Female sexual arousal disorder: Wikis


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Female Sexual Arousal Disorder
Classification and external resources
ICD-9 302.72

Female Sexual Arousal Disorder (FSAD) is similar to what used to be called frigidity. Female Sexual Arousal Disorder is characterized by a persistent or recurrent inability 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. The condition should be distinguished from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia), and from general loss of interest in sexual activity.

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.



There are several subtypes of female sexual arousal disorders. They may indicate onset: lifelong (since birth) or acquired. They may be based on context: they may occur in all situations (generalized) or be situation-specific (situational). For example, the disorder may occur with a spouse but not with a different partner.

The length of time the disorder has existed and the extent to which it is partner- or situation-specific, as opposed to occurring in all situations, may be the result of different causative factors and may influence the treatment for the disorder. It may be due to psychological factors or due to a combination of factors.

Diagnostic features

The DSM-IV (American Psychiatric Association 1994) diagnostic criteria for female sexual arousal disorders are outlined here:

A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.[1]

B. The disturbance causes marked distress or interpersonal difficulty.

C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Marita P. McCabe has noted that - "Difficulties arise with this definition in terms of what constitutes an adequate lubrication-swelling response. There is no “gold standard” regarding the length of time it should take to become aroused or the level of arousal that should be achieved. These responses may vary from one woman to another and are dependent on a range of factors, which include her general mood when sexual stimulation commences and her partner’s skill in stimulating her. There may also be differences in physiological and subjective levels of arousal, with some women reporting no feelings of sexual arousal despite evidence of vaginal vasocongestion and others reporting arousal in the absence of such evidence. The expectations and past experiences of clinicians and clients may also lead them to classify the same symptoms as female sexual arousal disorder in one woman but not in another." [2]


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. However, there have been some probative links between childhood sexual abuse and having a later sexual dysfunction.

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).

Kenneth Maravilla, Professor of Radiology and Neurological Surgery and Director of MRI Research Laboratory at the University of Washington, Seattle, presented research findings based on neuroimaging of women's sexual function. In a small pilot study of four women with female sexual arousal disorder, Maravilla reported there was less brain activation seen in this group, including very little activation in the amgydala. These women also showed increased activation in the temporal areas, in contrast to women without sexual difficulties, who showed deactivation in similar areas. This may suggest an increased level of inhibition with an arousal stimulus in this small group of women with FSAD.


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. It is also quite important to differentiate it from hypoactive sexual desire disorder.

An existing drug, bremelanotide, has also been found to increase libido in 90% of subjects, and was being developed with the intention of selling as a treatment for sexual arousal disorder. Bremelanotide (formerly PT-141) was in clinical tests until 2007, but was pulled from further testing due to adverse effects to the cardiovascular system.


The concept of female sexual arousal disorder is not without criticism. [3]


See also


  • 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

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