uations in which there is inadequate foreplay or arousal may lead to difficulties in penetration,
pain, or avoidance. Erectile dysfunction or premature ejacul ation in the male partner may
result in difficulties with penetration. These conditions should be carefully assessed. In some
situations, a diagnosis of genito-pelvic pain/p enetration disorder may not be appropriate. 
Comorbidity
Comorbidity between genito-pel vic pain/penetration disorder  and other sexual difficul-
ties appears to be common. Comorbidity with relationship distress is also common. This is
not surprising, since in Western cultures the inability to have (pain-free) intercourse with
a desired partner and the avoidance of sexual  opportunities may be either a contributing
factor to or the result of other sexual or re lationship problems. Because pelvic floor symp-
toms are implicated in the diagnosis of geni to-pelvic pain/penetrati on disorder, there is
likely to be a higher prevalence of other diso rders related to the pelvic floor or reproduc-
tive organs (e.g., interstitial cystitis, constipation, vaginal infection, endometriosis, irrita-
ble bowel syndrome).
Male Hypoactive Sexual Desire Disorder
Diagnostic Criteria 302.71 (F52.0)
A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and
desire for sexual activity. The judgment of deficiency is made by the clinician, taking
into account factors that affect sexual functioning, such as age and general and socio-
cultural contexts of the individual’s life.
B. The symptoms in Criterion A have persist ed for a minimum duration of approximately
6 months.
C. The symptoms in Criterion A cause clinically significant distress in the individual.
D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a