Do the DSM-5 criteria actually reflect the clinical reality of female sexual dysfunctions?

Background: The classification of female sexual dysfunctions (FSDs) remains inconsistent, with ongoing debate regarding the DSM-5's reliance on Basson's circular model to describe female sexual functioning.

Aim: This study evaluates the extent to which the DSM-5 diagnostic criteria reflect clinical reality and explores alternative models that may better capture female sexual functioning.

Methods: A cross-sectional study was conducted using a general population sample. Participants were classified into three non-clinical subgroups-Hypoactive Sexual Desire Disorder (HSDD), Female Sexual Arousal Disorder (FSAD), and Female Sexual Interest/Arousal Disorder (FSIAD)-based on DSM criteria. Descriptive and correlational analyses were performed using Pearson's correlation and chi-square tests to examine the relationships between diagnostic criteria and sexual response models.

Outcomes: The study assessed the relationships between DSM-IV-TR and DSM-5 diagnostic criteria and their associations with different sexual response models. The variables of interest included measures of sexual desire and arousal, assessed through the Female Sexual Function Index (FSFI) and the Sexual Desire Inventory-2.

Results: Findings revealed weak correlations between HSDD and FSAD criteria in DSM-IV-TR, with stronger negative correlations observed in DSM-5 criteria related to desire, arousal, and lubrication. Most women with sexual dysfunction identified with the circular model of female sexual functioning, although the linear model was predominant in the general population. Moderate associations were found between FSIAD and FSAD, whereas HSDD showed weaker associations with both.

Clinical implications: The findings suggest that the DSM-5 FSIAD diagnosis may not effectively distinguish between desire and arousal-related symptoms. Sexual desire appears to be better represented as a spectrum rather than a categorical diagnosis. However, these conclusions should be interpreted with caution due to the limitations of cross-sectional observational data.

Strengths & limitations: The size of the overall sample is a strength of the research; the lack of groups with clinician-made diagnoses and linguistic biases represented a limitation for the generalization of the results. Future studies should aim to analyze samples with clinician-made diagnoses.

Conclusion: Female sexual functioning is complex and cannot be adequately captured by a single model. Future revisions of the DSM should consider conceptualizing sexual desire along a continuum to better reflect clinical reality and guide diagnostic processes.