Sex Bias in the Diagnosis of Primary Orgasmic Dysfunction

M. Kaplan proposed that some diagnostic categories are constructed with a built-in sex bias, making diagnosis of females more likely by the very way the disorder is defined. However, critics such as Williams and Spitzer have remained unpersuaded that such categories exist. After briefly analyzing the concept of sex bias, I argue that Masters and Johnson's widely used diagnostic criteria for primary orgasmic disorders are sex biased in several ways. First, the female dysfunction is defined as lack of orgasmic achievement, whereas the male dysfunction is defined as lack of orgasmic ability, a narrower category. Second, a man is diagnosed as orgasmically dysfunctional only if he has experienced full arousal without orgasm, whereas a woman can be diagnosed as orgasmically dysfunctional even if she has never experienced arousal. Third, it is known that fewer women than men masturbate and that masturbation is the easiest way to reach orgasm; therefore, women are more likely than men to report lack of orgasmic achievement for reasons independent of orgasmic pathology. Problematic consequences of such biases include inflated incidence estimates for women, the appearance of enormous gender differences in pathology, ill-founded ideas about female psychosexual vulnerability, and overconfidence in the efficacy of sex therapy. Finally, contrary to Kaplan's critical comments about DSM-III, I argue that DSM-III's diagnostic criteria for orgasmic dysfunction correct the sex biases in Masters and Johnson's approach and represent substantial progress in diagnostic logic.