Criteria

Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR)[1]

The DSM-5-TR divides sexual dysfunction in women into:

  • Female sexual interest/arousal disorder

  • Female orgasmic disorder

  • Genito-pelvic penetration pain disorder

  • Substance/medication-induced sexual dysfunction

  • Other specified sexual dysfunction

  • Unspecified sexual dysfunction.

Female sexual interest/arousal disorder[1]

Lack of, or significantly reduced, sexual interest/arousal as manifested by at least three of the following:

  • Absent/reduced interest in sexual activity

  • Absent/reduced sexual/erotic thoughts or fantasies

  • No/reduced initiation of sexual activity, and typically unreceptive to a partner's attempts to initiate

  • Absent/reduced sexual excitement/pleasure during sexual activity in all or almost all (approximately 75% to 100%) sexual encounters

  • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual)

  • Absent/reduced genital and/or non-genital sensations during sexual activity (in all or almost all sexual encounters).

The above symptoms:

  • Must persist for a minimum of approximately 6 months

  • Must cause clinically significant distress in the individual

  • Are not better explained by a non-sexual mental disorder, a consequence of severe relationship distress, other significant stressors, or effects of a substance/medication or another medical condition.

Specifiers:

  • Lifelong or acquired (i.e., began after a period of relatively normal sexual activity)

  • Generalised or situational (i.e., only occurs with certain types of stimulation, situations, or partners).

Current severity can be defined as mild, moderate, or severe based on the individual’s degree of distress due to their symptoms.

Female orgasmic disorder[1]

Presence of at least one of the two following symptoms, experienced in almost all (approximately 75% to 100%) occasions of sexual activity:

  • Marked delay in, marked infrequency of, or absence of orgasm

  • Markedly reduced intensity of orgasmic sensations.

The above symptoms:

  • Must persist for a minimum of approximately 6 months

  • Must cause clinically significant distress in the individual

  • Are not better explained by a non-sexual mental disorder, a consequence of severe relationship distress, other significant stressors, or effects of a substance/medication or another medical condition.

Specifiers:

  • Never experienced an orgasm under any situation

  • Lifelong or acquired (i.e., began after a period of relatively normal sexual activity)

  • Generalised or situational (i.e., only occurs with certain types of stimulation, situations, or partners).

Current severity can be defined as mild, moderate, or severe based on the individual’s degree of distress due to their symptoms.

Persistent genital arousal disorder /genito-pelvic dysesthesia[13]

Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is not recognised as a diagnosis in the DSM-5-TR or ICD-11, but is an entity of increasing clinical attention and research.

The International Society for the Study of Women's Sexual Health defines PGAD/GPD as persistent or recurrent, unwanted or intrusive, distressing sensations of genital arousal that persist for ≥3 months and may include other genito-pelvic dysesthesia.[13]

  • Persistent or recurrent, unwanted or intrusive, distressing sensations of genital arousal (e.g., tingling, throbbing)

  • Duration ≥3 months

  • May include other types of genito-pelvic dysesthesia (e.g., buzzing, burning, twitching, itching, pain)

  • Most commonly experienced in the clitoris but may include other genito-pelvic regions

  • May include being on the verge of orgasm, experiencing uncontrollable orgasms, and/or having an excessive number of orgasms

  • Not associated with concomitant sexual interest, thoughts, or fantasies.

Associations:

  • Limited resolution, no resolution, or aggravation of symptoms by sexual activity

  • Compromised orgasm quality

  • Aggravation of genito-pelvic dysesthesia by certain circumstances (e.g., sitting, driving, sounds, anxiety, stress, nervousness)

  • Despair, emotional lability, catastrophisation, and/or suicidality

  • Absent evidence of genital arousal on physical examination.

Use of this content is subject to our disclaimer