In the DSM-IV (1994), the criterion that the diagnosis requires "marked distress or interpersonal difficulty" was added.The DSM-5, published in 2013, split HSDD into male hypoactive sexual desire disorder and female sexual interest/arousal disorder. The distinction was made because men report more intense and frequent sexual desire than women. According to Lori Brotto, this classification is desirable compared to the DSM-IV classification system because: (1) it reflects the finding that desire and arousal tend to overlap (2) it differentiates between women who lack desire before the onset of activity, but who are receptive to initiation and or initiate sexual activity for reasons other than desire, and women who never experience sexual arousal (3) it takes the variability in sexual desire into account. Furthermore, the criterion that 6 symptoms be present for a diagnosis helps safeguard against pathologizing adaptive decreases in desire. Criticism
General
HSDD, as currently defined by the DSM, has come under criticism of the social function of the diagnosis. HSDD could be seen as part of a history of the medicalization of sexuality by the medical profession to define normal sexuality. It has also been examined within a "broader frame of historical interest in the problematization of sexual appetite". HSDD has been criticized over pathologizing normal variations 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.
Merrem may refer to:

Meropenem, an antibiotic initially marketed under the trade name Merrem
Blasius Merrem (1761–1824), German naturalist, zoologist, ornithologist, mathematician, and herpetologist