A Streetcar Named “Derousal”? A Psychophysiological Examination of the Desire–Arousal Distinction in Sexually Functional and Dysfunctional Women

Abstract

Research indicates that desire and arousal problems are highly interrelated in women. Therefore, hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a new diagnostic category, female sexual interest/arousal disorder (FSIAD), was created to include both arousal and desire difficulties. However, no research has tried to distinguish these problems based on psychosocial-physiological patterns to identify whether unique profiles exist. This study compared psychosocial-physiological patterns in a community sample of 84 women meeting DSM-IV (American Psychiatric Association, 2000) criteria for HSDD (n = 22), FSAD (n = 18), both disorders (FSAD/HSDD; n = 25), and healthy controls (n = 19). Women completed self-report measures and watched neutral and erotic films while genital arousal (GA) and subjective arousal (SA) were measured. Results indicated that GA increased equally for all groups during the erotic condition, whereas women with HSDD and FSAD/HSDD reported less SA than controls or FSAD women. Women in the clinical groups also showed lower concordance and greater impairment on psychosocial variables as compared to controls, with women with FSAD/HSDD showing lowest functioning. Results have important implications for the classification and treatment of these difficulties.

Notes

¹To minimize the risk of arousal interference due to age-related hormonal changes (e.g., menopause) or physiological conditions with sexual side effects, we restricted our sample to those under age 50, for whom such conditions are less common.

²Given that the sexual stimulus employed across all subjects was an erotic film clip depicting heterosexual activity, individuals who self-identified as nonheterosexual had to be excluded to maximize the potential of a subjective arousal response.

³The frequency criterion was ultimately reduced from 75% to 50% after three years of testing due to recruitment difficulties. The mean frequency of sexual difficulties reported at screening was approximately 50%; however, even those who initially reported sexual difficulties 75% of the time showed frequency fluctuations, such that at testing the majority reported difficulties 50% to 75% of the time.

⁴Copies of these interviews are available upon request.

⁵Copies of these measures are available upon request. The 28-item measure includes all items composing the nine-item questionnaire, in addition to several more specific questions assessing participants’ feelings of desire and their perceptual awareness of different facets of sexual arousal.