The prevalence of female sexual interest/arousal disorder, as defined in this manual, is unknown. The prevalence of low sexual desire and of problems with sexual arousal (with and without associated distress), as defined by DSM-IV or ICD-lO, may vary markedly in relation to age, cultural setting, duration of symptoms, and presence of distress. Regard- ing duration of symptoms, there are striking differences in prevalence estimates between short-term and persistent problems related to lack of sexual interest. When distress about sexual functioning is required, prevalence estimates are markedly lower. Some older women report less distress about low sexual desire than younger women, although sexual desire may decrease with age.
By definition, lifelong female sexual interest/arousal disorder suggests that the lack of sexual interest or arousal has been present for the woman’s entire sexual life. For Criteria
A3, A4, and A6, which assess functioning during sexual activity, a subtype of lifelong would mean presence of symptoms since the individual’s first sexual experiences. The ac- quired subtype would be assigned if the difficulties with sexual interest or arousal de- veloped after a period of nonproblematic sexual functioning. Adaptive and normative changes in sexual functioning may result from partner-related, interpersonal, or personal events and may be transient in nature. However, persistence of symptoms for approxi- mately 6 months or more would constitute a sexual dysfunction.
There are normative changes in sexual interest and arousal across the life span. Fur- thermore, women in relationships of longer duration are more likely to report engaging in sex despite no obvious feelings of sexual desire at the outset of a sexual encounter com- pared with women in shorter-duration relationships. Vaginal dryness in older women is related to age and menopausal status.
Temperamental. Temperamental factors include negative cognitions and attitudes about sexuality and past history of mental disorders. Differences in propensity for sexual excitation and sexual inhibition may also predict the likelihood of developing sexual problems.
Environmental. Environmental factors include relationship difficulties, partner sexual functioning, and developmental history, such as early relationships with caregivers and childhood stressors.
Genetic and physiological. Some medical conditions (e.g., diabetes mellitus, thyroid dysfunction) can be risk factors for female sexual interest/ arousal disorder. There appears to be a strong inﬂuence of genetic factors on vulnerability to sexual problems in women.
ences between women with and without perceived lack of genital arousal.
There is marked variability in prevalence rates of low desire across cultures. Lower rates of sexual desire may be more common among East Asian women compared with Euro-
Canadian women. Although the lower levels of sexual desire and arousal found in men and women from East Asian countries compared with Euro-American groups may reﬂect less interest in sex in those cultures, the possibility remains that such group differences are an artifact of the measures used to quantify desire. A judgment about whether low sexual sexual interest/arousal disorder must take into account the fact that different cultures may pathologize some behaviors and not others.
By definition, the diagnosis of female sexual interest/arousal disorder is only given to women. Distressing difficulties with sexual desire in men would be considered under male hypoactive sexual desire disorder.
Difficulties in sexual interest/arousal are often associated with decreased relationship sat- isfaction.
Nonsexual mental disorders. Nonsexual mental disorders, such as major depressive disorder, in which there is “markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day,” may explain the lack of sexual interest/ arousal. If the lack of interest or arousal is completely attributable to another mental dis- order, then a diagnosis of female sexual interest/arousal disorder would not be made.
Substance/medication use. Substance or medication use may explain the lack of inter- est/arousal.
Another medical condition. If the sexual symptoms are considered to be almost exclu- sively associated with the effects of another medical condition (e.g., diabetes mellitus, en- dothelial disease, thyroid dysfunction, central nervous system disease), then a diagnosis of female sexual interest/arousal disorder would not be made.