Female sexual desire disorders: subtypes, classification, personality factors and new directions for treatment

Lack of sexual interest is highly prevalent in the general female population and, for more than two decades, low sexual desire has been the most common presenting problem in clinical institutions. The renewed interest in female sexual dysfunction has recently focused on biological and classification aspects whilst personality- and partner-related factors, as well as theoretical concepts, have largely been neglected. After critically reviewing the current diagnostic systems for female desire disorders, this paper specifically addresses the issues of personality and life history factors. In two empirical studies, 50 patients with low sexual desire were compared to a group of 100 sexually functional women by employing both semi-structured clinical interviews and a set of self-developed and standardised questionnaires. The results of these studies indicate that women seeking help for desire disorders exhibit marked signs of mood instability and a low and fragile self-regulation and self-esteem. In addition, they tend to be more worried, anxious, introverted and conventional when compared to sexually functional women. Interestingly, no significant differences in the variables relating to partnership quality in general could be detected. Although caution is needed due to sample size and methodological limitations, our results suggest a substantial level of at least subclinical psychiatric symptoms like mood-disorders, low self-esteem and feelings of guilt in women with sexual desire disorders. These problems seem to be rather deep-rooted and particularly affect the self-regulation and the inner balance of the personality. Overall, female sexual dysfunctions and low desire, in particular, cannot be conceptualised as discrete phase disorders, but rather as a global inhibition of sexual response together with a history of mood disorder, specific personality factors and an elevated level of psychological stress. This combination calls for broad-band treatment approaches where individual and interpersonal aspects can be taken into account simultaneously. In addition, the ubiquitous comorbidity, both with other sexual dysfunctions and with various personality and psychological problems, and the developmental sequence of the sexual problems must be adequately considered.