (e.g. increased heart rate). Subjective arousal refers to positive mental engagement and focus in respone to a sexual stimulus. This may include awareness of the presence or absence of genital changes or sensations during a sexual event (i.e. perceived arousal).

There is a close relation between desire and arousal problems. This implies that problems becoming aroused could diminish desire over time and vice versa. However, the correlation between desire and arousal does not account for all the variance. This implies that subjective arousal and desire are not the same variables. The frequency of desire can only explain a small part of the variance in subjective arousal frequency and the level of desire can only explain part of the variance in the level of subjective arousal. A lot of variance in subjective arousal is still unexplained by desire.

It can be expected that there is a low subjective arousal in women with low sexual desire if they are the same construct. However, women with low sexual desire do not necessarily have low subjective arousal. This implies that they are not the same construct.

This is important, as this implies the need to reintroduce the subjective arousal subtype in sexual dysfunction diagnoses. The diagnoses criteria have a major influence on how clinicians organize their thinking about sexual disorders (1, how clinical activity is coded for reimbursement (2), how populations are defined for clinical research (3) and how compounds or psychotherapeutic interventions are evaluated for the treatment of these disorders (4).