The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Men

INTRODUCTION: Hypoactive Sexual Desire Disorder (HSDD) is one of two sexual desire disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and is defined by two criteria: A-"persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" and B-"marked distress or interpersonal difficulty." AIM: This paper reviews the prevalence and correlates of low desire in men and qualitative and quantitative research on the experience of sexual desire in men and women. METHODS: A literature search of Medline, PudMed, and PsychInfo was used to identify any publication on low desire in men. MAIN OUTCOME MEASURE: The strength of empirical findings was used as a basis for making proposed revisions to the diagnostic criteria for HSDD in men. RESULTS: The dilemma of whether desire and arousal can be reliably differentiated in men is discussed, and parallels to the literature in women are drawn. Finally, I consider three options for the diagnosis of low desire in men for DSM-5. Option 1 proposes that the DSM-IV-TR name and criteria are preserved for men in DSM-5. Option 2 proposes that the recently proposed criteria for Sexual Interest/Arousal Disorder in women are also adopted for men, which would result in one gender-neutral category. Option 3 proposes that the criteria for Sexual Interest/Arousal Disorder also be applied to men, with a minor modification to one criterion (i.e., that absent or reduced genital and/or nongenital physical changes not be included as a criterion); this diagnosis would then be applied only to men. CONCLUSIONS: The evidence supporting each of these proposals is presented and critiqued. It is concluded that the proposal for DSM-5 should be made on the basis of field testing of new criteria.