Field Testing of ICD-11 Proposals for Female Sexual Dysfunctions in India: Cognitive Interviews with Patients

Background: Women's experiences of female sexual difficulties are shaped by cultural expectations.

Aim of the study: To investigate the cultural validity and clinical utility of the classification of female sexual dysfunctions (FSD) in the International Classification of Diseases - 11^th Revision (ICD-11) among Indian Women.

Methods: A purposive sample of 22 married women with probable sexual problems underwent cognitive interviews that were conducted using a semi-structured guide. The interviews were transcribed and analyzed qualitatively to help establish the content and cultural validity of the ICD-11 classification of FSD.

Results: Most participants had limited knowledge of the sexual act, felt unskilled in sex, and were led by their husbands in sexual matters. Many participants reported problems related to sexual dysfunction and sexual pain-penetration. Many participants with sexual pain-penetration issues and some with low sexual desire considered these symptoms to be problematic; however, this was rarely the case with the absence or lack of sexual arousal and orgasm. The application of the 'independent focus of clinical attention' requirement for diagnosis reduced cases by half for Hypoactive Sexual Desire Disorder (HSDD) and almost eliminated all cases of Female Sexual Arousal Dysfunction (FSAD) and Anorgasmia. Hence, this requirement was moved from essential (required) features to 'additional features' of the final ICD-11 sexual dysfunction guidelines.

Conclusion: Advancement toward a more precise nomenclature and classification system of FSD will facilitate better diagnosis which will ultimately lead to improved care for women with sexual dysfunction.