A Diagnostic History of Asexual Medicalization

Transcript

Courtney: Hello everyone and welcome back. My name is Courtney. I’m here with my spouse Royce. Together we are The Ace Couple and we are wishing you a very happy Ace Week. And more specifically, if you’re one of our early listeners, happy Disabled Ace Day. Happy five-year anniversary of Disabled Ace Day. Quick note for those of you who are not in the know.

Courtney: Ace Week is an annual celebration of asexual awareness, support, love, cake, of course. It always takes place on the last full Sunday to Saturday week in October, so the individual dates might change a little bit year to year, but every Wednesday of Ace Week is Disabled Ace Day, a particular opportunity to talk about the intersections of asexuality and disability.

Courtney: Our longtime listeners here will know that this is a topic very near and dear to our hearts, of which we have spoken aplenty. And I’m really excited for today’s episode because this has been a particular fascination of mine for years.

Courtney: Many aces who have been in the same room as me or the same chats as me has heard me go on and on about the history of medicalization of asexuality. And of course, we’ve touched upon medicalization of our orientation frequently throughout this podcast’s history. But very often we talk about personal experiences, modern ramifications of this, and I really want to start going back a little bit further. I would like to talk about the full history of asexuality being diagnosed as a problem. You know, one of the things we often hear from bad actors who don’t really believe that asexuality has been discriminated against will say things like, comparing to other queer identities, “Well, ace is never this, ace is never that.” Um, one that I used to hear pretty frequently is, well, asexuality was never in the DSM like homosexuality was.

Courtney: Homosexuality was considered a mental disorder up until the early 1970s. I want to say ’73.

Courtney: And hopefully by the end of this episode, you’ll have a little more history, knowledge, vocabulary to appropriately respond to those who might have such a bad faith argument as this. Because we know through lived experiences and studies alike that asexuality is incredibly pathologized. It is heavily medicalized. Asexuality as a sexual orientation is the most likely to be offered or undergo conversion therapy.

Courtney: And maybe if we look at the timeline of history, we can begin to understand a little more as to why that is. So who’s taking bets as to how far in history we’re starting today?

Royce: Well, I wasn’t a part of the research, but I assume we’re going before the DSM.

Courtney: Oh, we’re going back way before the DSM. Although a strong percentage of the individual details we’re gonna talk about is going to be about the history of the DSM as it pertains to um Shall we say all the ways in which asexuality has been put in here without actually saying the word?

Courtney: But no, we must go back far further. We’re talking 1100s, 1200s.

Courtney: We’re going back to the era of Pope Gregory the IX. Because before our modern era of medicine, a lot of discussion about sex and sexuality really only took place in the context of religion, at least in early text, early print. And those listeners of ours who have heard our rants about modern far-right Christian nationalists and their current attack on asexuality might start to see some parallels not only between early Catholic theory but also a little bit more modern medical history. It’s a little jarring how similar some of these arguments are when theoretically they should be very different contexts. So back in the day, the conversation about sexual issues, shall we say, revolved around frigidity. Frigidity, and of course, throw in sorcery for good measure.

Courtney: Not a diagnosis in the modern medical sense, but the highest religious leaders of the era identified these as two reasons why there might be impotence within the context of a good Catholic marriage.

Royce: Sorcery.

Courtney: Sorcery. You are either frigid or you have been ensorcelled. Some of you aces who are in the know are going to recognize the word frigid and probably bristle at it. It is still a word that in modern context has been used derogatorily. This is how long the word “frigid” in the context of, quote, “not wanting sex” or “not being able to have sex” has been used. Extremely entrenched history right here that I think is the natural starting point of this conversation about pathologizing a lack of sexual desire. Now, from the 1200s on to the 1600s, several hundred years of history, there were of course other religious leaders, namely Catholic, who would further talk about and expand the idea of frigidity. Some would try to define it more specifically, but the main purpose of a lot of these conversations was, is frigidity grounds for annulment?

Courtney: We’re gonna have some parallels to our conversation about modern marriage consummation laws as well today. Please go back and listen to those episodes if you have not already.

Courtney: But in the early 1600s, we have these Catholics, they’re saying, you know, if frigidity is, quote, um, coldness of passion. And because a good, proper marriage needs to involve sex, specifically the right kind of sex. And at this point in time, I actually do have- this is a quote I got from Sharonda J.

Courtney: Brown’s book, refusing Compulsory Sexuality: A Black Asexual Lens on our Sex-Obsessed Culture. So I’m gonna put a link to that in the show notes if you have not read it already. Definitely recommend it.

Courtney: This was at the time, late 1500s, early 1600s, a written assertion for what the perfect coupling should include. It should include erection, penetration, and ejaculation of the true seed.

Courtney: There was also some talk this might seem surprisingly early to those of you who do not know this history, but 1587, mind you, of sort of redirecting the conversation. It’s not just about reproduction only, but also, “copulation that satisfied desire.”

Courtney: So this is the era in which we’re talking about Frigidity. And again, for hundreds of years at this point, whether or not frigidity is worthy of an annulment. A lot of Catholic thinkers through this time would acknowledge that, you know, women can also be impotent. The word impotence at the time seemed to be used a little more flexibly than we think of it now. Because it wasn’t always just used to mean like, “can’t get an erection,” but they would say like, “women can also be impotent, but also, does it matter?” So there were several Catholic thinkers who, when talking about frigidity and or impotence, they’d say, “yes, men and women both can be, but it’s really only annulment-worthy if the man is impotent,” and it got real sexist, real fast as well you can imagine, because quite literally a lot of these conversations boil down to like, “It doesn’t really matter if the woman doesn’t want it, ’cause as long as there’s an erection, we can make something happen here.”

Courtney: But it was in the mid-1600s that we start adding some physicians to the conversation. Religious leaders have already been talking about frigidity and impotence and a coldness of passion, and various other horrendous phrases. But now we’ve got doctors chiming in saying, okay, well, you’ve given us your religious take on what frigidity is.

Royce: Sorcery.

Courtney: Sorcery. Let me give you my expert doctor opinion on what frigidity is.

Royce: And what time period is this? Is this the ghost in the blood type of physician work?

Courtney: This is mid-1600s. So usually when you get jokes like “ghost in your blood,” people are talking Victorian era doctor. We’re like 200 years before this.

Courtney: So we’ve got this Italian physician, Paolo Zacchia, saying that to be frigid is to have a, quote, “lack of native heat,” or in other words, feeling no venereal irritation, but also by not producing any seed within themselves whose Stimulus would move them to coitus. Sounds pretty asexual to me.

Courtney: But no, doctor’s diagnosis: frigid. Where for over 400 years by this point, “frigid” has been used by the Catholic Church. So even though we did have doctors chiming in in the 1600s here, it was the Victorian era, it was the mid to late 1800s where the full doctors have taken over now. Listen to the doctors, we’re the experts and we have thoughts, starts coming in.

Courtney: At first, still using the word frigid. So mid-1800s, so this is 1850s now.

Courtney: We’ve got physicians who are saying, well, actually frigidity is only a disease in women. Where oddly enough, all the way back to the 1200s, the Catholic Church is like, no, both both can be frigid. Now we have doctors in the 1800s going, “Eh, no, that’s just women, actually.”

Courtney: This new proposed heavily gendered definition of frigidity is women who, quote, “participate only passively in the act of copulation,” or “the absence of venereal desires,” or “the absence of pleasure.” three definitions for frigidity in women. Once this got documented in the medical context and the focus sort of turned back specifically on women, more physicians started exploring this and trying to define it, redefine it, give synonyms for it. In the 1860s, we have a proposed synonym for frigidity called anaphrodisia. And for, as you can see, many hundreds of years at this time, whether you literally cannot get an erection or if you just don’t want to have sex, they were kind of both just crammed into the same little basket because at the end of the day, you didn’t get the desired outcome as told by the church and later doctors.

Courtney: But now the physicians are in charge and we have to hyperanalyze everything and start subdividing things. In the 1880s, now we have a physician, Pierre Garnier, who specifically wanted to separate out- this is impotence, this is more physiological, this is closer to what we now understand to be the word impotence, versus frigidity, also known as anaphrodisia. Frigidity and anaphrodisia are psychological issues. They’re a neurosis. And this is the time where psychology really started budding as a science. We started getting psychiatrists and psychoanalysts. So we we start to evolve from here is just general physician to now we’re taking a specific psychological interest and sort of separating illnesses of the mind and illnesses of the body, which there are still many modern arguments to be made about whether or not the two should be separated, which we surely won’t get into today.

Courtney: But it’s during this period of time where the lens of medicine is really starting to turn toward the psychological. We have a lot more doctors who are able to communicate at a larger scale, more writings.

Courtney: And there’s a time throughout this where the diagnosis of frigidity or anaphrodisia starts to waffle back and forth on whether or not this is just a diagnosis for women or if it can be for both genders. And you do start getting doctors chiming in saying well, frigidity is a sickness, and it’s especially dangerous in women because it can lead to hysteria. Very, very literally, in the most crass language possible, there are doctors theorizing, well, frigidity is a sickness, dick is the cure. We can’t have a woman not getting laid, that’s not right, she’ll go crazy.

Courtney: I do often bristle a little bit. I normally don’t say anything because I get that there are allosexual, sex-positive people who just fundamentally understand the world differently than I do.

Courtney: But there was a whole wave of jokes about actually how awesome, like, late Victorian medicine was. These women who their their diagnosis Meant that treatment was for a vibrator or a dildo. And imagine going to the doctor just and and people talking about it like, oh, isn’t that so great?

Courtney: I can’t help but to view those jokes through an asexual lens. Like, we know asexual people exist. There’s almost no world where there wasn’t someone being diagnosed with frigidity who in a modern context may have self-describe themselves as an asexual person with our modern language and culture. And quite literally, can you imagine someone like that?

Courtney: Does not have any interest for sex, has no sexual desire, is being diagnosed with doctors saying, no, this is a problem for you. If you don’t have sex, you will become hysterical. Luckily, we’ve got a treatment for that.

Courtney: Absolutely not. Disgusting.

Courtney: Especially when you can trace a lot of these roots. I I know a lot of people who are borderline worshippers of modern psychiatry. And although there definitely is some good in the modern field of psychiatry, and there are completely life-saving or life-enhancing treatments to be found there, the basis for a lot of it was shaky at best.

Courtney: So even though there was some waffling back and forth about whether or not frigidity can be for men and women or just women, for the most part, a lot of medical folks at this time landed on, well, men have impotence, they can have a physiological reason, but the more this is a mental problem, which means you don’t want to have sex, tended to land on, “This is the women problem,” and that is frigidity. But as more and more doctors and psychoanalysts started to expand upon the concept of frigidity, a very interesting thing happened.

Courtney: Because while it started as lack of desire, lack of native heat, if you will. The basis for it, if we trace it back to the early Catholic theories, it has never just been a problem of not wanting sex, period. It’s not wanting the right kind of sex, with an asterisk. ’Cause this started as good Catholic marriage has to be a man and a woman, have to be having uh procreative sex. That’s the purpose, that’s what we want to happen, that’s what we’re trying to religiously mandate happens. So if you don’t want that at all, that’s bad.

Courtney: So this idea of frigidity, even though it sort of narrowed to just be women and narrowed to just be lacking a desire, it sort of started expanding again and became sort of a catch-all diagnosis, something that was very generic for anything that was seen as a problem that wasn’t having procreative heterosexual sex. So frigidity, for a time, was also used as a diagnosis for masturbation, same-sex attraction, sadomasochism, androgyny, women who were a little too dominant, a little too perceived to be masculine. And even um women who relied too heavily on clitoral stimulation for orgasm. All of those at one point or another could have garnered a diagnosis of frigid once it started expanding again.

Courtney: ’Cause now in the eyes of the doctors, wanting the wrong kind of sex is just as bad as wanting no sex. ’Cause at the end of the day, you don’t want the right kind of sex.

Courtney: Frigidity as a medical diagnosis that doctors are now using, after originally being concepted in a religious worldview, was used, as far as I can tell, at least up to the 1960s. I found a study published in 1959 entitled “Frigidity and Impotence.” And it literally opens with the line, this is a direct quote: “Frigidity is the most common sexual disability in women. By frigidity is meant an absolute disinterest or aversion to the sexual act.” Disinterest in the sexual act. Aversion to the sexual act. Tell me with a straight face, genuinely, that there was never an asexual person diagnosed on paper with frigidity.

Courtney: Now, after the 1960s, we started developing fancier diagnostic labels for the same kind of idea. So the actual word frigid, frigidity, started getting cycled out and replaced with other things. But like I said, in a modern context, frigid is still used as an insult. It’s still a derogatory name usually hurled toward women, often toward asexual women. Now, this one is really gross.

Courtney: In 1975, luckily this one didn’t catch on, it didn’t get put in the DSM, but there was a psychologist by the name of Nathan Hare who coined the term “sexual anorexia.” Which he defined as a fear or aversion to sexual activity, or in other words, a lack of sexual appetite. Gross.

Courtney: Glad that one didn’t catch on, but lamenting the fact that these next two to follow did catch on. So we’ve got the late ’70s now.

Courtney: Lots of psychologists, lots of studiers and followers of Freud. We are in the midst of the sexual revolution, and now we’re starting to get not only psychologists branching off from physicians, we’re starting to get specified sex therapists. And we’ve got two sex therapists of note who independently of one another were starting to develop a new diagnosis. to ostensibly mean the lack of sexual desire. We have Harold Leif who proposed the label inhibited sexual desire, and we have Helen Singer Kaplan who proposed hypoactive sexual desire. The context in which these two sex therapists were doing their work is that it is shortly after major works were published that revolved primarily around sexual dysfunction. But those works revolved mainly around our more modern usage of the word impotence.

Courtney: They were talking more about physiological functions. They were talking about how the genitalia functions. And so Leif and Kaplan, both independently as sex therapists, kind of realized in their practice, oh, some people just aren’t that interested in sex, and it kind of doesn’t have anything to do with the diagnoses that I have here. It doesn’t really have to do with impotence. It’s not really physiological. The standard diagnostic criteria and treatment for these other sexual dysfunctions recently documented thoroughly is is just not working for these people who just don’t have that much desire.

Royce: And it’s interesting, just based off of their word choice there, one of them saying hypo and one of them saying inhibited. Hypo tends to mean too little or or less than normal. I can’t think of the proper term, but if you were to use hypo in in front of some sort of vitamin or mineral, that would indicate a deficiency.

Royce: So that one seems to me to be pointing to a lower level of desire than would be expected from the norm, whereas inhibited seems to me to be focused much more on like an underlying trauma or something like that.

Courtney: So it’s really interesting that you immediately picked up on the differences in how those words could be received. Because uh some of you may be asking, well, we have two different phrases for a very similar phenomenon here.

Courtney: Which one was picked up? The answer is kind of both of them, one then the other. And it was because of language that one of them is still used today.

Courtney: But you used the word “normal,” and that is the key word.

Royce: And by normal, I was meaning a statistical average or something for the dataset.

Courtney: Well, and that’s the way you’re using it, but the field of psychology has a very long history of- I almost want to use the word “entitlement.” Entitlement to defining what is normal. And everything that’s outside of what they deem to be normal is therefore diagnosable and a problem. It surely can’t be that each individual person has their own individual normal baseline for sexual desire. And in the case of asexual people, that can be very little or completely absent, and that is perfectly fine and normal and healthy for that person. It is on a population-wide level, we have determined how much sex you should want. And if you want too little of it, that’s diagnosable. If you are having the wrong kind of sex, diagnosable. So these two, Leif and Kaplan, both thought there was a need for a new diagnosis.

Courtney: Because much like early Catholic thinkers who were like, here are the stages of proper copulation. Proper copulation needs X, Y, and Z.

Courtney: Sex therapists kind of did the same thing under their own lens. The uh books I was referencing, I just looked them up because I didn’t have them uh off the top of my head. Uh from 1966, there was a book, Human Sexual Response, and then in 1970, the book Human Sexual Inadequacy, which, wow, what a title. Um, these books like laid the foundation for sex therapy, and they had like a a model of human sexual response being excitement, plateau, orgasm, and resolution. They’re like, these are the steps of sex.

Courtney: But Kaplan here was like, Mm, we better change that model because there’s another step here that goes first and foremost, and that step is desire. If you don’t have the desire, you can’t even get to the excitement. So a lot of her work proposed adding hypoactive sexual desire as a diagnosis and also fundamentally changing the model to include desire as the first step. The first step in a medicalized view of how sex ought to be. Therefore, if the desire is absent or too low or wrong in some other way, diagnosable. Now here’s our less-than-fun parallel.

Courtney: Kaplan herself, in her own works—this is not the modern use of what her diagnosis has become- but she also, much like the earlier genericization of “frigid,” started to expand her definition of HSDD to include the homosexual, the masochist, the exhibitionist, the fetishist, and the pedophiliac. So very literally, we have a sex therapist whose language was formative in our modern DSM understanding of sexual dysfunction, beginning from a baseline of, “No, no, no, desire is part of sex, and if you don’t have that, that’s wrong. I’ve seen patients who don’t have a desire for sex.

Courtney: That’s bad. I’m gonna create a label for it, a diagnosis for it. It’s HSDD.”

Courtney: Very much following in the footsteps of frigidity that came before it. And she also started to expand it.

Courtney: Not having sex, bad. But wanting to have the wrong kind of sex, also bad. And when you follow that train of thought, of course, you’re going to end up at a worldview where being gay is bad, being asexual is bad. They’re both equally bad.

Courtney: And that’s when you get this ugly history of queer people being called pedophiles, because here we have a respected sex therapist of the time whose language still influences modern psychology, saying these are all the same thing. So if we have 1973, homosexuality is being taken out of the early iterations of the DSM. We now have 1980 is when the DSM-III was published, and Leif’s proposed diagnosis of inhibited sexual desire was added to the DSM, along with several other, quote, “sexual dysfunctions.”

Courtney: I’m not an expert in all of them, but this was showing the trend at the time. Diagnosing sexual dysfunctions is hot right now.

Courtney: We’ve got a lot of proposals, we’ve got a lot of options, different labels, we’re adding them. A lot of these got added with little to no empirical evidence.

Courtney: But 1980 DSM-III, inhibited sexual desire. The definition of this diagnosis is persistent, and pervasive inhibition of sexual desire.

Courtney: 1987, however, DSM-III-R was revised. ISD was changed to Kaplan’s language, hypoactive sexual desire disorder. And at the time, my understanding of this change is that this version of the DSM, they were trying to sort of standardize it. There were a lot of diagnoses that were added from very theoretical points of view, and they wanted language that was less suggestive of these theories. And the word “inhibited” sounded like too Freudian. Like, that’s a little too Freudian.

Courtney: We can’t be looking at it just from this point of view. We need everything to be a little more, you know, standardized, a little more empirical. So instead of throwing the diagnosis out because they decided it’s too theoretical, they’re like, let’s just change the language. We’ve already got another proposed definition for basically the same thing already, so let’s just swap that out. Alongside hypoactive sexual desire disorder, they also added in this revision sexual aversion disorder, which yes, is abbreviated to SAD. The definition of SAD being persistently or recurrently deficient or absent sexual fantasies and desire for sexual activity.

Courtney: So they added fantasies. If you don’t have fantasies now, well, that’s just sad.

Courtney: And I don’t fully understand why in this 1987 iteration they decided to add subtypes. So inhibited sexual desire changed to hypoactive sexual desire, but they also started adding like subtypes. So you can have Lifelong hypoactive sexual desire disorder, or you can have acquired hypoactive sexual desire disorder. You can also have generalized hypoactive sexual desire disorder, or you can have situational hypoactive sexual desire disorder. Which is fascinating to me, ’cause let’s actually use an example of that.

Courtney: Lifelong HSDD. For your entire life, you have not had sexual fantasies or a desire for sexual activity. And it’s generalized, which means it’s not just your current partner that you don’t want to have sex with right now.

Courtney: It’s everybody. It’s generalized and lifelong.

Courtney: That that that sounds like asexuality to me. That that that really does. That really does. But then comes 1994 when the DSM-IV was published.

Courtney: At this time, they’re looking back. They already tried to sort of remove some of the theoretical language, but now they’re starting to understand more and more that scientific standards are rising, and they’re going to be a little more rigid about changes that they allow. In theory, that sounds like a good thing, but there was a committee on sexual dysfunctions in the writing and publishing of this version of the DSM, and the committee themselves could not find enough studies on either HSDD or SAD to actually warrant them staying in the DSM as is. But they were quite literally told that they could not make changes to the current diagnoses and diagnostic criteria without being able to point to research that supports the change. They’re like, we don’t have enough research to support it going in here in the first place.

Courtney: And they’re like, all right, well, show me the study that says we can remove it then. Um, what?

Courtney: And thus, HSDD and SAD remained in the DSM-IV. They did kind of add a blanketed qualifier to everything, every single diagnosis under sexual and gender identity disorders. Yes, that is literally what the section is called. And they sort of added a, “Mm, if the things we’re describing come with distress and interpersonal difficulty.” Allegedly, this was such a quick, thoughtless change that some members of that committee don’t even recall discussing it. This is something I have heard through the grapevine. from within the asexual community. So take it with a grain of salt, but I kinda believe it.

Courtney: In 1998, between editions of the DSM, totally removed from the DSM itself, the Sexual Function Health Council of the American Foundation of Urologic Disease convened for an inaugural consensus development panel on female sexual dysfunction. They wanted to create a way to classify female sexual dysfunction as a diagnosable and therefore treatable disorder. Does anybody have any guesses what happened in 1998 that may have contributed to the setting up of this panel?

Courtney: Viagra hit the market. We’re not going to include the “female Viagra” in today’s timeline because, believe you me, that is an entire episode all on its own. But as an attempt to classify FSD, female sexual dysfunction, absolutely fits on our timeline of everything Asexuality has been diagnosed as. The suggested prevalence for FSD was that it affects 20 to 50% of women. So tell me now, if we’re taking population averages and 50% of people are one way? In what world?

Courtney: It it really, really just shows that when it comes to sexual desire, it’s never viewed as a neutral fact about someone. There consistently throughout history has been a hidden agenda, a baseline assumption of what sex and sexuality should be. And anything outside of that box of “should be” is wrong. Whether it’s religiously chastised, whether it is legislated against, whether it’s diagnosed medically, psychologically.

Courtney: Because I I think these estimates are all bogus anyway. I think the very notion of female sexual dysfunction is already flawed. from the outset, but if we were taking them at their word and they said 50% of women have this medical condition- is that really a medical condition? Or are 50% of women just that way?

Courtney: And maybe that’s fine. Maybe it’s fine! Leave women alone!

Courtney: So, thanks in large part to a small committee of activists who organized via AVEN, the DSM-five, which was published in 2013, did add a footnote about asexuality, sort of. What they did in the DSM-five was they took the diagnosis of hypoactive sexual desire disorder and they split it into two different things. And they gendered it again. Again, we’ve got this waffling back and forth.

Courtney: Is this just for women or is this for women and men? Maybe they both have something like this, but maybe they’re different words. This is not new. There’s a large historical precedence for this, and I see this as a natural extension of that.

Courtney: Based on the 2013 publishing of the DSM-five, we now have female sexual interest slash arousal disorder, which for some reason has been separated from male hypoactive sexual desire disorder. We’re going to get into these modern diagnoses in more detail next week, so please stay tuned for that. We’re actually going to dig into the current language for the current standard diagnostic manuals. in use today. But for the sake of our timeline, what you need to know today is that this committee on AVEN saw a lot of the same concerns that I am addressing today. And as a result, they heavily advocated that asexuality be acknowledged as a valid sexual orientation with the hopes that there wouldn’t continue to be asexual people diagnosed with things like a- and they won a small victory here. Unfortunately, a lot of the language in, for example, right now I have pulled up female sexual interest disorder or female sexual arousal disorder in the full tome that is the DSM-five.

Courtney: After using much of the same language in the DSM’s predecessor for HSDD. For example, lifelong versus acquired, generalized versus situational, absent or reduced interest in sexual activity. A lot of these same key phrases that we have a precedence for already. A lot of that stayed very much the same.

Courtney: But then they add right at the very end, if a lifelong lack of sexual desire is better explained by one’s self-identification as “asexual,” then a diagnosis of female sexual interest slash arousal disorder would not be made. First of all, gotta love the the scare quotes around asexual.

Courtney: But we’ll go a little deeper next week into my thoughts about why this is not enough. This is still very, very good work by those activists on AVEN.

Courtney: It’s not nothing, but based on the history of the DSM and these diagnoses specifically, it is far from enough. And further compounded by the fact that it’s not enough, there are like abridged desk reference versions of the DSM, and this is usually what a psychologist might have on their desk. This is what a psychiatrist might have on their shelf. Um, most are not going to have the enormous tome of absolutely everything. Surely some might. Um, whether or not they’re regularly cracking it open remains to be seen.

Courtney: But the desk reference version of these does not include that little disclaimer. So there are plenty of medical professionals who are not actually seeing that line about asexuality.

Courtney: In 2022, the ICD-11 was published. This is what is used by the World Health Organization. So the DSM, the Diagnostic and Statistical Manual of Mental Disorders, is very much used in the US. The International Classification of Diseases, 11th revision, is very much used more prominently in other parts of the world.

Courtney: The newest version of which, published in 2022, did not make the change that the DSM-five did. So in the ICD-11, hypoactive sexual desire dysfunction is still there. They use dysfunction instead of disorder, but very much the same thing.

Courtney: The definition being: absence or marked reduction in desire or motivation to engage in sexual activity, as manifested by any of the following: one, reduced or absent spontaneous desire, sexual thoughts or fantasies. two, reduced or absent responsive desire to erotic cues and stimulation. Or three, inability to sustain desire or interest in sexual activity once initiated. The pattern of diminished or absent spontaneous or responsive desire or inability to sustain desire or interest in sexual activity has occurred episodically or persistently over a period of at least several months and is associated with clinically significant distress. That was four years ago that that reference was published.

Courtney: Other more casual terms that aren’t necessarily published in a DSM or an ICD, but I have seen medical authorities use- think like medical schools, hospital reference websites, all in recent modern history- I’ve also heard “pleasure dissociative orgasmic disorder.” I’ve heard “sexual anhedonia.” And maybe my personal favorite, uh, “sexual apathy.” I think that was like the University of Maryland or something was talking about sexual apathy.

Courtney: So as I said, next week we’re gonna get a lot more into the verbiage and my concerns about the current diagnoses on the books, but I just, I just kind of want to go back and count how many different, like, diagnoses we’ve had in this. Surely my timeline is not even a comprehensive one.

Courtney: Surely there are others, but we have impotence, frigidity, Anaphrodisia. Sorcery. Sexual anorexia. Inhibited sexual desire. Hypoactive sexual desire. Hypoactive sexual desire disorder. Sexual aversion disorder. Female sexual dysfunction. Male hypoactive sexual desire disorder. Female sexual arousal slash interest disorder. Sexual anhedonia. Sexual apathy. Pleasure dissociative orgasmic disorder.

Courtney: What was our count there? 15. 15 different problems to be addressed that by another name could easily be called asexuality. And through a different lens, could be a perfectly normal, healthy, empowering, liberating, beautiful way to be. If you’ve ever wondered why asexuality seems to be, even still to this day, heavily medicalized, heavily pathologized, hopefully this gives you a little more context as to where we came from and how we got to this point. If you found this conversation interesting, please tune in next week because we are going to dig into the current language of the DSM and the ICD.

Courtney: And until then, I am wishing all of my aces in the audience a very happy Ace Week. Every allo in the audience, go buy your favorite asexual a cake and or garlic bread. to their preference.

Courtney: And as always, I am going to leave you all off with today’s featured Marketplace vendor. In honor of Disabled Ace Day, of course we are going to shout out one of our many fabulous disabled ace marketplace vendors, Aleta Perez, where you can find prints and TTRPG supplements by an aroace, nonbinary, indigenous artist. Now, Alita here has some beautiful illustrated works. There is a volume of Nature’s Aesthetics, which is absolutely awesome. It’s, it’s independent content for Wander Home, which I personally have not played yet, but I have seen wonderful things. And you can bet as soon as I have an opportunity to play this game, I will be running right here to buy this book. But even if you are not a player of Wanderhome, there is other beautiful artwork to be seen and purchased, including a pack of wallpapers.

Courtney: Or I personally love a short story called Alone Exalted. A small stakes fantasy story taking place during a festival for a land spirit. This is actually available for pay what you want on the artist’s Ko-fi and itch.io. So links to find all of these are gonna be in the usual places, the show notes on our website, as well as the description box if you happen to be listening on YouTube.

Courtney: Or if you’re feeling the ace week spirit, you can simply uh buy a coffee for Aleta Perez. It is a very nice thing to do. to tip all of these wonderful ace creators during our week.

Courtney: So as always, thank you all so much for being here, and we will talk to you all next time.