It is not uncommon for many women to have some sort of sexual problem at some time during their life.  Low sexual desire or low libido is the most common problem stated by women followed by insufficient vaginal lubrication resulting in painful sex. 

But there is another disorder found in women that can have a hugely negative impact on a couple’s sex life unless they seek out help for it – female sexual arousal disorder.

What is female sexual arousal disorder?

When low libido and inadequate vaginal lubrication occur together it is referred to as female sexual arousal disorder (FSAD).  FSAD has both physiological and psychological causes with the unintended results of avoiding sex, painful intercourse, and sexual tension in a couple’s relationship.

The physiological changes in FSAD or lack thereof include a woman’s persistent or recurrent inability to achieve or maintain an adequate lubrication-swelling response during sexual activity.  Under normal circumstances, when a woman is aroused and sexually excited, there will be physical changes occurring that include increased blood flow to her lower abdomen and genitals. The increased blood flow causes seepage of fluid through the walls of the blood vessels in which the fluid also seeps into the vagina providing lubrication before and during intercourse.  This happens very quickly and both a woman and man will often notice it.

The increase in blood flow also stimulates the upper part of the vagina, the uterus, the cervix, and the clitoris to all expand and swell.  When the expanding and swelling is combined with increased lubrication, this is designed to accommodate the entry of the penis into the vagina.

In order to allow blood flow to the genitals helping a woman to become aroused, there are several neurotransmitters and hormones released.  The brain also plays a critical role in creating a woman becoming sexually aroused – sexually charged images in the brain cause several neurochemicals to be released, including serotonin and dopamine causing feelings of sexual desire in a woman.  Foreplay is crucial for women in order to feel sexual excitement and when she has a partner who has good lovemaking skills and techniques this enhances those feelings and the physical response. 

A woman with FSAD does not have these physical responses of producing enough fluid to lubricate the vagina or is unable to maintain them during the course of sexual activity.  When this happens on an ongoing basis, the woman may avoid sexual intimacy altogether creating difficulties in the relationship. 

Physiological and psychological reasons for FSAD

FSAD is a complex condition with often multiple factors leading to it.  It can be a lifelong disorder or it could develop after an illness or emotional trauma.  What is known is that FSDA is usually a combination of both physiological and psychological factors often appearing together leading to the disorder.

Physiological reasons for FSAD:

·         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

·         Medical conditions that damage blood vessels such as diabetes, heart disease or high blood pressure

·         Medical conditions causing changes in hormone levels such as thyroid disorders, adrenal gland disorders or removal of the ovaries

·         Low levels of sex hormones due to agingor menopause

·         Side effects of medications such as antidepressants, antipsychotic drugs, sedatives, birth control pills, or drugs to lower blood pressure

Psychological reasons for FSAD:

·         Chronic mild depression

·         Emotional stress

·         Past sexual abuse

·         Emotional abuse

·         Self-image issues

·         Relationship problems with partner

·         Post-traumatic stress disorder, obsessive-compulsive disorder, or major depression

Treatment and prognosis of FSAD

The first step in treating FSAD is for the woman to discuss the situation with her doctor, most likely starting with her gynecologist first.  She can also bring up it with her family doctor or a psychotherapist.  There should a thorough physical examination to evaluate the medical aspects of the disorder along with laboratory testing of blood and urine samples to rule out any undiagnosed medical conditions such as diabetes. 

From there, the treatment will depend on the cause of FSAD.  If the reason is due to physical causes, then the problem can be treated as such.  It could be that the lack of lubrication is due to naturally decreasing hormone levels associated with aging that can be helped by hormone replacement therapy (HRT).  A woman may also try nonprescription preparations available in pharmacies for supplementing a woman’s natural lubrication.

If there are psychological issues for FSAD, then a woman can benefit from sex therapy focusing in the sexual dysfunction.  Sex therapists can help individuals and couples to overcome their sexual difficulties by identifying emotions, improving communication and promoting problem-solving strategies.  It is not unusual for couples needing help to work through relationship issues that may have led to sexual dysfunction before they will see an improvement in their sexual relationship.