International Consultation on Sexual Medicine ReportDefinitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015
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)
- et al.
Proposal for changes in diagnostic criteria for sexual dysfunctions
J Sex Med
(2007) - et al.
Revised definitions of women’s sexual dysfunction
J Sex Med
(2004) - et al.
An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the Second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation
J Sex Med
(2014) - et al.
Persistent genital arousal disorder: characterization, etiology, and management
J Sex Med
(2013) - et al.
Psychiatric disorders: a conceptual taxonomy
Am J Psychiatry
(2007) - et al.
Sexual dysfunctions: classifications and definitions
J Sex Med
(2007)
Cited by (347)
Association of resilience with female sexual dysfunction
2024, MaturitasCombination of synthetic and natural polymers on the characteristics and evaluation of transdermal hydrogel-forming microneedles preparations integrated with direct compressed tablets reservoir sildenafil citrate
2023, Journal of Drug Delivery Science and TechnologySexual dysfunction in patients with diabetes: association between remnant cholesterol and erectile dysfunction
2024, Lipids in Health and DiseaseInvestigating the role of the pelvic floor muscles in sexual function and sexual response: a systematic review and meta-analysis
2024, Journal of Sexual Medicine
Conflict of Interest: The authors report no conflicts of interest.
Funding: None.