(074) Not just a matter of labels: The Importance of Distinguishing Between Sexual Desire, and Mental and Genital Sexual Arousal
Authors: Bittoni C , Kiesner J , Pastore M 
Published: May 2023

Abstract

Introduction
While researchers and clinicians have long discussed sexual desire and sexual arousal as two distinct entities, the DSM has moved from treating them separately (DSM-IV) to amalgamating desire and arousal disorders into one single diagnosis (“Female Sexual Interest/Arousal Disorder”; DSM-5). Consistent with the idea of combining them, the original publication of the FSFI found a single factor for desire and arousal (Rosen et al, 2000). Experts in sexual medicine, however, have opposed the use of this single diagnostic entity (Goldstein et al., 2017). Furthermore, Meston and colleagues have provided extensive data showing that among women, a distinction should also be made between mental and genital arousal, given the low concordance between the two.

Objective
The aim of these analyses was to clarify the distinction between three constructs of female sexual function: sexual desire (SD); mental sexual arousal (MSA); and genital sexual arousal/lubrication.

Methods
A sample of 138 female university students completed the FSFI. Structural equation modelling was used to test the goodness of fit of four different models examining the structure of the SD, MSA and lubrication subscales. The first model includes only a single factor (Fig. 1), the second and third models include two factors (Fig. 2 and 3), and the fourth model includes three factors (Fig. 4), thus maintaining the distinction between the three constructs.

Results
Factor loadings and correlations for the four models are presented in Figures 1-4, and although all questions loaded well on the latent factors in all four models (with the exception of fantasy in model 3), the fit indices differed significantly across models. Specifically, models 1 and 2 did not fit the data well (CFI = .64; TLI = .55; RMSEA = .21, Figure 1; CFI = .67; TLI = .58; RMSEA = .21 Figure 2). The third model showed improvement, but still did not fit the data well (CFI = .90; TLI = .87; RMSEA = .11; Figure 3), whereas the fourth model did fit the data well (CFI = .93; TLI = .91; RMSEA = .09; Figure 4). Moreover, the fourth model was found to be the best fitting model: AICc weight = .999, showing 99.9% certainty that the fourth model is the best model (1,427 times more likely to be the best model as compared to the third model). Correlations among constructs in the final model were low (r = .25) to moderate (r = 62).

Conclusions
Although the DSM-5 and a plethora of research have combined and confounded sexual desire and arousal as if they are the same, the current study shows that the subjective experience of these constructs are clearly differentiated. Moreover, although it has been claimed that the distinction between MSA and lubrication might be theoretically, but not clinically, relevant (Meston & Stanton, 2018), consensus in terminology is essential to move toward a more accurate understanding of sexual desire, and mental and genital sexual arousal. Doing so will also enable the use of appropriate measures and labels in the context of new research and in reference to past literature.

Disclosure
No