interest/arousal disorder. the distinction was made because men report more intense and frequent sexual desire than women. according to lori brotto, this classification is desirable compared to the dsm-iv classification system because: (1) it reflects the finding that desire and arousal tend to overlap (2) it differentiates between women who lack desire before the onset of activity, but who are receptive to initiation and or initiate sexual activity for reasons other than desire, and women who never experience sexual arousal (3) it takes the variability in sexual desire into account. furthermore, the criterion that 6 symptoms be present for a diagnosis helps safeguard against pathologizing adaptive decreases in desire. criticism general hsdd, as currently defined by the dsm, has come under criticism of the social function of the diagnosis. hsdd could be seen as part of a history of the medicalization of sexuality by the medical profession to define normal sexuality. it has also been examined within a "broader frame of historical interest in the problematization of sexual appetite". hsdd has been criticized over pathologizing normal variations in sexuality because the parameters of normality are unclear. this lack of clarity is partly due to the fact that the terms "persistent" and "recurrent" do not have clear operational definitions. hsdd may function to pathologize asexuals, though their lack of sexual desire may not be maladaptive. because of this, some members of the asexual community lobbied the mental health community working on the dsm-5 to regard hypoactive sexual desire not as a disorder, but as a sexual orientation. other criticisms focus more on scientific and clinical issues. hsdd is such a diverse group of conditions with many causes that it functions as little more than a starting place for clinicians to assess people. the requirement that low sexual desire causes distress or interpersonal difficulty has been criticized. it has been claimed that it is not clinically useful because if it is not causing any problems, the person will not seek out a clinician. one could claim that this criterion (for all of the sexual dysfunctions, including hsdd) decreases the scientific validity of the diagnoses or is a cover-up for a lack of data on what constitutes normal sexual function. the distress requirement is also criticized because the term "distress" lacks a clear definition. nice (uk) assessment hypoactive sexual desire disorder is not recognized as a disorder by the national institute for health and care excellence for the british national health service, with the judgement based on an article in the journal of medical ethics that "hypoactive sexual desire disorder is a typical example of a condition that was sponsored by industry to prepare the market for a specific treatment". dsm-iv criteria prior to the publication of the dsm-5, the dsm-iv criteria were criticized on several grounds. it was suggested that a duration criterion should be added because lack of interest in sex over the past month is significantly more common than lack of interest lasting six months. similarly, a frequency criterion (i.e., the symptoms of low desire be present in 75% or more of sexual encounters) has been suggested. the current framework for hsdd is based on a linear model of human sexual response, developed by masters and johnson and modified by kaplan consisting of desire, arousal, orgasm. the sexual dysfunctions in the dsm are based around problems at any one or more of these stages. many of the criticisms of the dsm-iv framework for sexual dysfunction in general, and hsdd in particular, claimed that this model ignored the differences between male and female sexuality. several criticisms were based on the inadequacy of the dsm-iv framework for dealing with females' sexual problems. increasingly, evidence shows that there are significant differences between male and female sexuality. level of desire is highly variable from female to female and there are some females who are considered sexually functional who have no active desire for sex, but they can erotically respond well in contexts they find acceptable. this has been termed "responsive desire" as opposed to spontaneous desire. the focus on merely the physiological ignores the social, economic and political factors including sexual violence and lack of access to sexual medicine or education throughout the world affecting females and their sexual health. the focus on the physiological ignores the relationship context of sexuality despite the fact that this is often the cause of sexual problems. the focus on discrepancy in desire between two partners may result in the partner with the lower level of desire being labeled as "dysfunctional," but the problem really sits with the difference between the two partners. however, within couples the assessment of desire tends to be relative. that is, individuals make judgments by comparing their levels of desire to that of their partner. the sexual problems that females complain of often do not fit well into the dsm-iv framework for sexual dysfunctions. the dsm-iv system of sub-typing may be more applicable to one sex than the other. research indicates a high degree of comorbidity between hsdd and female sexual arousal disorder. therefore, a diagnosis combining the two (as the dsm-5 eventually did) might be more appropriate.