Summary DSM5
8) Sexual dysfunction
= Clinically sign. disturbance in a person’s ability to respond sexually or to experience sexual
pleasure
Possible to have several
Specify whether:
- Lifelong= problem present from first sexual experience
- Acquired= problem developed after period of relatively normal sexual functioning
- Generalized= sexual difficulties not limited to certain types of
stimulations/situations/partners
- Situational= sexual difficulties that only occur with certain types of
stimulations/situations/partners
Considering factors; partner health, relationship, individual vulnerability (poor body image,
history of abuse), psychiatric comorbidity, cultural or religious factors! and medical factors
(Almost) all= 75%-100%
2) Delayed ejaculation
a. Symptoms experienced on (almost) all occasions of partnered sexual activity
(situational and generalized), and without the individual desiring delay
- Marked delay in ejaculation
- Marked infrequency or absence of ejaculation
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: difficulty or inability to ejaculate despite the presence of adequate
sexual stimulation and the desire to ejaculate
The definition of “delay” does not have precise boundaries
- Differential diagnosis: medical condition (nerve damage, MS, diabetic or alcoholic),
situational factors (dependent partner of context), medication (antidepressive,
antipsychotics and opioids) and retrograde ejaculation (=sperm goes to the bladder,
instead of outside)
Distinguish ejaculation (body reflex) and orgasm (subjective experience) > anhedonia
ejaculation= ejaculation without satisfaction
2) Erectile disorder
, a. Symptoms experienced on (almost) all occasions of partnered sexual activity
(situational and generalized)
- Marked difficulty in obtaining an erection during sexual activity
- Marked difficulty in maintaining an erection until the completion of sexual activity
- Marked decrease in erectile rigidity
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: the repeated failure to obtain or maintain erections during
partnered sexual activities. Check sexual history; duration 6 months, at least 75% of
the time, situational or generalized
Can experience a decreased sense of masculinity, fear of future sexual encounters and reduced
sexual desire/satisfaction
- Differential diagnosis: depressive disorder, substance/medication use, another medical
condition (age, vascular disease, spinal cord injury, stress) and other sexual
dysfunctions (may coexist with premature (early) ejaculation and male hypoactive
sexual desire disorder)
2) Female orgasmic disorder
a. Symptoms experienced on (almost) all occasions of partnered sexual activity
(situational and generalized)
- Marked delay/ infrequency/ absence of orgasm
- Markedly reduced intensity of orgasmic sensations
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: descriptions of an orgasm are widely varied and lack of orgasm
during intercourse alone does not indicate the disorder
- Differential diagnosis: depressive disorder, substance/medication, other medical
condition (MS, spinal cord injury), interpersonal factors (relationship distress/
violence) and comorbidity with female sexual interest/arousal disorder
2) Female sexual interest/arousal disorder
a. A lack of/ reduced sexual interest/arousal, as manifested by at least 3 of the following:
- Absent/ reduced interest in sexual activity
, - Absent/reduced sexual/erotic thoughts or fantasies
- No/ reduced sexual excitement/pleasure during sexual activity in (almost) all sexual
encounters
- Absent/reduced sexual interest/arousal in response to any internal or external
sexual/erotic cues
- Absent/reduced (non-)genital sensations during sexual activity in (almost) all sexual
encounters
b. Duration 6 months (short-term changes are normal, due to life events)
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: a ‘desire discrepancy’ in which a woman has lower desire for
sexual activity than her partner, is not sufficient to diagnose.
Because sexual desire and arousal frequently coexist and are elicited in response to adequate
sexual cues, the criteria for female sexual interest/arousal disorder consider that difficulties in
desire and arousal often simultaneously characterize the complaints of women with this
disorder.
Variability in how sexual interest and arousal are expressed, so different symptoms for
different women is possible
NOT the same as being asexual, because female sexual interest/arousal disorder causes
individual distress and having an asexual identity does not cause distress
- Differential diagnosis: depressive disorder, substance/medication, medical condition
(diabetes mellitus, central nervous disease), interpersonal factors (relationship distress/
violence), genito-pelvic pain or inadequate or absent sexual stimuli
Comorbidity; sexual distress and dissatisfaction with sex life, depression, thyroid problems,
anxiety, urinary incontinence, arthritis and inflammatory or irritable bowel disease are also
associated with sexual arousal problems
2) Genito-pelvic pain/ penetration disorder
a. Persistent or recurrent difficulties with one (or more) of the following:
- Vaginal penetration during intercourse
- Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation/during/result
of penetration
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal
penetration
b. Duration 6 months
, c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: The four symptoms are interrelated; a diagnosis can be made if
there is marked difficulty in any one dimension, but all must be assessed
Genito-pelvic pain; may be superficial (vulvovaginal) or deep (pelvic), provoked or
spontaneous, and described qualitatively (e.g., burning, throbbing). Pain can persist after
intercourse and occur during urination.
Fear or anxiety about penetration; can be anticipatory, during, or after penetration, sometimes
resembling a phobic reaction, leading to avoidance of sexual or medical situations.
Pelvic floor muscle tension; may present as reflexive spasms or voluntary guarding due to
fear, anxiety, or pain; relaxation can sometimes allow penetration.
- Differential diagnosis: other medical condition (endometriosis, pelvic inflammatory
disease, vulvovaginal atrophy), somatic symptoms, phobia or inadequate sexual
stimuli
2) Male hypoactive sexual desire disorder
a. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and
desire for sexual activity. The judgment of deficiency is made by the clinician, taking
into account factors that affect sexual functioning, such as age and general and
sociocultural contexts of the individual’s life
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Differential diagnosis: depressive disorder, substance/medication, other medical
condition, interpersonal factors or erectile dysfunctions
2) Premature (early) ejaculation
a. Ejaculation during sexual activity within one minute or before individual wishes to
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
8) Sexual dysfunction
= Clinically sign. disturbance in a person’s ability to respond sexually or to experience sexual
pleasure
Possible to have several
Specify whether:
- Lifelong= problem present from first sexual experience
- Acquired= problem developed after period of relatively normal sexual functioning
- Generalized= sexual difficulties not limited to certain types of
stimulations/situations/partners
- Situational= sexual difficulties that only occur with certain types of
stimulations/situations/partners
Considering factors; partner health, relationship, individual vulnerability (poor body image,
history of abuse), psychiatric comorbidity, cultural or religious factors! and medical factors
(Almost) all= 75%-100%
2) Delayed ejaculation
a. Symptoms experienced on (almost) all occasions of partnered sexual activity
(situational and generalized), and without the individual desiring delay
- Marked delay in ejaculation
- Marked infrequency or absence of ejaculation
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: difficulty or inability to ejaculate despite the presence of adequate
sexual stimulation and the desire to ejaculate
The definition of “delay” does not have precise boundaries
- Differential diagnosis: medical condition (nerve damage, MS, diabetic or alcoholic),
situational factors (dependent partner of context), medication (antidepressive,
antipsychotics and opioids) and retrograde ejaculation (=sperm goes to the bladder,
instead of outside)
Distinguish ejaculation (body reflex) and orgasm (subjective experience) > anhedonia
ejaculation= ejaculation without satisfaction
2) Erectile disorder
, a. Symptoms experienced on (almost) all occasions of partnered sexual activity
(situational and generalized)
- Marked difficulty in obtaining an erection during sexual activity
- Marked difficulty in maintaining an erection until the completion of sexual activity
- Marked decrease in erectile rigidity
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: the repeated failure to obtain or maintain erections during
partnered sexual activities. Check sexual history; duration 6 months, at least 75% of
the time, situational or generalized
Can experience a decreased sense of masculinity, fear of future sexual encounters and reduced
sexual desire/satisfaction
- Differential diagnosis: depressive disorder, substance/medication use, another medical
condition (age, vascular disease, spinal cord injury, stress) and other sexual
dysfunctions (may coexist with premature (early) ejaculation and male hypoactive
sexual desire disorder)
2) Female orgasmic disorder
a. Symptoms experienced on (almost) all occasions of partnered sexual activity
(situational and generalized)
- Marked delay/ infrequency/ absence of orgasm
- Markedly reduced intensity of orgasmic sensations
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: descriptions of an orgasm are widely varied and lack of orgasm
during intercourse alone does not indicate the disorder
- Differential diagnosis: depressive disorder, substance/medication, other medical
condition (MS, spinal cord injury), interpersonal factors (relationship distress/
violence) and comorbidity with female sexual interest/arousal disorder
2) Female sexual interest/arousal disorder
a. A lack of/ reduced sexual interest/arousal, as manifested by at least 3 of the following:
- Absent/ reduced interest in sexual activity
, - Absent/reduced sexual/erotic thoughts or fantasies
- No/ reduced sexual excitement/pleasure during sexual activity in (almost) all sexual
encounters
- Absent/reduced sexual interest/arousal in response to any internal or external
sexual/erotic cues
- Absent/reduced (non-)genital sensations during sexual activity in (almost) all sexual
encounters
b. Duration 6 months (short-term changes are normal, due to life events)
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: a ‘desire discrepancy’ in which a woman has lower desire for
sexual activity than her partner, is not sufficient to diagnose.
Because sexual desire and arousal frequently coexist and are elicited in response to adequate
sexual cues, the criteria for female sexual interest/arousal disorder consider that difficulties in
desire and arousal often simultaneously characterize the complaints of women with this
disorder.
Variability in how sexual interest and arousal are expressed, so different symptoms for
different women is possible
NOT the same as being asexual, because female sexual interest/arousal disorder causes
individual distress and having an asexual identity does not cause distress
- Differential diagnosis: depressive disorder, substance/medication, medical condition
(diabetes mellitus, central nervous disease), interpersonal factors (relationship distress/
violence), genito-pelvic pain or inadequate or absent sexual stimuli
Comorbidity; sexual distress and dissatisfaction with sex life, depression, thyroid problems,
anxiety, urinary incontinence, arthritis and inflammatory or irritable bowel disease are also
associated with sexual arousal problems
2) Genito-pelvic pain/ penetration disorder
a. Persistent or recurrent difficulties with one (or more) of the following:
- Vaginal penetration during intercourse
- Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation/during/result
of penetration
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal
penetration
b. Duration 6 months
, c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Diagnostic features: The four symptoms are interrelated; a diagnosis can be made if
there is marked difficulty in any one dimension, but all must be assessed
Genito-pelvic pain; may be superficial (vulvovaginal) or deep (pelvic), provoked or
spontaneous, and described qualitatively (e.g., burning, throbbing). Pain can persist after
intercourse and occur during urination.
Fear or anxiety about penetration; can be anticipatory, during, or after penetration, sometimes
resembling a phobic reaction, leading to avoidance of sexual or medical situations.
Pelvic floor muscle tension; may present as reflexive spasms or voluntary guarding due to
fear, anxiety, or pain; relaxation can sometimes allow penetration.
- Differential diagnosis: other medical condition (endometriosis, pelvic inflammatory
disease, vulvovaginal atrophy), somatic symptoms, phobia or inadequate sexual
stimuli
2) Male hypoactive sexual desire disorder
a. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and
desire for sexual activity. The judgment of deficiency is made by the clinician, taking
into account factors that affect sexual functioning, such as age and general and
sociocultural contexts of the individual’s life
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
- Differential diagnosis: depressive disorder, substance/medication, other medical
condition, interpersonal factors or erectile dysfunctions
2) Premature (early) ejaculation
a. Ejaculation during sexual activity within one minute or before individual wishes to
b. Duration 6 months
c. Symptoms causes sign. distress in individual
d. Not explained by effects of substances, medical conditions and severe relationship
distress
