There are a number of cogent criticisms of the current nomenclature system. The system developed to diagnose psychosexual disorders has been adopted to classify disorders presumed to be organic in etiology (44). Duration and severity criteria for diagnosis are unclear. Many of the diagnoses overlap, and the criteria for diagnosing female sexual disorders have been criticized. To put all of this in perspective, a brief description of the history of the diagnostic system will follow. The Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed in the United States although it is employed by professional in other countries as well. The DSM is supposed to correspond to the International Classification of Diseases (ICD). The DSM-I was developed in 1952. The DSM-II was developed to correspond with the ICD-8. Psychosexual disorders in the DSM-II were grouped under one diagnostic entity, genitourinary disorders. The DSM-III was developed to reflect changes in diagnosis and still remains compatible with the ICD-9. The nomenclature developed by William Masters, Helen Singer Kaplan, and Harold Lief had tremendous impact on the development of classifications of psychosexual disorders in DSM-III. This manual listed inhibited sexual desire, inhibited sexual excitement, inhibited female orgasm, inhibited male orgasm, premature ejaculation, functional dyspareunia, functional vaginismus, and ego-dystonic homosexuality. In DSM-IIIR, ego-dystonic homosexuality was deleted and sexual aversion disorder was added. The names of certain diagnoses were changed. For example, inhibited sexual desire became hypoactive sexual desire disorder. Sexual arousal disorder and male erectile disorder were substituted, respectively, for inhibited male and female sexual arousal disorders. Throughout, changes in criteria sets have been minimal. In DSM-IV, most of the names and criteria sets resemble DSM-IIIR. The requirement that a disorder be diagnosed only if it causes significant personal distress was added to put a high threshold for diagnosis (45). The DSM based classification remains unclear. For instance, it intermingles terms of sexual dysfunction(s) and sexual disorder(s) in an unclear manner.
Current nomenclature includes hypoactive sexual desire disorder, sexual aversion disorder, sexual arousal disorder, dyspareunia, vaginismus, premature ejaculation, erectile disorder, and male and female orgasmic disorders. In addition, each diagnosis is sub-typed into acquired or lifelong and global or situational. Several groups have suggested modification to the criteria sets for female sexual disorders (46).
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