Reconceptualising women’s sexual desire and arousal in DSM-5

The publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 was the culmination of more than a decade of work by the APA DSM-5 task force and Work Groups. From 2007 to 2013, I served as a member of the Sexual Dysfunctions subworkgroup, part of the Sexual and Gender Identity Disorders workgroup. In the area of sexual disorders, some of the most significant changes were made in diagnostic categories for female sexual dysfunction. The DSM-IV categories of desire and arousal disorders (Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder) were replaced by a new, much broader diagnosis which included behavioural, subjective and physical aspects of sexual experience (Female Sexual Interest/Arousal Disorder). Other major changes included the addition of more specific and stringent severity and duration criteria and a list of contextual factors, for example, partner factors or cultural/religious factors that should be assessed by clinicians before making a diagnosis. This article reviews the rationale behind these major changes and outlines the process and some of the key challenges faced by the DSM-5 Sexual Dysfunctions subworkgroup in developing their recommendations.