Female sexual arousal disorder (FSAD) refers to the persistent or recurrent inability of a woman to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response that otherwise is present during female sexual arousal and sexual activity. In a large sample of American women between the ages of 18 and 59, 19% reported having this difficulty.
Simply stated, female sexual arousal disorder is the persistent or recurring inability of a woman to maintain adequate genital lubrication, swelling or other response, such as nipple sensitivity, during the excitement stage of sexual activity. Female sexual arousal disorder involves a lack of response to the usual types of sexual stimulation (such as kissing, dancing, watching an erotic video, and touching the genitals) which normally should cause sexual arousal – mentally or emotionally (subjectively), physically (such as swelling, tingling, or throbbing in the genital area or vaginal wetness), or both.
For a woman to be aroused or sexually excited means that not only her body but also her mind is responding to the sexual activity. For many women, adequate sexual arousal involves physical as well as “psychological” and “situational” stimulation, such as intimacy with a partner, the exchange of confidences, the sharing of hopes and dreams and fears, and not only directly prior to the sexual event.
In general, the female sexual response cycle based on the work of Masters and Johnson and Kaplan depicts a sexual desire phase and a subsequent sexual arousal phase, characterised by genital vasocongestion, followed by a plateau phase of higher arousal, resulting in orgasm and subsequent resolution.
Based on this model, the arousal (excitement) phase of a woman’s sexual response can last minutes or much longer. During this time her blood pressure rises, breathing becomes more rapid, and her pulse rate increases. As her sexual excitement intensifies, blood flow to the pelvic region especially the vagina and vulva increases resulting in vasocongestion – the process by which vaginal tissues becomes plump and swollen with an increased volume of blood.
As the spongy tissues of the walls of the vagina engorge with blood, the swelling pushes tiny beads of this lubrication through the glands in the walls of the vagina. The composition, odour, and amount of this vaginal secretion vary from woman to woman, and also vary for an individual woman at different times of her life. In most women the clitoris will become erect, but this does not happen for every woman. Blood engorges the nipples as well, causing them to become erect. Vasocongestion also contributes significantly to a woman’s overall sexual sensitivity.
Unfortunately, a woman with FSAD either does not have these physical responses or does not maintain them through completion of sexual activity. The lack of arousal and lubrication may result in painful intercourse (dyspareunia), emotional distress, or relationship problems.
Causes of Female Sexual Arousal Disorder
FSAD for some women might be a lifelong disorder (they have never experienced a normal lubrication-swelling response); or acquired (developed after illness or emotional trauma, through physiological changes, or as a side effect of surgery, radiotherapy for cancer, or medication). FSAD can also be generalised (occurring with different partners and in many different settings), or it can be situation-specific (occurring only with certain partners or under particular circumstances).
The causes of female sexual arousal disorder are quite complex but tend to have the same causes as hypoactive sexual desire disorder (HSDD). Issues like depression, low self-esteem, anxiety, stress, and other psychological factors; drugs, and relationship problems commonly interfere with sexual arousal. Inadequate sexual stimulation or the wrong setting for sexual activity can also contribute. In addition, FSAD may be due either to psychological factors or to a combination of physiological and psychological factors.
The Physiological causes of FSAD may include damage to the blood vessels of the pelvic region resulting in reduced blood flow; damage to the nerves in the pelvic area resulting in diminished arousal; general medical conditions that damage blood vessels (coronary artery disease, high blood pressure, diabetes mellitus); nursing a baby (lactation); general medical conditions that cause changes in hormone levels (thyroid disorders, adrenal gland disorders, removal of the ovaries); lower levels of sex hormones due to aging (menopause); and side effects of medications (antidepressants, antipsychotic drugs, drugs to lower blood pressure, sedatives, birth control pills, or other hormone-containing pills)
Psychological causes of FSAD include chronic mild depression (dysthymia); emotional stress; past sexual abuse and emotional abuse; self-image problems; relationship problems with partner; and other mental health disorders (major depression, post-traumatic stress disorder, or obsessive-compulsive disorder).
The physical and psychological factors leading to FSAD often appear together. For example, a woman who does not experience arousal because of illness or the side effects of medication may then develop self-image and relationship problems that reinforce her difficulty in reaching arousal.
Treatment of Female Sexual Arousal Disorder
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.
Measures that help couples with most sexual dysfunction treatment can be particularly helpful in treating FSAD. For example, treatment includes the following:
1. Enhancing trust and intimacy in the couple’s relationship
2. Making the setting as conducive to sexual activity as possible
3. Helping a woman learn to focus during sexual activity
4. Identifying and communicating what stimulates the woman, as for hypoactive sexual desire disorder
Couples may experiment with different stimuli, such as a vibrator, fantasy, or erotic videos. Couples may also try activities other than vaginal intercourse. For example, couples may do sensate focus exercises (where each partner takes turn touching each other in pleasurable ways). Such exercises can enhance intimacy and lessen anxiety before sexual activity.
Drugs that are likely causes are stopped if possible. If a selective serotonin reuptake inhibitor (an antidepressant) is the cause, adding bupropion (a different type of antidepressant) may help. Or another antidepressant may be substituted.
For women who have atrophic vaginitis, doctors may prescribe estrogen, applied to the genital area as a cream, inserted into the vagina in a ring or as a tablet, or taken by mouth. For women who are taking oral contraceptives, doctors may recommend substituting contraceptive skin patches or using a barrier method (condom or diaphragm). For women taking estrogen therapy by mouth, doctors may recommend instead taking estrogen another way, such as a skin patch or gel.