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.
Because of this, some members of the asexual community lobbied the mental health community working on the DSM-5 to regard asexuality as a legitimate sexual orientation rather than a mental disorder.Other criticisms focus more on scientific and clinical issues. HSDD is such a diverse group of conditions with many causes that it functions as little more than a starting place for clinicians to assess people. The requirement that low sexual desire causes distress or interpersonal difficulty has been criticized. It has been claimed that it is not clinically useful because if it is not causing any problems, the person will not seek out a clinician. One could claim that this criterion (for all of the sexual dysfunctions, including HSDD) decreases the scientific validity of the diagnoses or is a cover-up for a lack of data on what constitutes normal sexual function. The distress requirement is also criticized because the term "distress" lacks a clear definition. NICE (UK) assessment
Hypoactive sexual desire disorder is not recognized as a disorder by the National Institute for Health and Care Excellence for the British National Health Service, with the judgement based on an article in the Journal of Medical Ethics that "Hypoactive sexual desire disorder is a typical example of a condition that was sponsored by industry to prepare the market for a specific treatment". DSM-IV criteria
Prior to the publication of the DSM-5, the DSM-IV criteria were criticized on several grounds.