The difference between mild sexual difficulties and diagnosable sexual dysfunction is an ongoing debate among health professionals, but it has been stirred up recently by changes to diagnostic criteria. Unlike science and medicine, psychology still uses symptom-based diagnosis, and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is vague because it specifies symptoms lasting at least 6 months, occurring almost always in sexual encounters, and causing  distress in order to be considered a sexual dysfunction.

Some worry that these criteria will exclude individuals with sexual dysfunction from treatment, while proponents feel that this narrower approach is an essential refinement of the DSM that will protect people with transient and mild difficulties from being labeled as sick and keep health care costs manageable. 

A new paper estimates the impact of these morbidity criteria on the prevalence of sexual dysfunction.  To predict the impact of the DSM-5’s take on sexual dysfunction, researchers analyzed data from sexually active respondents to Britain’s Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). 11,509 male and female participants aged 16 to 74, reporting at least one sexual partner in the past year, responded to questions about sexual function problems.

Among sexually active men, the prevalence of reporting one or more of four specific sexual problems was 38.2%, but only 4.2% met the DSM-5 duration, severity, and distress criteria. Corresponding figures for women reporting one or more of three specific sexual problems, were 22.8% and 3.6%. The drop in prevalence after applying morbidity criteria is dramatic, but still suggests huge numbers of people affected- around 1.8 million in the UK and 8.9 million in the U.S.

The fact that only just over a third of men and women reporting a problem meeting all three criteria had sought professional help in the last year, suggests that a huge number of people experiencing dysfunction are not receiving help - around 1.2 million in the UK and 5.8 million in the U.S. Overall, this study helps demonstrate how the DSM-5 diagnostic criteria impose a focus on clinically significant symptoms, posing promising applications in both clinical and research contexts.

Citation: "Estimating the Prevalence of Sexual Function Problems: The Impact of Morbidity Criteria", Kirstin R. Mitchell, Kyle G. Jones, Kaye Wellings, Anne M. Johnson, Cynthia A. Graham, Jessica Datta, Andrew J. Copas, John Bancroft, Pam Sonnenberg, Wendy Macdowall, Nigel Field&Catherine H. Mercer, The Journal of Sex Research, 25 Nov 2015 DOI:10.1080/00224499.2015.1089214