Sexual arousal disorders involve a lack of subjective arousal or of physical genital response to sexual stimulation—nongenital, 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, distractibility) 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 after menopause or postpartum. Age-related reduction of testosterone or vulval dystrophy (eg, lichen sclerosus) may contribute. 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
Treatment is similar to that of sexual desire/interest disorder (see Sexual Dysfunction in Women: Sexual Desire/Interest Disorder).
Genital arousal disorder
When estrogen is deficient, initial treatment is vaginal estrogen (or systemic estrogen if indicated for other postmenopausal symptoms). Other investigational therapy includes vaginal dehydroepiandrosterone (DHEA) 13 mg at night. This drug may increase lubrication and lessen vulvovaginal atrophy in 2 wk and improve genital sensitivity and orgasm in 12 wk. This drug does not appear to increase serum testosterone or estrogen. It modestly increases serum DHEA, but levels are still considerably lower than those in younger women.
Last full review/revision April 2013 by Rosemary Basson, MD, FRCP(UK)