434 Sexual Dysfunctions
ing lack of signs of physical sexual arousa l may be the primary features. Because sexual
desire and arousal frequently coex ist and are elicited in respon se to adequate sexual cues,
the criteria for female sexual in terest/arousal disorder take into account that difficulties in
desire and arousal often simult aneously characterize the co mplaints of women with this
disorder. Short-term changes in  sexual interest or arousal are common and may be adaptive
responses to events in a woma n’s life and do not represent a sexual dysfunction. Diagnosis
of female sexual interest/arousal disorder requires a minimum duration of symptoms of
approximately 6 months as a reflection that the symptoms must be a persistent problem.
The estimation of persistence may be determin ed by clinical judgment when a duration of
6 months cannot be ascertained precisely.
There may be absent or reduced frequency or inte nsity of interest in se xual activity (Crite-
rion A1), which was previously termed hypoactive sexual desire disorder.  The frequency or inten-
sity of sexual and erotic thoughts or fantasie s may be absent or reduced (Criterion A2). The
expression of fantasies varies widely across women and may include memories of past sexual
experiences. The normative decline in sexual thoughts with age should be taken into account
when this criterion is being assessed. Absence or  reduced frequency of initiating sexual activ-
ity and of receptivity to a partner’s sexual invitations (Criterion A3) is a behaviorally focused
criterion. A couple’s beliefs and preferences for sexual initiation  patterns are highly relevant to
the assessment of this criterion. There may be ab sent or reduced sexual excitement or pleasure
during sexual activity in almos t all or all (approximately 75%– 100%) sexual encounters (Cri-