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:
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 is clinical (see Sexual Dysfunction in Women: Diagnosis).
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% testosterone prepared by a pharmacist and applied twice weekly to the clitoris.
Last full review/revision January 2009 by Rosemary Basson, MD, FRCP(UK)
Content last modified February 2012