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• Sexual Dysfunction in Women
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Sexual arousal disorders involve a lack of response to one or more types of sexual stimulation—subjective, physical genital, or both.

Sexual arousal disorders can be categorized as subjective, genital, or combined. All definitions are clinically based, distinguished in part by the woman's response to genital and nongenital stimulation, as follows:

• Subjective: Women do not feel aroused by any type of sexual genital or nongenital stimulation (eg, kissing, dancing, watching an erotic video, physical stimulation), despite the occurrence of physical genital response (eg, genital congestion).
• Genital: Subjective arousal occurs in response to nongenital stimulation (eg, an erotic video) but not in response to genital stimulation. This disorder typically affects postmenopausal women and is often described as genital deadness. Testing confirms reduced genital congestion in response to sexual stimulation in some women; in others, genital congestion is normal, but genital sexual sensitivity seems reduced.
• Combined: Subjective arousal in response to any type of sexual stimulation is absent or low, and women report absence of physical genital arousal (ie, they report need of external lubricants and may state they know that swelling of the clitoris no longer occurs).

Etiology

Causes may involve psychologic (eg, depression, low self-esteem, anxiety, stress) or physical factors or both (see Sexual Dysfunction in Women: Etiology). Inadequate sexual stimulation or the wrong setting for sexual activity can also contribute.

Genital arousal disorder may result from a low level of estrogen or possibly testosterone, as occurs during or after menopause, or from vulval dystrophy (eg, lichen sclerosus). Certain chronic disorders (eg, diabetes, multiple sclerosis) can damage autonomic or somatic nerves, leading to decreased congestion or sensation in the genital area.

Diagnosis

Diagnosis is clinical (see Sexual Dysfunction in Women: Diagnosis).

Treatment

Subjective arousal disorder: See Sexual Desire/Interest Disorder on see Sexual Dysfunction in Women: Sexual Desire/Interest Disorder.

Genital arousal disorder: When estrogen is deficient, initial treatment is local estrogen (or systemic estrogen if indicated for other postmenopausal symptoms). A phosphodiesterase inhibitor may be tried empirically if symptoms are refractory to estrogen therapy; it benefits only women with reduced genital congestion (eg, due to autonomic nerve damage). Other investigational therapy includes a trial of 0.2 mL topical 2% testosteroneSome Trade Names
DELATESTRYL
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prepared by a pharmacist and applied twice weekly to the clitoris.

Last full review/revision January 2009 by Rosemary Basson, MD

Content last modified January 2009