CLASSIFICATION General Sexual Issues
Sexual disorders in general are classified in the Text Revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). One of the sections in DSM-IV-TR is titled “Sexual and Gender Disorders.” Sexual disorders classified in the DSM system follow the thinking of Masters and Johnson (1), and Kaplan (10). The former described a “Sex Response Cycle” (SRC) that consisted of four phases, each of which they named: “excitement,” “plateau,” “orgasm,” and “resolution.” Kaplan then added another element that had previously been missing, namely, “desire.” In addition, she reconceptualized the SRC into three parts: “desire,” “response,” and “orgasm,” each of which was associated with a different disorder. The DSM system is similarly organized.
To many, the SRC is intellectually appealing and clinically useful in orga- nizing thoughts about patient problems. However, it is not without considerable drawbacks. First, as discussed earlier, some see it as much more useful when con- sidering the sexual sequence experienced by men compared with women (5). Second, the phases are described in such a way as to seem discrete; but, in actual fact, they flow into each other. For example, desire is not simply at the beginning of a sexual event, but under ordinary circumstances, continues the whole way through (11). Similarly (although ostensibly less common in men vs. women), desire may follow arousal as, for example, when a man awakens in the morning with an erection and only then becomes sexually interested.