Formerly known as frigidity, female sexual dysfunction (FSD) has always been a controversial diagnosis, and now studies are pointing to relationship dissatisfaction and male performance as risk factors. Just whose problem is this, anyway? New research suggests that broad tactics such as treating a woman’s anxiety and improving communication with her partner may be more useful than focusing on the physical mechanics of sex.

Female sexual dysfunction is a broad diagnosis that indicates trouble in one or more of four areas: desire, pain, arousal and orgasm. Controversy about FSD has centered on two key points: whether those who are pushing it as a physiological disorder have something to gain from medicalizing it and whether it reflects society’s attempt to pathologize women’s naturally variable sexuality. According to sexologist Andrea Burri, author of a study from the U.K. on FSD that appeared in the September 2011 issue of the Journal of Sexual Medicine, “Describing a sexual dysfunction as a physiologically caused abnormality leaves out factors related to the patient’s sexual partners and socialization factors. Personally, I believe that we are using the term way too arbitrarily.” Although she accepts that some women do have a physiological impairment that can contribute to sexual problems, she thinks that using loose diagnostic criteria lumps far too many women into the category of dysfunction.

Burri’s study, which assessed about 1,500 women in the U.K. for FSD, found that 5.8 percent of them reported recent problems with sex, and another 15.5 percent reported lifelong dysfunction. Hyposexual (low) desire was the most common problem overall, and the most common predictor of FSD was relationship dissatisfaction. This finding supports the criticism that the concept of FSD is misleading because it implies that there is something wrong with the woman who “has” it, when in fact it is often the relationship that has issues. The study also found anxiety, experience of abuse and obsessive-compulsive disorder to be common predictors of lifelong FSD.

A study last June also pointed to relationship dissatis­faction as a risk factor for FSD, as well as male premature ejaculation—so in this case, his dysfunction becomes hers, further obscuring the diagnosis.

One way researchers are attempting to minimize some of these issues is by including personal distress as a diagnostic criterion for FSD. Pain during sex or a lack of desire, arousal or orgasm does not indicate a disorder unless it is causing distress to the woman herself—and that does not include the distress she might feel because of her partner’s reaction in bed, explains Marita McCabe, a psychology professor at Deakin University in Melbourne, Australia. Burri cautions that the distress criterion nonetheless presents some concerns. “A considerable proportion of women who do not report a sexual problem do report feeling distressed about their level of sexual functioning, so there is the question as to what causes a woman to feel sexual distress,” she says. “Is it really an intrinsic feeling, or is it caused by societal expectations?”

Regardless of its cause, distress about sex is quite treatable. McCabe authored a study last October showing Internet-based therapy to be effective for FSD when it focused on three objectives: helping participants feel more comfortable about their bodies, lowering their anxiety in sexual situations and improving communication with their partners.

This article was published in print as "It's Not Me, It's Us."