A new sexual revolution

(1) sexual dysfunctions are defined by the presence of pain or an alteration during one or more of the phases of the linear sexual response cycle (desire – arousal – orgasm – resolution). In the fifth edition of this manual, DSM-5, (2) published in 2013, sexual dysfunctions were considered gender-specific, in which the difficulties with desire and arousal of the woman constitute a single dysfunction (female sexual interest/arousal disorder). The genito-pelvic pain/penetration disorder is also now one single category, replacing, respectively, dyspareunia and vaginismus (as they were in DSM-IV), since according to North-American specialists, they are conditions difficult to distinguish. As to subtypes, the dysfunctions continue to be characterized as lifelong (primary) or acquired (secondary), and generalized (when they occur under any circumstance) or situational. But the intensity of distress (mild, moderate, or severe) now also composes the characterization of the dysfunctions and the context should be specified: factors relative to the partner, to the relationship, to individual vulnerability, to culture, to religion, and those of medical origin must be reported. A minimum duration of six months has been established as a criterion for the diagnosis of sexual dysfunction in order to avoid " overdiagnosis " and to increase precision, distinguishing transient sexual difficulties from more persistent sexual dysfunction, and therefore, pathological problem. As to issues related to gender incongruence, united as gender identity disorder in DSM-IV, a new (less stigmatizing) diagnostic denomination has been suggested by DSM-5: gender dysphoria, considered a multicategory concept, since it encompasses gender dysphoria in children, adolescents, and adults. The previous criterion A (cross-gender identification) and B (aversion towards one's gender) have been merged, as there was no evidence that could justify keeping the two separate. In children, " a strong desire to be of the other gender " substitutes the previous " repeatedly stated desire " (from DSM-IV) to encompass the condition of some children who, within a coercive environment, may not verbalize this desire. The criterion A1 for children, " a strong desire to be of the other gender or an insistence that he or she is the other gender " is necessary,