Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
J Sex Med. 2017 Nov;14(11):1365-1371. doi: 10.1016/j.jsxm.2017.08.013. Epub 2017 Sep 22.
In the professional literature and among our professional societies, female sexual dysfunction nomenclature and diagnostic criterion sets have been the source of considerable controversy. Recently, a consensus group, supported by the International Society for Women's Sexual Health, published its recommendations for nosology and nomenclature, which included only one type of arousal dysfunction, female genital arousal disorder, in its classification system. Subjective arousal was considered an aspect of sexual desire and not part of the arousal phase.
To advocate for the importance of including subjective arousal disorder in the diagnostic nomenclature in addition to the genital arousal subtype.
We reviewed how the construct of subjective arousal was included in or eliminated from the iterations of various diagnostic and statistical manuals. The Female Sexual Function Index (FSFI) was used to examine the relations among subjective arousal, genital arousal, and desire in women with and without sexual arousal concerns.
Sexual arousal through a self-report Film Scale, physiologic sexual arousal through vaginal photoplethysmography in response to an erotic film, and the FSFI.
The clinical literature and experience support differentiating subjective arousal from desire and genital arousal. Correlations between the FSFI domains representing desire and subjective arousal, although sufficient to suggest relatedness, share approximately 58% of the variance between constructs-a lower shared variance than FSFI domains representing subjective arousal and orgasm. Similarly, when looking at FSFI individual items best representative of sexual desire and subjective arousal, the large majority of the variance in subjective arousal was unexplained by desire. A third line of evidence showed no significant difference in levels of subjective arousal to erotic films between sexually functional women and women with desire problems. If desire and subjective arousal were the same construct, then one would expect to see evidence of low subjective arousal in women with low sexual desire.
Optimized treatment efficacy requires differentiating mental and physical factors that contribute to female sexual dysfunction.
Support for our conclusion is based on clinical qualitative evidence and quantitative evidence. However, the quantitative support is from only one laboratory at this time.
These findings strongly support the view that female sexual arousal disorder includes a subjective arousal subtype and that subjective arousal and desire are related but not similar constructs. We advocate for the relevance of maintaining subjective arousal disorder in the diagnostic nomenclature and present several lines of evidence to support this contention. Althof SE, Meston CM, Perelman M, et al. Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women. J Sex Med 2017;14:1365-1371.
在专业文献和我们的专业学会中，女性性功能障碍的命名法和诊断标准一直存在相当大的争议。最近，一个得到国际女性性健康学会支持的共识小组发布了他们的分类系统命名法建议，其中仅包括一种唤醒障碍，即女性生殖器唤醒障碍。主观唤醒被认为是性欲的一个方面，而不是唤醒阶段的一部分。
倡导在诊断命名法中除了生殖器唤醒亚型外，还应包括主观唤醒障碍。
我们回顾了主观唤醒的结构是如何被纳入或排除在各种诊断和统计手册的迭代中的。使用女性性功能指数（FSFI）来检查有和没有性唤醒问题的女性中主观唤醒、生殖器唤醒和欲望之间的关系。
通过自我报告的电影量表进行性唤醒，通过阴道光体积描记术对色情电影的生理唤醒，以及 FSFI。
临床文献和经验支持将主观唤醒与欲望和生殖器唤醒区分开来。尽管代表欲望和主观唤醒的 FSFI 域之间的相关性足以表明它们之间的关联性，但它们共享大约 58%的结构差异-这一共享差异低于代表主观唤醒和性高潮的 FSFI 域。同样，当查看最能代表性欲和主观唤醒的 FSFI 单项时，主观唤醒的大部分变异无法用欲望来解释。第三条证据表明，在性功能正常的女性和有欲望问题的女性中，对色情电影的主观唤醒水平没有显著差异。如果欲望和主观唤醒是同一结构，那么人们应该看到性欲低的女性主观唤醒水平低的证据。
优化治疗效果需要区分导致女性性功能障碍的心理和生理因素。
我们结论的支持基于临床定性证据和定量证据。然而，目前定量证据仅来自一个实验室。
这些发现强烈支持女性性唤醒障碍包括主观唤醒亚型的观点，并且主观唤醒和欲望是相关的，但不是相似的结构。我们主张在诊断命名法中保留主观唤醒障碍，并提出了几条支持这一观点的证据。
