Rethinking Female Sexual Dysfunction: Shifting from Assumptions to Redefinition

Abstract

Objective:

Female sexual dysfunction can be diagnosed when women report low sexual desire or arousal, orgasmic difficulties, or sexual pain, along with related distress. However, this conceptualization reflects cultural and clinical assumptions rather than women’s own concerns about their sexual function. The purpose of this personal view article is to highlight limitations in current definitions of female sexual dysfunction and emphasize the gap between clinical criteria and women’s own experiences of female sexual dysfunction.

Method:

This personal view synthesizes existing literature and conceptual arguments to examine how cultural, clinical, and diagnostic assumptions shape understandings of female sexual dysfunction, and contrasts these with women’s experiences.

Results:

There is a disconnect between diagnostic criteria and lived experience of female sexual dysfunction. Many women reporting low sexual function do not experience distress, while others report sexual distress despite what might be considered normal sexual function. This disconnect suggests that current understandings of female sexual dysfunction may inadequately capture women’s sexual concerns. Further, the prevailing focus on physical aspects of sex overlooks the emotional, relational, and psychological dimensions of women’s sexuality.

Conclusion:

There is a need to redefine female sexual dysfunction in a way that avoids pathologizing common and non-distressing experiences among women. Moving forward, clinical definitions must be grounded in what women themselves identify as problematic.

Women are often labeled as having sexual problems, difficulties, concerns, or dysfunction when they experience clinically low levels of sexual arousal and desire, difficulty orgasming, or sexual pain. However, assuming low sexual function in these domains is a “problem” is inaccurate, given that many women do not view it as problematic. Even describing sexual function as “low” implies that there is an understanding of what could be considered “normal” sexual function, which is difficult given the wide range of normality. ¹ Much of what is labeled as sexual dysfunction in women reflects cultural and clinical assumptions, not actual distress or impairment. While distress remains central to diagnosis, research often examines low sexual function through narrowly defined physical domains, such as desire, arousal, orgasm, and pain, without accounting for distress. These physical aspects of sex are often treated as proxies for dysfunction, yet it remains unclear whether they reflect the concerns women themselves find most distressing, highlighting a disconnect between diagnostic criteria and women’s lived sexual experiences. Consideration is needed as to whether the current diagnoses of sexual dysfunction specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) truly capture the sexually related concerns of women. ² Women’s sexuality has been over-pathologized, and women’s own perspectives and needs remain largely ignored in research and in shaping clinical diagnoses. In the sections that follow, we will discuss some of the assumptions made about female sexual dysfunction and then provide a suggestion for a more meaningful definition.

Acknowledging Assumptions About Female Sexual Dysfunction

Female sexual dysfunction is a heterogeneous classification within the DSM-5-TR that includes three domains: (a) Absent or reduced sexual arousal or desire, (b) difficulty orgasming, and (c) sexual pain. ² Inherent to these domains are assumptions about the population norm and typical levels of sexual function for women, despite a lack of understanding or agreement about what would constitute normal sexual function for women. Research indicates that nearly half of all women report “low sexual function” in at least one of these three domains.^3,4 This high prevalence challenges the notion that such experiences are inherently dysfunctional and invites reconsideration of what constitutes “normal” sexual function for women. It could be argued that there is nothing abnormal about this experience and that “low sexual function” is the norm. This suggests that the norm is artificially inflated.

Women’s experiences of sexual dysfunction diverge from clinical definitions, with many unconcerned about low sexual function and others distressed despite no identifiable dysfunction.^3–6 While the DSM specifies that the presence of clinically significant distress is necessary for a diagnosis, it is common for researchers to assess low sexual function and refer to it as problems or dysfunctions without considering distress. This highlights an assumption that low sexual desire or arousal, difficulty orgasming, and sexual pain are inherently problematic for women. On the contrary, less than half of women experiencing low sexual function in these domains report related distress.^3,4 Further, a third of all women report sexual distress despite the absence of any of these predefined sexual dysfunctions. ⁶ When women’s distress about sex is examined, we see that sexual distress is seldom about these specific domains of sexual function.^5,6 This indicates that women experience sexual distress about factors outside of these domains, yet research remains limited in identifying these concerns. Because existing diagnoses and research frameworks often fail to capture the full scope of women’s sexually related concerns, many may be left without access to appropriate treatment or support to alleviate their distress. As such, further consideration is needed to determine whether the current domains of sexual dysfunction labeled in the DSM and across the literature accurately reflects sexual related concerns for women.

A related assumption associated with female sexual dysfunction is the emphasis on physical aspects of sex. According to the DSM, female sexual dysfunction involves difficulties in the physical aspects of sexual function, such as genital sensations and orgasm, which leads to distress. This conceptualization is based on research on male sexual functioning, yet women’s sexual response cycle is different from that of men. Bancroft and colleagues have shown that physical aspects of low sexual function are poor predictors of sexual distress among women and that sexual distress is influenced by emotional, cultural, and relational aspects of sex rather than the physical aspects of sex. ⁵ For women, sexuality is relational, emotional, and psychological. ⁷ Therefore, the current diagnoses of sexual dysfunction, which are based on physical aspects of sex, offer a simplistic and inaccurate understanding of female sexual dysfunction.

The importance of women’s sexual satisfaction has been underestimated. Promisingly, women commonly report sexual satisfaction despite the presence of low sexual function. ⁸ In part, this underestimation occurs because of the assumption that orgasm is synonymous with pleasure for women. Studies exploring satisfaction and orgasm in women indicate that this is not the case. In their study, Lentz and Zaikman found evidence that sexual satisfaction is not solely dependent on orgasm. ⁹ Likewise, Ferenidou and colleagues show that women report sexual satisfaction irrespective of their low sexual function, and further to this, when we look at low sexual satisfaction, this is associated with higher distress.^8,10 This suggests that women can be sexually satisfied despite physical aspects, and that as long as women feel sexually satisfied, then they may not have concerns about their sexual function. Indeed, it has been proposed that sexual satisfaction disorder be added to the DSM, yet this has not been done.

Redefining Female Sexual Dysfunction

Given the assumptions highlighted above, a new definition of female sexual dysfunction needs to be adopted. There is a need to reconsider whether it is necessary to specify physical symptoms and particular domains of sexual function. Sexual dysfunction could perhaps more accurately and inclusively involve distress about any aspect of sexual functioning. Certainly, women should be supported to address low desire and arousal, orgasmic difficulty, or sexual pain if it concerns them. However, it is vital to stop assuming that these are inherently problematic to women, and to avoid language that pathologizes this experience. This is particularly important given that approximately half of all women report so-called “low” sexual function, suggesting clinical understanding of what “normal” sexual function is among women needs to be revisited. It is crucial to recognize that women’s sexual concerns may not center on the physical domains traditionally prioritized in clinical models. Given that low sexual function in these areas poorly predicts distress, there is a need to investigate what truly matters to women. A necessary starting point is simple yet often overlooked: Asking women themselves.