On the whole traumatic birth thing again...

[ailbhe]

From http://www.psychnet-uk.com/dsm_iv/female_orgasmic_disorder.htm :

Female Orgasmic Disorder occurs when there is a significant delay or total absence of orgasm associated with the sexual activity.

That bit's ok.

This condition must cause a problem in the relationship with the sexual partner in order to be defined as a disorder.

THAT BIT ENRAGES ME BEYOND BELIEF.

Comments

[firecat]

Sheesh. How hard would it have been to write "This condition must bother the woman who has it" instead?

[ailbhe]

Well, the clinical definition doesn't include that introductory paragraph, but it's still enraging.

[serene]

How awful.

Musing: I wonder if they mean to imply "as a [psychological] disorder" and might be meaning that if the sexual relationship is fine, then they assume it's a medical problem. I mean, not like women EVER have orgasms when ALONE, on no no no never!

[ailbhe]

Yeah, plus it's totally possible for the sexual and romantic relationship to be fine and for the woman to be dissatisfied with her lack of orgasm within that relationship anyway, even though she's completely happy about her partner(s) and everything they do together.

[serene]

Of course. I'm just trying to suss out what they're thinking. Probably unwise.

[ailbhe]

I think there is no thinking here...

It's not even part of the actual *clinical* definition, it's just their guidance paragraph before the full text of the diagnosis. Mind you, the clinical definition isn't much better.

[st-lemur.livejournal.com]

At least it doesn't say "husband" :(

[ailbhe]

It might as well, honestly.

[juliet]

I... cannot actually find coherently rage-explicating words for that. It just makes me flail in distressed fury.

[ailbhe]

I THINK I NEED TO KILL SOMEONE NOW.

[juliet]

/me hands you a pickaxe

I keep looking at that & trying to find a better reading of it (e.g. it's an incompetent way of saying that it's a disorder only if the woman herself feels that it upsets her sex life), but a) yeah, right, that's not how sex & women is treated, medically; & b) even then it explicitly includes an extensive range of 'sex life'.

Actually I think I will have that pickaxe back to seek targets myself. THIS KIND OF SHIT IS WHY I NO LONGER WANT TO GO INTO PSYCHOLOGY.

[ailbhe]

Women don't masturbate, for a start.

[thereyougothen.livejournal.com]

No, never. Now go wash your mind out with soap.

[jentifred.livejournal.com]

Is that what I've been doing wrong? Crap.

[songster.livejournal.com]

Actually, that appears to be a bad website rendition of the DSM-IV criteria, which are as follows:

http://www.behavenet.com/capsules/disorders/forgdis.htm

Diagnostic criteria for 302.73 Female Orgasmic Disorder

A. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis of Female Orgasmic Disorder should be based on the clinician's judgment that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

[songster.livejournal.com]

There's a proposed revision for DSM-V here
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=172

Only major difference I can see is that it takes out the comment about "clinician's judgement" and replaces it with a more objective benchmark of problems that affect >75% of sexual experiences over >6 months.

[ailbhe]

The whole thing does explain why once I stopped being suicidal everyone decided it was all better now. Clearly I need to be more distressed about it. I am so, so tired of being distressed about things in order to get them treated as real problems.

[songster.livejournal.com]

Yup. I can see why they want to avoid medicalising things that aren't causing anyone any distress, though.

The problem is that once you try to draw that line, you're essentially asking the patient to diagnose themselves - how distressed is "enough"? You end up not treating the people that put up and shut up, and (perhaps) wasting resources on people who have less severe problems but just complain louder. Also, even though the diagnostic criteria are drafted in as non-sexist a manner as possible, with identical wording, it ends up institutionalising society's sexism.

[ailbhe]

Well, for me, this *is* a "less severe problem." It's just that it has been going on for six years now, and isn't getting better. Given the hassle we had to get them to investigate "in constant severe pain," and the further hassle for "in unbearable pain during sex," I don't fancy my chances this time.

Unless I send Rob in with a big MY WIFE IS DEFECTIVE I WILL DIVORCE HER rant on, but I can't see him managing it convincingly. He's a lousy liar.

[songster.livejournal.com]

Hmm, in your case I suspect you'd get pushed about from pillar to post - i.e. whether it's a physical problem or a mental one. DSM-IV only applies to the latter: I have no idea what the criteria are for diagnosing a physiological problem with female sexual response, nor where to look it up. Nor, unfortunately, whether anything can be done about it in either eventuality. :-/

[ailbhe]

I've been *told* there are no further physical reasons for problems, which I'm not at all sure I believe but is in my notes. But I think getting them to recognise that it's a problem *at all* might be very difficult. "You must expect some discomfort after childbirth," for example.

[songster.livejournal.com]

Well, I guess it's worth a shot if you have the energy >.<

The boxes they'll want ticked appear to be:

1) How long it's been going on (to catch DSM-V proposed criteria)
2) Whether it happens every time you have sex (likewise)
3) Whether it's a problem when masturbating as well as having sex (the "is Rob just crap" test)

... worth pointing out here that there wasn't a problem (so far as I know) prior to L being born.

4) Does it cause you or Rob distress (may be best if you can go in as a joint appointment and say it causes you both distress?).

They'll want to rule out physical causes (do you have some communication from the obs/gynae people to say there's no physical reason for problems?) and any drug interactions (antidepressants etc.)

[ailbhe]

Heh. 1) Six years, as far as we know. Not that we were able to TRY for the first two of those. 2) It fails to happen, haha. Yes. 3) I haven't even bothered attempting self-stimulation for years because it's so completely and utterly pointless and miserable-making. 4) No, we're far too tired of and accustomed to it to find it actively distressing. I get sad sometimes - and very occasionally angry - but not much any more. What's the point?

[xiphias.livejournal.com]

"Sad" and "occasionally angry" means "distress".

The problem here is that you're British, and the DSM criteria are written largely by Americans.

When you read "distress", imagine the AMERICAN definition of "distress", not the BRITISH one.

[ailbhe]

I'm not British! I'm operating within a British system though.

[deborah_c]

That sounds horribly familiar. My GP recently took Bad Hormonal Stuff Happening Again as "oh, you're just depressed, have some pills". I had to scream quite a lot to get something done about it, and fortunately was able to bypass her. (In her defence, she's normally quite good, but not this time.)

[songster.livejournal.com]

Note the almost identical wording for the male equivalent:

http://www.behavenet.com/capsules/disorders/morgdis.htm

Diagnostic criteria for 302.74 Male Orgasmic Disorder

A. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

[songster.livejournal.com]

(and once again the proposed revision for DSM-V is to remove the "clinician's judgement" aspect and use an objective benchmark.)
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=173


I'm not sure why psychnet-uk.com put such a misleading preface to its article: I think they were trying to avoid stigmatising people with a "disorder" in cases where it's not causing them or their partner any distress, but they worded it remarkably badly if so. However, the crap bit isn't actually part of DSM-IV.

[geekette8.livejournal.com]

This does give me images of a clinician watching with a clipboard and then holding up scoreboards for the focus, intensity and duration!

[ailbhe]

Oh, good god. I really don't fancy giving anyone *detail* about this.

[hobbitbabe.livejournal.com]

How about

"This condition must be considered a problem by the person who has it in order to be defined as a disorder"

[xiphias.livejournal.com]

. . . which is precisely what the AMERICAN definition says.

[pauamma]

http://ailbhe.livejournal.com/883721.html?thread=4991753#t4991753

[shinydan.livejournal.com]

That's absolutely crazy.

[kcobweb.livejournal.com]

There are no words for this.

[ailbhe]

There aren't even adequate volume settings.

[taimatsu]

GRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR!

[ailbhe]

Quite.

[xiphias.livejournal.com]

. . . and they just made that up. That's NOT part of the actual definition. That whole first paragraph is just made up with no reference to ANYTHING medical.

[ailbhe]

"B. The disturbance causes marked distress or interpersonal difficulty," is still in there, though. And really, it doesn't. I still think it's a problem though. It's just that I don't have the energy for "marked distress".

[xiphias.livejournal.com]

"Marked" means "noticable." If you don't care, it's not a problem. If you DO care, it is. You do, so it is.

[ailbhe]

My experience of my expressions of distress is that medical professionals consider them entirely invisible. Unless I consciously Act Distressed, rather than calmly stating the degree of my distress. Same with physical pain; merely saying "that is intensely painful, that is almost unbearable" or similar gets me nowhere; I have to *act* it. That bit is easier since the Big Pain Event six years ago, but it used to be extremely difficult to deal with.

[trinker.livejournal.com]

I *hate* the way that pain/distress is evaluated. I've heard from two people whose pain responses I knew in great detail that they went into the ER for appendicitis, and nearly burst because they weren't inclined to blubber and howl, and the SOP was "not until they're screaming". (Two different people, two different hospitals, different decades.)

[rmc28]

Yes. I don't easily DO revealing emotion, and I made the mistake once of using my energy to hang onto my ability to communicate my severe pain, so the evil locum doctor insisted that he had to examine me "just to be sure".

The part where I screamed and nearly went into shock from the pain may have convinced him that I was serious about the pain. But FFS.

Ailbhe is right, I get better treatment when I use my energy to overcome my reserve and cry, than when I keep it for communicating.

[erik]

This reminds me a lot of my recent (about a year ago) Kidney Stone Episode, where I calmly told the ER staff that the pain was unbearable, and the pain I'd felt an hour ago was the worst I'd ever felt and it was worse than that now (while curled into a ball). They flat didn't believe me, and it wasn't until I was actually going into shock from the pain that they started to treat my pain.

[the0lady.livejournal.com]

I find that mental distress is especially dofficult to convince people of; there is a particular brand of medical professional who will dismiss you as a malingerer unless they can dismiss you as a hysteric.

I don't have any issues externalising my emotions, but I used to think that when speaking to someone with scientific training it was better to be rational and stick to facts, measurables and testable hypotheses. WRONG! Breaking down in floods of tears earn you contempt, but also gets you treatment.

I do have to make the observation that this is a very English/British Catch-22, by the way. I think it's something to do with the very fact of having/admitting to a mental problem being seen as so shameful and flawed that there is no "right" way to about being that patient...

[hitchhiker.livejournal.com]

WTF, MATE!!!!!

[treadpath.livejournal.com]

GAH. Horrible!!!! Makes me want to bite really hard whoever put that there. Grr.