Sexología

Advances in Diagnosis and Classification of the Sexual Disorders:

I. The Sexual Dysfunctions

Autor:
Carlos E. Berganza







Advances in Diagnosis and Classification of the Sexual Disorders:

I. The Sexual Dysfunctions



"In both solitary and sociosexual behaviour there may be activities that are sufficiently unusual to warrant the label deviant behaviour. The termdeviant should not be used as a moral judgement but simply as indicating that such activity is not common in a particular society. Since human societies differ in their sexual practices, what is deviant in one society may be normal in another."

The Encyclopaedia Britannica

Sexual disorders constitute an important component of the most visible international diagnostic systems in psychiatry today.Sexual and Gender Identity Disorders, for instance, are one of the 18 sections in which DSM-IV (American Psychiatric Association, 1994) is divided. This section contains three sub-sections: a) the sexual dysfunctions; b) the paraphilias; and c) the gender identity disorders. Since sexual practices vary so much across socio-cultural groups, and since the issue of sexual normative behavior is avery complex one, it becomes unclear when and upon what organizing principle, the medical establishment starts classifying sexual "perversions", "deviations" or "disorders", the evolving terminology with which these clinical conditions are known through the times. It is even less clear how the criteria for defining a specific sexual behavior as "perverted", "deviant’ or "disordered" came about. Inexplaining their rationale to make recommendations to the "Options Book" in preparation for DSM-IV (American Psychiatric Association, 1994), the Work Group on Sexual Disorders "found limited published data supporting the current diagnoses and criteria sets" (Schmidt, Jr., et al, 1996, p. 1082). This lack of consistent empirical evidence made it difficult for the Work Group to propose "data-based"recommendations for changes to the DSM-III-R (American Psychiatric Association, 1987) schema. It is interesting, however, that several recommendations proposed by the Work Group were intended to enhance DSM-IV’s compatibility with ICD-10.

In ICD-10 (World Heath Organization, 1992), the equivalent of the DSM-IV Sexual Disorders section is distributed along a different structure. First, athree-digit category, [F52] Sexual Dysfunction not Caused by Organic Disorder or Disease is one of the seven that constitute the two-digit section [F5] Behavioral Syndromes Associated With Physiological Disturbances and Physical Factors. The other two categories, [F64] Gender Identity Disorder, and [F65] Disorders of Sexual Preference, are integrated to the two-digit section [F6] Disorders of AdultPersonality and Behavior.

The Sexual Dysfunctions:

According to ICD-10, "sexual dysfunction covers the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish. Sexual response is a psychosomatic process and both psychological and somatic processes are usually involved in the causation of sexual dysfunctions" (pp. 355). Although not making itexplicit, the ICD-10 definition of sexual dysfunctions goes in line with the sexual response cycle proposed originally by Masters and Johnson (1966, 1970). This becomes more evident by Masters, Johnson and Kolodny’s (1986) proposal that "Human sexual response is multidimensional, with input from feelings and thoughts, learning and language, personal and cultural values, and many other sourcescombining with our biological reflexes to create a total experience" (pp. 55-56).

It seems evident from the review of the literature that before DSM-III (American Psychiatric Association, 1980) lack of generalization in criteria sets employed to characterize and classify sexual disorders predominated. Clinicians and researchers resorted to schemas proposed by Masters and Johnson (1966; 1970) and H....