REVIEWS: Two Challenges for the Classification of Sexual Dysfunction


Cynthia A. Graham, PhD, Oxford Doctoral Course in Clinical Psychology, Isis Education Centre, Warneford Hospital, Headington, Oxford OX3 7JX, UK. Tel: +44 (0) 1865 226431; Fax: +44 (0) 1865 226364; E-mail:


Introduction.  The current classification of sexual function (in particular, the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV) has lately attracted significant criticism at both research and clinical levels. Despite this, there has been a reluctance to return to the drawing board. Instead, attempts to improve the system have been marginal, constrained by the need to secure professional consensus, the desire for continuity with traditional categories, and the emphasis on diagnostic agreement (reliability).

Aim.  In this article, we examine two key challenges currently faced by the DSM: how to effectively acknowledge the relational context of sexual problems and how to avoid pathologizing normal variation.

Results.  We raise some possible new directions, such as ways in which relational processes could be integrated into the current system, and possibilities for introducing a dimensional rather than a categorical model of sexual function.

Conclusions.  We argue that if the next version of DSM (version V) is to avoid the weaknesses inherent in the present system, then a return to the drawing board is precisely what is required. Mitchell K, and Graham CA. Two challenges for the classification of sexual dysfunction. J Sex Med 2008;5:1552–1558.