REVIEWS: Proposal for Changes in Diagnostic Criteria for Sexual Dysfunctions


Robert Segraves, MD, PhD, MetroHealth—Psychiatry 2500, MetroHealth Drive, Cleveland, OH 44122, USA. Tel: +1-216-7783634; Fax: +1-216-7785907; E-mail:


Introduction.  Officially sanctioned diagnostic criteria have a major influence on treatment decisions and on how populations are defined for clinical research. The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association has had a major influence on research concerning the treatment of sexual disorders and has been criticized on numerous grounds.

Aim.  The purpose of this article is to describe the evolution of criteria sets in the DSM and to critically evaluate suggestions for modification of this system.

Method.  All living members of the DSM work groups on sexual dysfunction were contacted regarding their recollections of the evolution of criteria sets. Literature concerning diagnostic criteria for the sexual dysfunctions in the DSM, as well as literature suggesting modification of this system, was reviewed.

Main Outcome Measure.  Recommendations for changes in the DSM-V system were based upon a review of the evidence concerning optimal criteria for each diagnostic entity.

Results.  The original diagnostic system from sexual disorders in the DSM was developed by expert opinion, literature searches, and solicitation of feedback for other experts in the field. There have been minimal changes in the DSM criteria for sexual dysfunctions because of the requirement that there be substantial empirical data before modification of the system would be considered. An international consensus group has suggested major modification in criteria concerning female sexual dysfunctions. There is a growing database that documents the need to change criteria for premature ejaculation.

Conclusions.  It is recommended that some of the suggested modifications to the criteria sets for sexual dysfunctions be adopted by the DSM-V committee. It is also recommended that specific criteria related to duration and severity be adopted, in order to clearly distinguish sexual disorders from transient alterations in sexual function related to life stress and relationship discord. Segraves R, Balon R, and Clayton A. Proposal for changes in diagnostic criteria for sexual dysfunctions. J Sex Med 2007;4:567–580.