Women with female sexual arousal disorder have a persistent or recurrent inability to attain, or maintain until completion of the sexual activity, an adequate lubrication swelling response of sexual excitement, that causes marked distress or interpersonal difficulty and is not better accounted for by such conditions as depression, anxiety, bipolar disorder, attention deficit hyperactivity disorder, etc, and is not due exclusively to the direct physiological effects of a drug of abuse, or a medication such as an anti-androgen, etc or a general medical condition.
Women with female sexual arousal disorder can be subclassified as having a subjective sexual arousal disorder. A subjective sexual arousal disorder is consistent with an absence or markedly diminished feeling of sexual excitement or sexual pleasure from any type of sexual stimulation, however, vaginal lubrication or other signs of physical response, such as throbbing, pulsations, engorgement, and swelling still occur.
Women with female sexual arousal disorder can be subclassified as having a genital, subjective, or combined sexual arousal disorder. In a national survey of women in heterosexual relationships. Over 30% of the sample complained of lubrication while 7% reported personal distress about poor lubrication. Often women female sexual arousal disorder will complain that they have dead genitals. The prevalence of the female sexual arousal difficulties, with lack of “lubrication-swelling response” has been reporte range between 11% and 31%. The prevalence of subjective sexual arousal difficulties is less well known except for one study which found a prevalence of approximately 17%. Like desire complaints, when distress is also considered, the prevalence of arousal impairment drops markedly to approximately 6-7%.
Sexual arousal, especially subjective sexual arousal, may be the result of a multifaceted balance of brain excitatory and inhibiting neurochemicals. The most important brain neurochemicals involved in excitatory subjective arousal include norepinephrine, dopamine, oxytocin, and melanocortins. The most important brain neurochemicals involved in inhibitory subjective arousal include serotonin, prolactin, opioids and endocannabinoids. The actions of these facilatory neurochemicals are modified and influenced by the endocrine milieu provided by testosterone, estrogen and progesterone.
Psychological issues, such as sexual abuse, emotional neglect in childhood, traumatic experiences during puberty, perceived stress, distraction/attention, self-focused attention, anxiety, depression, personality variables, and body image self-consciousness may cause subjective arousal problems in various ways. There may be problems with motivation to have sexual activity especially concerns with the need to be emotionally close to the partner, to satisfy the partner, to feel like a woman, or to feel accepted. There may be problems with cognitive pathways referring to the meaning given to the sexual activity, where previous experiences may have provided negative memories.
Biologic issues may cause genital arousal problems in various ways. There have been research studies showing the negative impact on genital sexual arousal of chronic medical illness, hypothyroidism, metabolic syndrome, obesity, hyperlipidemia, diabetes, testosterone deficiency syndrome, childbirth, cancer surgery, chemotherapy, radiation therapy, menopause, oral contraceptives, antidepressants, and infertility treatments
Women with female sexual arousal disorder from a subjective sexual arousal disorder complain of an absence or markedly diminished feeling of sexual excitement or sexual pleasure from any type of sexual stimulation, however, vaginal lubrication or other signs of physical response, such as throbbing, pulsations, engorgement, and swelling still occur.
Women with female sexual arousal disorder from a genital sexual arousal disorder complain of an absence or impaired genital sexual arousal. These women complain of problems with achieving sexually arousal such as a wet vulva, engorged labia, nipple erection, vaginal lubrication, congestion of the vaginal walls, tumescence and erection of the clitoris, and swelling of the labia.
Women with female sexual arousal disorder from a combined genital and subjective arousal disorder complain of absence or markedly diminished feeling of sexual excitement or sexual pleasure from any type of sexual stimulation as well as complaints of absent or impaired genital sexual arousal involving problems with vulval swelling, throbbing, pulsations, engorgement and/or vaginal lubrication.
Psychological treatment of sexual arousal problems generally consists of sensate focus exercises and masturbation training, with the emphasis on becoming more self-focused and assertive. Biologic treatment of women with female sexual arousal disorder includes use of hormones. There is evidence that treatment with local and systemic estrogen benefits vulvo–vaginal atrophy and relieves vaginal dryness and dyspareunia. An adequate estradiol level is important for maintaining vaginal lubrication and avoiding dyspareunia, however, low estradiol levels not invariably result in dyspareunia. There are some human data linking improved genital sensitivity to estrogenized tissue.
Testosterone levels peak when women are in their 20s and drop gradually with age, so that women in their 40s have approximately half the level of circulating total testosterone as women in their 20s. Testosterone levels do not decline consistently during or after menopause. Testosterone is known to act on multiple tissue and receptor sites throughout the body, including clitoris, minor vestibular glands, vaginal muscularis and pelvic floor striated muscles.
Testosterone insufficiency in women with adequate estrogen levels could lead to a diminished sense of well-being and energy, fatigue, and decreased sexual desire. The brain uses neurosteroids that strongly influence sexual interest and motivation. Sex steroid production and action within the brain may be as relevant to women’s sexual function as peripheral testosterone.The effects of phosphodiesterase type 5 inhibitors such as sildenafil in women with female sexual arousal have been investigated in several controlled and uncontrolled studies.