女性性功能障礙分類的新知

An Update ofthe Classification ofFemale Sexual Dys:function Disorders

本文主要目的是在介紹女性性功能障礙分類及相關研究的最新發展。根據美國精神醫學會（AmericanPsychiatricAssociation[APA]）， 1994年新編的第四版1精神疾病診斷手冊i（DiagnosticandStatisticalManualofMentalDisorders，TheFourthEdition，DSM-IV），女性性功能障礙的診斷系統，包括女性性欲、性興奮、性高潮及性疼痛等障礙，每項女性性功能障礙都均有其嚴謹的定義，每項診斷均包括有造成顯著「個人的痛苦」及「人際關係的困難」的適應問題。在1998年舉行了一次有關女性性功能障礙的共識會，針對DSM-IV（APA，1994）的女性性功能障礙重新修訂診斷準則，專家建議在診斷準則中，除掉「造成人際關係的困難」準則，增加願意參與性活動接受性（receptivity）、非性方面主觀的性興奮反應、非陰部局部的身體反應及非性交性疼痛。此外「性滿意度」的觀念，雖然在這次會議中未被正式採納，但也引起了熱烈討論。由於女性性功能障礙分類不斷有新的發展，我們建議要準確的評估女性性功能及其障礙，需要改良主觀性的評估問卷，發展有效客觀的測量方式。雖然在這次共識會中，女性性功能障礙準則已經放寬不少，但是臨床工作者還是要增加關於女性性功能障礙的詢問，追蹤藥物所誘導產生的女性性功能障礙，並加以處置以增加病人藥物的順從性，及保護女性病人的權益及幸福。This article is intended to describe recent research and clinical advances in classifying female sexual dysfunction disorders. Its diagnostic system has been based on the 1994 American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, The Fourth Edition (DSM-IV), which consists of female sexual desire ( libido ), arousal (excitement) , orgasmic and pain disorders. The system has strict uses of definition in each disorder and the presences of marked personal distress or interpersonal difficulties. The suggestions of a recent consensus meeting held in Boston in 1998 include the omission of criterion of interpersonal difficulties in DSM-IV. The introduction of sexual receptivity, subjective excitement, nongenital sexual excitement, and noncoital pain. Furthermore, the concept of sexual satisfaction disorser, was also discussed but not officially adapted by the consensus meeting. Based on above-noted advances in classifying female sexual dysfunction disorder, we suggest that improving reliable questionnaire and objective measurements is needed to assess female sexual function/dysfunction. Although the criteria to diagnose female sexual dysfunction have been relaxed by this consensus meeting, clinicians are still alerted to increase the sensitivity to inquire about female patients’ sexual dysfunction for management, to improve their medication compliance, and to protect their benefits.