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 organizing thoughts about patient problems. However, it is not without considerable

"The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), is used in Canada but ICD-9 is still used in many parts of the world. The development of DSM-IV-TR was closely coordinated with Chapter V of ICD-10.

drawbacks. First, as discussed earlier, some see it as much more useful when considering 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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