Female Sexual Aversion Disorder

Sexual aversion disorder is typically classified as a subcategory of hypoactive sexual desire disorder (HSSD) and is often confused with a lack of sexual desire.^(1,2) Many experts consider it a phobia or anxiety disorder, although its sexual context also classifies it as a sexual disorder. It also may be a dual disorder encompassing sexual anxiety and panic disorder.^(1,3)

Diagnostic Criteria

The second international multidisciplinary group gathered by the American Foundation for Urologic Disease defines the problem as "extreme anxiety and/or disgust at the anticipation of/or attempt to have any sexual activity.⁽³⁾ As with other sexual disorders, whether or not the disorder causes personal distress is critical to the diagnosis.⁽¹⁾ The DSM-IV-TR published in 2000 describes sexual aversion disorder as "the persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner; the disturbance causes marked distress or interpersonal difficulty, and the sexual dysfunction is not accounted for by another Axis I disorder (except another sexual dysfunction)."⁽⁴⁾

Little is known about the etiology, prevalence, or treatment of the disorder, except that it is a lifelong or acquired conditioned response that is frequently associated with a history of sexual trauma or abuse, and it affects more women than men.^(1,2) Aversion to sexual activity is rarely an initial presenting complaint, because patients often seek to avoid any genital contact, even in the context of a gynecologic examination. They also may avoid talking about their aversion to sex in a therapeutic setting. It is important to rule out HSDD because there is some overlap of symptoms, and some women with aversion disorder have intact libidos and even report pleasure on the rare occasions when they engage in sexual activity.⁽¹⁾

Kingsberg and Janata have proposed revising the current DSM-IV-TR diagnoses and criteria in order to better distinguish between primary (lifelong) and secondary (acquired) sexual aversion disorder (see Table 11).⁽¹⁾

Treating Sexual Aversion Disorder

As with diagnosis, treatment of sexual aversion disorder is difficult, largely because patients are often resistant to discussing the disorder. At this time, treatment consists of referral to a psychologist or sexologist for desensitization therapy.⁽¹⁾

References:

1. Kingsberg SA, Janata JW. Sexual aversion disorder. In: Levine S, ed. Handbook of Clinical Sexuality for Mental Health Professionals. New York, NY: Brunner-Routledge, 2003; pp 153-166.
2. Anastasiadis AG, Salomon L, Ghafar MA, et al. Female sexual dysfunction: state of the art. Curr Urol Rep 2002;3:484-491.
3. Basson R, Leiblum S, Brotto L, et al. Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynecol 2003;24:221-229.
4. American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.