terion A4). Lack of pleasure is a common presenting clinical complaint in women with low de-
sire. Among women who report low sexual desire , there are fewer sexual or erotic cues that
elicit sexual interest or arousal (i.e., there is a lack of “responsive desire”). Assessment of the
adequacy of sexual stimuli will assist in determining if there is a difficulty with responsive sex-
ual desire (Criterion A5). Freque ncy or intensity of genital or nongenital sensations during sex-
ual activity may be reduced or absent (Crite rion A6). This may include reduced vaginal
lubrication/vasocongestion, but because physiological measures of genital sexual response do
not differentiate women who report  sexual arousal concerns from those who do not, the self-
report of reduced or absent genital or  nongenital sensations is sufficient. 
For a diagnosis of female sexual  interest/arousal disorder to  be made, clinically signif-
icant distress must accompany the symptoms in  Criterion A. Distress may be experienced
as a result of the lack of sexual interest/arousal or as a result of significant interference in
a woman’s life and well-being. If a lifelong lack of sexual desire is better explained by one’s
self-identification as “asexual,” then a diagnosis of female sexual interest/arousal disor-
der would not be made.
Associated Features Supporting Diagnosis 
Female sexual interest/arousal disorder is fr equently associated with problems in experi-
encing orgasm, pain experienced during sexual  activity, infrequent sexual activity, and
couple-level discrepancies in desire. Relationship difficulties and mood disorders are also
frequently associated features of female sexual interest/arousal disorder. Unrealistic ex-
pectations and norms regarding the “appropriate” level of sexual intere st or arousal, along