Understanding Female Sexual Arousal Disorder

What is female sexual arousal disorder?

Female sexual arousal disorder occurs when the body doesn’t respond to sexual stimulation.

It used to be considered its own condition. Doctors treated it differently than hypoactive sexual desire disorder. That refers to a lack of desire for sexual activity.

However, experts recently concluded it’s very difficult to distinguish between these two conditions. In response, doctors now use the term female sexual interest/arousal disorder (FSIAD), according to new guidelines in the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

FSIAD is one of several conditions that fall under the umbrella of sexual dysfunction, which also includes:

• pain during intercourse
• inability to orgasm
• lack of sexual desire

While having a sexual dysfunction can feel isolating, it’s actually fairly common. About 40 percent of women experience some type of sexual dysfunction, such as FSIAD, in their life.

FSIAD can be frustrating, but it is treatable. Read on to learn more about the symptoms and available treatment options.

What are the symptoms?

For many women, the symptoms of FSIAD come and go. Some have symptoms every time they try to have intercourse or engage in sexual activity. Others may only experience them occasionally.

Symptoms of FSIAD include:

• Decreased sexual desire. You may begin to lose interest in sex. While this can be due to lack of arousal, it may also be a symptom of stress and anxiety from having FSIAD.
• Few thoughts related to sex. You may rarely think about sex.
• Less initiation of sexual activity. You may not initiate sex and may be unreceptive to a partner’s attempts to initiate sex.
• Decreased sexual excitement or pleasure during sex. Sexual stimulation or other things that used to turn you on no longer do.
• Reduced arousal from internal or external sexual cues. You may no longer be aroused by cues like psychological intimacy, reading about enjoyable sex, or recalling an erotic fantasy.
• Lack of genital or nongenital sensations during sex. When having sex, you might not feel much in your genital area or other erogenous zones.

What causes it?

Arousal sets off a series of events in the body: Blood flow to the tissues around the vaginal opening and clitoris increases, causing swelling. The vagina produces natural lubricant.

These events are the result of a series of chain reactions. Any interruption in the process can cause FSIAD.

Many things, both psychological and physical, can affect the arousal process.

Psychological causes

Emotional and mental health issues that can cause FSIAD include:

• low self-esteem
• poor body image
• stress
• anxiety
• depression
• relationship problems
• negative thoughts
• guilt
• trauma

Hormonal causes

Hormones are a necessary element of arousal. Changes in hormone levels may affect your ability to be aroused. However, it’s not clear whether there’s a direct relationship between hormone levels and sexual function.

Things that can cause hormonal changes and possible FSIAD include:

• menopause
• birth control pills
• pregnancy

Anatomical causes

Arousal depends greatly on the body’s circulatory and neurological systems. Problems with either of these may cause FSIAD.

Some potential anatomical causes include:

• diminished blood flow to the vagina
• nerve damage in the pelvis
• infection of the vagina or bladder
• thinning, drying vaginal tissues

Other causes

Other factors can also lead to FSIAD, including:

• Medications. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, may cause FSIAD.
• Medical treatments. If you’re undergoing chemotherapy or radiation, you may experience FSIAD. Likewise, a recent surgery may interfere with arousal and sexual stimulation.
• Inadequate sexual simulation. You might have trouble getting aroused if the stimulation you receive from yourself or your partner isn’t sufficient.
• Diabetes. Diabetes can affect your nervous and vascular systems. This may make arousal more difficult because your body is unable to send the necessary hormones, blood, and electrical signals for arousal.

Who gets it?

Studies on female sexual arousal disorder show that low sexual desire and problems with sexual arousal vary widely by age, cultural setting, duration of symptoms, and presence of distress.

A 2009 study found that 3.3 percent of participants between the ages of 18 and 44 had female sexual arousal disorder, while 7.5 percent of participants between the ages of 45 and 64 experienced it.

How is it diagnosed?

FSIAD is sometimes hard for doctors to diagnose since many cases involve a combination of underlying conditions. In addition, many women may feel uncomfortable talking to their doctor about their symptoms and their sex life. This prevents a lot of women from getting diagnosed.

Most doctors start by asking a series of questions about your sexual and mental health. Next, they’ll likely give you a pelvic exam to rule out any physical causes of your symptoms, such as an infection or nerve damage.

In some cases, your doctor may also do a complete blood count test to get a better idea of your overall health.

If your doctor determines your symptoms aren’t due to physical causes, they may refer you to a psychotherapist who specializes in sexual health. This health professional can help you discover the emotional cause behind your FSIAD and help you create a treatment plan that suits you.

If you don’t feel comfortable talking to your doctor about your symptoms, consider looking for a new one.

The International Society for the Study of Women’s Health offers a tool that allows you to search for trained sexual health providers in your area.

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) also provides a national directory of certified sex therapists and counselors.

How is it treated?

Learn more

Treatment for FSIAD focuses on identifying any underlying causes and treating them. Many women find that a combination of treatments seems to work best.

Depending on the underlying cause, treatments often include medication, therapy, or a combination of both.

Some medication-related treatments include:

• Hormone therapy. If the underlying cause is hormonal, hormone therapy may help treat low estrogen or testosterone, vaginal dryness, or pain during intercourse.
• Changing medication dosage. If a medication you take, such as an antidepressant, is causing your symptoms, adjusting your dosage may help.

Working with a therapist who specializes in sexual health, either on your own or with your partner, can also help address some of the psychological elements of FSIAD.

Even if you don’t have any underlying mental health conditions, a therapist can help you identify what actually stimulates you and any barriers that are getting in the way. They can also provide guidance on how to build trust and intimacy with your partner, which can play a large role in arousal.

When looking for a therapist, consider seeing someone who’s a sex therapist. These are mental health professionals who focus on different aspects of sexuality, from dealing with past trauma to helping people identify what arouses them.

You can start your search with AASECT’s directory of sex therapists in both the United States and other countries.

At home, you can also try creating a relaxing environment to help your brain and body prepare for a variety of sexual activities.

Experiment with different elements, such as soft lighting, relaxing music, or soft fabrics. If you’re in a partnered relationship, you can also try talking to your partner about trying sexual activities outside of intercourse, such as massage or showering together.

A sex therapist can also assign homework, such as masturbation and fantasy training (which you can do with or without a partner). They can also provide you tools to help improve sexual communication.

The bottom line

Many women experience a form of sexual dysfunction at some point, including problems being aroused. While having FSIAD can feel isolating and frustrating, it can be treated.

Start by making an appointment with your doctor to rule out any underlying physical or psychological conditions that might be causing your symptoms. You can also try seeing a sex therapist either on your own or with your partner.

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