Definition

Female sexual arousal disorder (FSAD) occurs when a woman is continually unable to attain or maintain arousal and lubrication during intercourse, is unable to reach orgasm, or has no desire for sexual intercourse.

  Description

The disorder typically affects up to 25 percent of all American women, or an estimated 47 million women. Three-fourths of women with FSAD are postmenopausal. Women describe it as being "unable to get turned on," or being continually disinterested in sex. It is also called "frigidity." Other terms for the disorder include dyspareunia and vaginismus, both of which involve pain during intercourse.

  Causes and symptoms

There are numerous causes of this disorder. They include:

• physical problems, such as endometriosis, cystitis, or vaginitis
• systemic problems, such as diabetes, high blood pressure, or hypothyroidism. Even pregnancy or the postpartum period (time after delivery of a child) may affect desire. Menopause is also known to reduce sexual desire.
• medications, including oral contraceptives, anti-depressants, antihypertensives, and tranquilizers
• surgery, such as mastectomy or hysterectomy which may affect how a woman feels about her sexual self.
• stress
• depression
• use of alcohol, drugs, or cigarette smoking

Symptoms vary. A woman may have no desire for sex, or may not be able to maintain arousal, or may be unable to reach orgasm. She may also have pain during sex or orgasm, which interferes with her desire for intercourse.

  Diagnosis

To make a diagnosis, a woman's physician - either family doctor, gynecologist, or even urologist -- takes a complete medical history to determine when the problem started, how it presents, how severe it is, and what the patient thinks may be causing it. The doctor will also conduct a complete physical examination, looking for any abnormalities in the genital region

  Treatment

The physician should start by providing education about the disorder and recommending various non-medical treatment strategies. These include:

• use of erotic materials, such as vibrators, books, magazines and videos
• sensual massage, avoiding the genitals
• position changes to reduce pain
• use of lubricants to moisten the vagina and genital area
• kegel exercises to strengthen the vagina and clitoris
• therapy to overcome any relationship or sexual abuse issues

Medical treatments include:

• estrogen replacement therapy, which may help with vaginal dryness, pain and arousal
• testosterone therapy in women who have low levels of this male hormone (Side effects, however, may include deepening voice, hair growth, and acne)
• the EROS clitoral therapy device (EROS-CTD), recently approved by the Food and Drug Administration; a small vacuum pump, placed over the clitoris and gently activated to provide a gentle suction designed to increase blood flow to the region, which, in turn, helps with arousal
• using the herb yohimbine combined with nitric oxide has been found to increase vaginal blood flow in postmenopausal women and thus help with some forms of FSAD

  Alternative treatment

Natural estrogens, such as those found in soy products and flax, may be effective. Herbal remedies include belladonna, gingko, and motherwort. However, there is no scientific evidence to prove these herbs actually help. Some women squirt vitamin E in their vagina to increase lubrication.

Women may also want to see a sexual therapist for additional help.

  Prognosis

Generally, once women seek the appropriate help they are quite likely to find a way to resolve their problems. Often, a holistic approach, using physical as well as emotional therapies, is required for success.

  Prevention

Maintaining a close and open relationship with a partner is one way to avoid the emotional pain and isolation that can lead to sexual dysfunction. Additionally, women should learn if any medications they take affect sexual function, and should refrain from alcohol and drugs and quit smoking. Women who have anxieties and fears about sexual intercourse, whether because of earlier abuse, rape, or a prudish upbringing, should deal with those issues through therapy.

   Key Terms:

Dyspareunia pain in the pelvic area during or after sexual intercourse. Vaginismus An involuntary spasm of the muscles surrounding the vagina, making penetration painful or impossible.

   Resources:

Books

• Berman M.D., Jennifer, Berman Phd, Laura, and Elisabeth Bumiller For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. Henry Holt & Company, Inc., 2001.
• Reichman, Judith I'm Not in the Mood : What Every Woman Should Know About Improving Her Libido. Quill Publishing, 1999
• Rako, M.D., Susan The Hormone of Desire : The Truth About Testosterone, Sexuality, and Menopause. Three Rivers Press, 1999.

Periodicals

• "Restoring Sexual Health." Consumer Reports On Health. (March 2001) 8-10.
• "Consumer Update: Female Sexual Problems." American Association for Marriage and Family Therapy. 14 June 1999.

Organizations

• Female Sexual Medicine Center UCLA Medical Center 924 Westwood Blvd., Suite 520 Los Angeles, CA 90024 310.825.0025 www.newshe.com
• National Women's Health Resource Center, 120 Albany Street Suite 820 New Brunswick, NJ 08901, 877-986-9472 www.healthywomen.org

Other