Sexual Issues

19 May

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.

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