Why Is Absent/Low Sexual Desire a Mental Disorder (except when patients identify as asexual)?

ABSTRACT This analytic essay challenges the psychiatric practice of treating absent/low sexual interest/desire/arousal as a mental disorder. It does so by calling attention to the fact that asexuality is treated differently than other non-heterosexual orientations. The current DSM contains no psychiatric diagnosis which has, as its primary symptom, same-sex sexual desire. Yet, the same DSM offers diagnoses such as male hypoactive sexual desire disorder and female sexual interest/arousal disorder which have, as their primary symptom, absent/low sexual interest/desire/arousal. One of the unfortunate consequences of treating absent/low sexual desire as a mental disorder is that it perpetuates the false belief that those who experience their sexuality differently than the heterosexual ‘sexusociety’ norm are less healthy and more dysfunctional. It is also troubling because of the implied gender bias: women are more likely to experience absent/low sexual interest/desire/arousal than men and more likely to be diagnosed with a sexual interest/desire/arousal disorder. Women’s sexual desires, or the absence thereof, are, thus, more likely to be seen as abnormal. Since that judgment has long been used to pressure women to engage in sex they do not want, the unavoidable inference is that the psychiatric tradition of diagnosing absent/low sexual desire as pathological has placed, and continues to place, women at greater risk of sexual exploitation and abuse. The remedy: stop treating absent/low sexual desire as pathological. Recognize that people are sexually different and are entitled to desire sex a lot, a little, or not at all—whatever feels right for them.