Sexual aversion

A critical feature of sexual aversion, according to the authors of this chapter, is that “sex is experienced as inherently disgusting.” While historically classified as a sexual desire disorder, present diagnostic nosology has subsumed sexual aversion into the category of genito-pelvic pain/penetration disorder (DSM-5), or a sexual pain/penetration disorder, or a phobia (ICD-11). However, Borg, Both, ter Kuile, and de Jong make a strong case in Chapter 10 that the decision to eliminate a separate diagnosis of sexual aversion was misguided, observing: “When individuals who are disgusted by sex are nonetheless forced to engage in it, this may give rise to fear and pain, but this does not imply that such individuals can best be categorized as suffering from a phobia or from GPPPD.” They point out that because of the universality of the emotion of disgust, there are strong theoretical reasons to believe that this emotion can interfere with sexual function. They
support this contention through case histories and empirical studies. They point out that sexual aversion disorder may not only exist as a separate disorder but in fact, may also be a primary underlying issue for many individuals suffering from reduced desire and arousal or vaginismus. Unfortunately, there are no systematic treatment studies for sexual aversion, but clinical experience and theory suggest that prolonged and hierarchical exposure is an important first treatment step.