“Graham, Boyton, & Gould (2017). Challenging narratives of ‘dysfunction’. “ – Article summary

The human sexual response cycle (HSRC) proposes a linear series of phases of sexual response. The phases are excitement (1), arousal (2), orgasm (3) and resolution (4). This model assumes that these phases are the same for men and women and the first sexual dysfunctions were based on this model. However, one model of sexual response does not fit all people.

In the DSM-5, duration and severity criteria were added to prevent overdiagnosis of sexual dysfunction. There is no empirical basis for the distinction between subjective arousal and desire. Symptoms must persist for 6 months and for all or almost all sexual encounters. To meet the criteria for a dysfunction, a woman needs to meet three of the following six criteria:

• Absent/reduced interest in sexual activity.
• Absent/reduced sexual/erotic thoughts or fantasies.
• Absent//reduced sexual excitement/pleasure during sexual activity on all or almost all encounters.
• Absent/reduced sexual interest in response to any internal or external sexual/erotic cues.
• Absent/reduced genital or non-genital sensations during sexual activity on all or almost all sexual encounters.
• No/reduced initiation of sexual activity and typically unresponsive to a partner’s attempts to initiate.

Flibanserin is the first medication to receive FDA approval for the treatment of HSDD. The drug has mixed effects on serotonergic and dopaminergic transmitter systems. Compared to the costs of using the drug, the benefits appear to be marginal.

The Even the Score campaign attempted to increase awareness of HSDD and push for treatment. This campaign claimed that men received more treatment for a similar disorder, although this claim is not true.

Many women seek or desire pharmaceutical treatment for FSD. They seek to return to the level of sexual desire they experienced earlier in the relationship and they claim that desire should remain unaffected by anything outside of the bedroom. This means that they believe that sexual desire is mainly influenced by physiological factors and not by psychological factors.

It is possible that the idea of normal (i.e. having sex frequently) causes distress and anxiety in women who do not live up to that ideal. This causes this behaviour to be pathologized. A focus on the relationship may thus be more effective than a focus on sexual desire.

In most research, there is no clear distinction between sex and desire. The lack of this definition of sex makes it difficult to address where the problems with desire/orgasm may exist. Furthermore, it perpetuates the idea that only vaginal sex equals to real sex. This leads to people who experience pleasure from non-PIV sex but not from PIV sex are categorized as dysfunctional while this is not necessarily the case.

Sex in research on FSD is represented in the following way:

• Desire is strong and spontaneous rather than reactive and responsive.
• Orgasms are goals to be achieved.
• Sex refers to penis-in-vagina sex.
• Sex is a vital and central part of any relationship.
• Sex is the glue that holds relationships together.
• Good and healthy sex requires frequent and novel sexual experiences.
• Other forms of sex (e.g. oral sex) are not commonly included.
• Male desire and orgasm are uncomplicated while women’s desire and orgasm are complex and difficult/time-consuming to achieve.

In research, sex is typically not seen as diverse and varied.

The media has typically not been critical around the arguments presented in favour of and against pharmacological treatment for FSD. They have also not been critical towards the terminologies that are sued and the alternatives (e.g. other types of sex also seen as sex and not only as a precursor to PIV sex). Lastly, the media has also not been critical about the safety and efficacy of the drugs and has mainly focused on the need for this pharmacological treatment.

Pharmacological treatment has been hampered by the heterogeneous participant pool (e.g. heterosexual; Western) and this influences the external validity.