Female sexual arousal disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Female orgasmic disorder

Overview

Female sexual arousal disorder is the condition of decreased, insufficient, or absent lubrication in females during sexual activity, and sexual contact in females. Loss of interest in sex occurs most commonly in women as they age and approach menopause.

Although female sexual dysfunction is currently a contested diagnostic, pharmaceutical companies are beginning to promote products to treat FSD, often involving low doses of testosterone.

Classification

Subtypes are provided to indicate onset (Lifelong versus Acquired), context (Generalized versus Situational), and etiological factors (Due to Psychological Factors, Due to Combined Factors) for Female Sexual Arousal Disorder.

Causes

A number of studies have explored the factors that contribute to female sexual arousal disorder and female orgasmic disorder. The data relating to both the psychological and the physical domain will be evaluated below. In the psychological domain, the impact of past (childhood, adolescence) and current events - both within the individual and within the current relationship - will be considered.

Impact of Events During Childhood and Adolescence

Most studies that have assessed the impact of childhood experiences on female sexual dysfunction are methodologically flawed. They rely on retrospective recall, which is particularly problematic when emotional responses to the event as well as the actual occurrence of the event are being reported.

Individual Factors

There has been little investigation of the impact of individual factors on sexual dysfunction in women. Such factors include stress, levels of fatigue, gender identity, health, and other individual attributes and experiences that may alter sexual desire or response.

Relationship Factors

A substantial body of research has explored the role of interpersonal factors in sexual dysfunction among women, particularly in relation to orgasmic response. These studies have largely focused on the impact of the quality of the relationship on the sexual functioning of the partners. Some studies have evaluated the role of specific relationship variables, whereas others have examined overall relationship satisfaction. Some studies have explored events; others have focused on attitudes as an empirical measure of relationship functioning. Subject populations have varied from distressed couples to sexually dysfunctional clients to those in satisfied relationships.

Physical Factors

Estimates of the percentage of female sexual dysfunction attributable to physical factors have ranged from 30% to 80%. The disorders most likely to result in sexual dysfunction are those that lead to problems in circulatory or neurological function. These factors have been more extensively explored in men than in women. Physical etiologies such as neurological and cardiovascular illnesses have been directly implicated in both premature and retarded ejaculation as well as in erectile disorder (Hawton 1993), but the contribution of physiological factors to female sexual dysfunction is not so clear. However, recent literature does suggest that there may be an impairment in the arousal phase among diabetic women. Given that diabetic women show a significant variability in their response to this medical disorder, it is not surprising that the disease’s influence on arousal is also highly variable. In fact, the lack of a clear association between medical disorders and sexual functioning suggests that psychological factors play a significant part in the impact of these disorders on sexual functioning (Melman et al. 1988).

Differential Diagnosis

• Another medical condition

• Diabetes mellitus
• Endothelial disease
• Thyroid dysfunction
• Central nervous system disease

• Interpersonal factors

• Severe relationship distress
• Intimate partner violence
• Stressors

• Inadequate or absent sexual stimuli
• Nonsexual mental disorders
• Other sexual dysfunctions

• chronic genital pain
• Lack of interest and arousal during sexual activity

• Substance/medication use

Risk Factors

• Childhood stressors
• Diabetes mellitus
• Genetic predispoition
• Negative cognitions and attitudes about sexuality
• Past history of mental disorders
• Propensity for sexual excitation and sexual inhibition
• Relationship difficulties
• Relationships with caregivers

• Sexual functioning of partner
• Thyroid dysfunction

Diagnostic Criteria

DSM-V Diagnostic Criteria for

“

A.Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following: 1.Absent/reduced interest in sexual activity. 2.Absent/reduced sexual/erotic thoughts or fantasies. 3.No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate. 4.Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts). 5.Absent/reduced sexual interest/arousal in response to any internal or external sexual/ erotic cues (e.g., written, verbal, visual). 6.Absent/reduced genital or non genital sensations during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts). AND B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. AND C.The symptoms in Criterion A cause clinically significant distress in the individual. AND D.The sexual dysfunction is not better explained by a non sexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: Generalized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners. Specify current severity: Mild: Evidence of mild distress over the symptoms in Criterion A. Moderate: Evidence of moderate distress over the symptoms in Criterion A. Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

”

Treatment

Although the way in which female sexual arousal disorder and female orgasmic disorder are expressed shows a wide degree of variation, there is no evidence to suggest either that different factors contribute to the two disorders or that different treatment strategies should be used. In fact, the same treatment strategies are generally applied for both disorders. These strategies may need to be supplemented with additional techniques to resolve specific problems for individual women, but they are generally good starting points for resolving the issues that contribute to the development and maintenance of the sexual problem. Because the relationship between the woman and her partner has been shown to play a significant role in both the development and the maintenance of sexual problems, most programs are designed to be implemented by the couple, although there may also be additional strategies that focus on the individual.

An existing tanning drug, bremelanotide, has also been found to increase libido in 90% of subjects, and therefore is being developed with the intention of selling as a treatment for sexual arousal disorder.

Source

• Female Sexual Arousal Disorder and Female Orgasmic Disorder

See also

• Sexual arousal disorder
• Sexual dysfunction
• Sexual function
• Anorgasmia

References

Barlow DH: Causes of sexual dysfunction: the role of anxiety and cognitive interference. J Consult Clin Psychiatry 54:140-148, 1986

Beck JG, Barlow DH: Current conceptualisations of sexual dysfunction: a review and an alternative perspective. Clin Psychol Rev 4:363-378, 1984

Cahill C, Llewelyn SP, Pearson C: Long term effects of sexual abuse which occurred in childhood: a review. Br J Clin Psychol 30:117-130, 1991

Delaney SM, McCabe MP: Secondary inorgasmia in women: a treatment program and case study. Sexual and Marital Therapy 3:165-190, 1988

Hallstrom T, Samuelsson S: Changes in women's sexual desire in middle life: the longitudinal study of women in Gothenburg. Arch Sex Behav 19:259-268, 1990

Hawton K: Sex Therapy. Oxford, UK, Oxford University Press, 1993

Heiman JR, Gladue BA, Roberts CW, et al: Historical and current factors discriminating sexually functional from sexually dysfunctional married couples. J Marital Fam Ther 12:163-174, 1986

Hoch Z, Safir MP, Peres G, et al: An evaluation of sexual performance - comparison between sexually dysfunctional and functional couples. J Sex Marital Ther 7:195-206, 1981

Hof L, Berman E. The sexual genogram. J Marital Fam Ther 12:39-47, 1986

Hulbert DF. The role of assertiveness in female sexuality: a comparative study between sexually assertive and sexually non-assertive women. J Sex Marital Ther 17:183-190, 1991

Kilpatrick AC. Some correlates of women's childhood sexual experiences: a retrospective study. J Sex Res 22:221-242, 1986

Salamonsen LA: Hormonal activity in the endometrium: tissue remodelling and uterine bleeding, in Progress in the Management of Menopause. Edited by Wren BG. London, Parthenon, 1997, pp 212-216

Salmon UJ, Geist SH: The effects of androgens upon libido in women. Journal of Clinical Endocrinology 3:235-238, 1943

Segraves RT, Segraves KB. Human sexuality and aging. Journal of Sex Education and Therapy 21:88-102, 1995

Spector IP, Carey P: Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature. Arch Sex Behav 19:389-408, 1990

Spector KR, Boyle M: The prevalence and perceived aetiology of male sexual problems in a non-clinical sample. Br J Med Psychol 59:351-358, 1986

External links

• Latest Trial Supports Importance of Testosterone for Sexual Function in Women Studied
• Useful Addresses - The Sexual Dysfunction Association
• Female Libido
• Causes of Female Sexual Dysfunction
• A brief review that explores issues of the medicalization of the female orgasm
• Our Bodies Ourselves chapter on Female Sexual Dysfunction: A Feminist View