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Arch Sex Behav (2010) 39:256270 DOI 10.1007/s10508-009-9542-2
ORIGINAL PAPER
The DSM Diagnostic Criteria for Female Orgasmic Disorder
Cynthia A. Graham
Published online: 26 September 2009 American Psychiatric Association 2009
Abstract This article reviews the DSM diagnostic criteria for Female Orgasmic Disorder (FOD). Following an overview of the concept of female orgasm, research on the prevalence and associated features of FOD is briey reviewed. Specic aspects of the DSM-IV-TR criteria for FOD are critically reviewed and key issues that should be considered for DSM-V are discussed. The DSM-IV-TR text on FOD focused on the physiological changes that may (or may not) accompany orgasm in women; one ofthemajorrecommendations here is that greater emphasis be given to the subjective aspects of the experience of orgasm. Additional specic recommendations are made for revision of diagnostic criteria, including the use of minimum severity and duration criteria, and better acknowledgment of the crucial role of relationship factors in FOD.
Keywords Female Orgasmic Disorder DSM-V
Sexual problems Women
Introduction
In 1980, the concept of psychosexual dysfunction appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1980). The term psychosexual was chosen to highlight the prevailing assumption at the time that psychological factors were of crucial importance in the etiology of sexual problems (American Psychiatric Association, 1980, p. 261). DSM-III utilized the human sexual response cycle (HSRC) developed by Masters and Johnson (1966) as the framework for classifying sexual dysfunctions, with problems in sexual functioning
possible at any one or more of the phases of desire, excitement, orgasm, or resolution. The DSM-III diagnostic criteria for inhibited female orgasm are shown in Table 1.
In DSM-IV and DSM-IV-TR (American Psychiatric Association, 1994, 2000), the concept of inhibition no longer featured and, accordingly, Inhibited Female Orgasm was renamed Female Orgasmic Disorder (FOD). The essential feature of the disorder remained the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. The major change in DSM-IV-TR was the added requirement that the problem cause marked distress or interpersonal difculty (Criterion B) (see Table 2). One interesting change from DSM-III was the removal of the statement (in Criterion A) that while inability to experience orgasm during coitus in the absence of manual clitoral...