International Consultation on Sexual Medicine Report
Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015

https://doi.org/10.1016/j.jsxm.2015.12.019Get rights and content

Abstract

Introduction

Definitions of sexual dysfunctions in women and men are critical in facilitating research and enabling clinicians to communicate accurately.

Aims

To present the new set of definitions of all forms of sexual dysfunction in women and men adopted by the Fourth International Consultation on Sexual Medicine (ICSM) held in 2015.

Methods

Classification systems, including the International Classification of Diseases, 10th Edition and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and systems that focus on only specific types of sexual dysfunctions (eg, the International Society for Sexual Medicine definition for premature ejaculation) were reviewed.

Main Outcome Measures

Evidence-based definitions were retained, gaps in definitions were identified, and outdated definitions were updated or discarded. Where evidence was insufficient or absent, expert opinion was used. Some definitions were self-evident and termed clinical principles.

Results

The evidence to support the various classification systems was carefully evaluated. A more comprehensive analysis of this evidence can be found in two other articles in this journal that consider the incidence and prevalence and the risk factors for sexual dysfunction in men and women. These data were used to shape the definitions for sexual dysfunction that have been recommended by the 2015 ICSM.

Conclusion

The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions. As more research and clinical studies are conducted, there likely will be modifications of at least some definitions.

Introduction

This article describes the different classification systems for sexual dysfunction that have been used to guide research and practice in sexual medicine. Then, the definitions of sexual dysfunctions for men and women adopted by the Fourth International Consultation on Sexual Medicine (ICSM) are introduced. Draft definitions of these sexual dysfunctions and the rationale for their adoption were presented to the general meeting of the Fourth ICSM in June 2015. Comments from delegates were incorporated into a revised set of definitions, and then these revised definitions were presented to the chairs of the other ICSM committees. The final definitions in this article are those that were approved and adopted by the Fourth ICSM.

Commonly accepted diagnostic criteria influence how clinicians organize their thinking about clinical conditions, how clinical activity is coded for reimbursement, and how populations are defined in clinical research. Clinicians can use the experience of other clinicians only to the extent that they agree on the definition of the condition being studied or treated. Data from clinical trials and epidemiologic studies are relevant to the clinician only to the extent that they use similar definitions of the condition being treated by the clinician. Commonly accepted definitions permit global information exchange and communication among clinicians, their patients, and health care systems. These systems also facilitate the training of future clinicians and are used by other sectors such as health care policy makers, payers of health care, and pharmaceutical companies.1

Various approaches to taxonomy are used in medicine. A classic approach in medicine is to define a disease by its etiology. Such an approach applies in certain bacteriologic infections and nutritional deficiencies.2 However, the etiology of sexual dysfunctions is often unknown or presumed to be multifactorial. In such cases, a descriptive taxonomy is used. Most current classification systems for sexual dysfunctions are primarily descriptive. A problem with the most widely used current systems of classification is the assumption of mind vs body dualism, with disorders being classified as psychiatric or medical in etiology.3 This problem is perhaps best appreciated in the definition of lifelong female orgasmic disorder. Although current research indicates a clear genetic contribution to orgasmic function, psychosocial influences are perhaps of equal or greater importance. In most cases, one cannot easily separate organic from non-organic factors. Part of this separation of diagnostic systems can be understood in historical context. With some exceptions, most treatments of sexual disorders before the advent of the phosphodiesterase inhibitors were by psychiatrists or psychologists and it was commonly assumed that the vast majority of sexual disorders had psychological etiologies.4

Section snippets

Major Classification Systems

Although different classification systems for sexual dysfunctions have been proposed, the International Classification of Diseases, 10th Edition (ICD-10)5 by the World Health Organization and the Diagnostic and Statistical Manual of Mental Disorders (fourth edition with text revision or fifth edition; DSM-1V-TR and DSM-5)6, 7 by the American Psychiatric Association have been the most widely used systems internationally. Although the DSM system is a psychiatric system, some of its diagnostic

International Classification of Diseases, 10th Edition

The ICD-10 was approved by the World Health Association in 1990 and published in 1992.5 This system is in the process of revision. Completion of the ICD-11 is anticipated in 2017. In the ICD-10, one codes disorders as organic or as non-organic. The organic sexual dysfunction codes are erectile dysfunction (ED), vaginismus, and dyspareunia of organic etiology. All organic codes are contained in the chapter on diseases of the genitourinary system. In contrast, there are 10 separate non-organic

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

The DSM published by the American Psychiatric Association has been translated into more than 20 languages and has had a major role in Europe and the United States in setting criteria for the diagnosis of mental disorders. Specific criteria for sexual dysfunctions were introduced in the DSM-III in 1980 and then modified in subsequent versions (DSM-III-R in 1987, DSM-IV in 1994, and DSM-IV-TR in 2000). The DSM-5 was introduced in 2013.

The DSM-57 represents a major shift conceptually from the

Diagnostic Criteria in Epidemiologic Studies

There are inherent difficulties in gathering data in epidemiologic studies that can be meaningfully linked to clinically based definitions and classifications. Population-representative survey studies of sexual dysfunction must take into account time constraints on the interview instrument such that no more than three or four questions per dysfunction are feasible. In addition, if a study attempts to link sexual functionality to other features of the individual respondent, then it might not be

Definitions of Sexual Dysfunctions Recommended by This Consultation

It is important to realize that currently there are two officially sanctioned systems with international influence, the DSM-5 and the ICD-10. The ICD-10 is focused on the definition of medical conditions and the DSM-5 is a document that primarily defines psychiatric conditions. As a result, there are inherent biases in the definitions from these two diagnostic systems. The DSM-5 was introduced in May 2013. Although it has been legitimately criticized, it is simply too soon after its

Definitions of Sexual Dysfunctions That Occur in Women

In relation to the definitions of sexual dysfunctions that occur in women, the definitions have been drawn from several classification systems. There was consensus by the ICSM on the definitions described in this article. Thus, the input into these final definitions has been drawn from a large number of international experts in the field of sexual dysfunction.

Members of the Fourth ICSM were of the view that hypoactive sexual desire dysfunction should be kept as a separate entity from female

Definitions of Sexual Dysfunctions That Occur in Men

Each definition was chosen for being the closest reflection of current evidence or expert opinion. Some definitions in this list are identical to definitions used in previous ICSMs, the ICD-10, the DSM-5, or other existing sources. Some definitions are modifications of previous definitions. The list also contains several new terms that have not been formally defined previously. Each definition was chosen for being the closest reflection of current evidence or expert opinion. The Fourth ICSM

Conclusion

These definitions were adopted by the Fourth ICSM in 2015. This consultation was comprised of many of the top international experts in the field of male and female sexual dysfunction. The definitions have many levels of empirical support, and some are based on expert clinical opinion, rather than a strong research base. However, these definitions were seen to represent the most up-to-date reflections of the definitions for sexual dysfunction. It is imperative that research be conducted to

References (13)

There are more references available in the full text version of this article.

Cited by (347)

View all citing articles on Scopus

Conflict of Interest: The authors report no conflicts of interest.

Funding: None.

View full text