Does Sexual Dysfunction Always Involve Personal Distress?

A quick review of the DSM-IV, the diagnostic manual for psychological disorders, makes it clear that in order for a sexual dysfunction to be diagnosed, the disorder must cause the patient marked personal distress or interpersonal difficulty, in addition to substantive sexual symptoms. Why is this so? Distress is not a necessary element of a diagnosis of thyroid disease or a fractured fibula, so why does the diagnosis of a sexual dysfunction require a finding of manifest personal distress?

The somewhat complicated answer has to do with the social values inherent in the diagnostic process. In the context of medical practice, a diagnosis is a set of operations designed to identify what is wrong with the patient under assessment, determine the mechanism through which the disorder occurs, and, ideally, help to identify treatment alternatives.

Yet sexual dysfunctions, like some other disorders, are not universally greeted with distress and concern. Some people of advanced years, for example, may view their sexual problem as a natural function of the aging process, somewhat akin to losing the strength and agility to do cartwheels. These people will tell you that, while they enjoyed cartwheels when they were young, they have moved past that chapter of their lives and are now invested in other things.

To insist on assigning a diagnosis of dysfunction to a patient with no feelings of distress about it runs the risk of pathologizing individuals who simply are less invested in their sexuality than other people in similar circumstances might be. Not everyone who experiences low or no sexual desire is bothered by this. We must remain alert to and respect those individuals' value systems and experiences.