DSM-5 and represents a merging of vaginismus and dyspareunia, which were highly co-
morbid and difficult to distinguish. The diagno sis of sexual aversion disorder has been re-
moved due to rare use and la ck of supporting research.
There are now only two subtyp es for sexual dysfunctions: lifelong versus  acquired
and generalized  versus situational.  To indicate the presence and degree of medical and
other nonmedical correlates, the following associated features  have been added to the text:
partner factors, relationship factors, individu al vulnerability factors, cultural or religious
factors, and medical factors.
Gender Dysphoria
Gender dysphoria  is a new diagnostic class in DSM-5 and reflects a change in conceptual-
ization of the disorder’s defining features by emphasizing the phenomenon of “gender in-
congruence” rather than cross-gender identification per se, as was the case in DSM-IV gender
identity disorder. Gender dyspho ria includes separate sets of criteria: for children and for
adults and adolescents. For the adolescents an d adults criteria, the previous Criterion A
(cross-gender identification) and Criterion B (aversion toward one’s gender) are merged. In
the wording of the criteria, “the other sex” is replaced by “the other gender” (or “some alter-
native gender”).” Gender  instead of sex is used systematically because the concept “sex” is in-
adequate when referring to individuals with a disorder of sex development. In the child
criteria, “strong desire to be of the other gend er” replaces the previous “repeatedly stated de-
sire to be...the other sex” to capture the situat ion of some children who, in a coercive envi-