Diagnosis of FSD
The APA classifies sexual disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) because they tend to disrupt interpersonal relationships and cause psychological distress. All disorders listed in the DSM in some way disturb the process of arousal and the sexual response cycle. Although controversial, it is the standard approach used by many psychiatrists and clinicians in the United States and other countries to female sexual problems.
Hypoactive sexual desire disorder is characterized by an absence of libido. There is no interest in initiating sex and little desire to seek stimulation. Sexual aversion disorder is characterized by an aversion to or avoidance or dismissal of sexual prompts or sexual contact. It may be acquired following sexual or physical abuse or trauma and may be life-long. The main feature of female sexual arousal disorder is an inability to achieve and progress through the stages of "normal" female arousal. Female orgasmic disorder is defined as the delay or absence of orgasm after "normal" arousal. Dyspareunia is marked by genital pain before, during, or after intercourse. Vaginismus is the involuntary contraction of the perineal muscles around the vagina as a response to attempted penetration. Contraction makes vaginal penetration difficult or impossible.
These disorders must cause personal distress and must not be accounted for by a medical condition. A distinction is made between disorders that are life-long and those that are acquired, as well as those that are situational and generalized.
In cases where a medical condition is suspected as the underlying cause, whether it causes inadequate blood flow, nerve-related loss of sensitivity, or reduced hormone levels, a specialist conducts an appropriate diagnosis. Sexual problems may be symptomatic of diseases that require treatment, like diabetes, endocrine disorders of the hypothalamic-pituitary-gonadal axis, and neurological disorders.
The American Foundation of Urologic Disease (AFUD) classifies the APA's criteria into these four types of disorder:
- Hypoactive sexual desire disorder; includes sexual aversion disorder
- Sexual arousal disorder
- Orgasmic disorder
- Sexual pain disorders; includes vaginismus, dyspareunia
Contrary to APA stipulation, dyspareunia (pain during intercourse) may be diagnosed as a result of inadequate vaginal lubrication, which may be considered an arousal disorder and treated as such. Pain is associated with recurrent medical conditions, including cystitis
Physiological Diagnostic Tests
Vaginal blood flow and engorgement (pooling and swelling of vaginal tissue) can be measured with vaginal photoplethysmography, in which an acrylic tampon-shaped instrument inserted in the vagina uses reflected light to sense flow and temperature. It cannot be used to assess advanced levels of arousal, say, during orgasm, because movement skews its reading. Also, limited knowledge of normative vaginal engorgement levels makes for only speculative results. Vaginal pH testing, commonly performed by gynecologists and urologists to detect bacteria-causing vaginitis, may be useful. A probe inserted into the vagina takes the reading. Decreasing hormone levels and diminished vaginal secretion associated with menopause cause a rise in pH (over 5), which is easily detected with the test. A biothesiometer, a small cylindrical instrument, may be used to assess the sensitivity of the clitoris and labia to pressure and temperature. Readings are taken before and after the subject watches erotic video and masturbates with a vibrator for approximately 15 minutes.