ICD-10 Code: F52.22
Female sexual interest/arousal disorder is part of a cluster of diagnoses called the sexual dysfunctions. Sexual dysfunctions are a group of psychiatric conditions that include:
Sexual dysfunctions are characterized by a significant impairment in a person's ability to respond sexually or to experience sexual pleasure. This can refer to an inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest. An individual may have several sexual dysfunctions at the same time.
Biology, Psychology, and Sexual Function
Several factors can disrupt sexual functioning. Medical conditions such as multiple sclerosis, spinal cord injury or other nerve damage, diabetes, endocrine (hormonal) disorders, and menopausal status can all lead to problems of sexual interest or sexual capacity. Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), may have sexual side effects. Some age-related vascular, nerve-related, and hormonal changes can also adversely affect sexual functioning. It is important to note that when sexual dysfunctions can be primarily attributed to one or more of these biological factors, it should not be diagnosed as a psychiatric disorder, and treatment should target the underlying medical problem. However, in many cases, medical concerns can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a psychiatric diagnosis may be appropriate.
Other psychiatric disorders can adversely affect sexual function. As one example, Major Depressive Disorder may be characterized by decreased interest in all or almost all of one's usual activities. Sexual interest, therefore, may be diminished. In such cases, a separate diagnosis of a sexual dysfunction is not warranted. However, as was the case with medical conditions, other psychiatric disorders can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
Several psychological issues, even in the absence of a diagnosable psychiatric disorder, can contribute to sexual dysfunction. Negative body image may lead to feelings of anxiety around sexuality, inhibiting desire or capacity. Performance anxiety may similarly lead to problems of sexual function. Stressors, such as work or family concerns, may preoccupy the individual, affecting sexual interest or performance. A history of sexual trauma or other negative historical events may create negative associations with sexuality, thus undermining function. In such cases, a diagnosis of a sexual dysfunction is usually warranted.
Relationship factors can also contribute to problems of sexual functioning. At a purely physical level, often an individual's sexual concerns stem not from a problem within the individual, but from a lack of appropriate sexual stimulation from his or her partner. At an interpersonal level, some couples suffer from poor sexual communication, have poor understanding of sexuality, have different desires or preferences for sexual activity, or feel negatively about each other. All of these factors have the potential to adversely affect sexual arousal or performance. Such cases should not be diagnosed as a psychiatric disorder. Again, however, relationship problems can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
The etiology of a sexual dysfunction is frequently unclear, and clinical judgment is needed. Often, multiple possible explanations need to be explored, using both medical and psychiatric examination procedures.
The prevalence of female sexual interest/arousal disorder in women is unknown. The prevalence significantly varies depending upon the definition of the disorder, age, cultural background, duration of symptoms, and presence of distress.
The disorder is characterized by a reduction in sexual interest or arousal. The following symptoms can be experienced:
The disorder is also associated with the following sexual complications:
There are five factors that should be taken into consideration during the assessment and diagnosis of female sexual desire disorder:
As described above, not all incidents of interest or arousal dysfunction in women warrants a diagnosis of Female Sexual Interest/Arousal Disorder. Medical issues, adverse effects of drugs or medications, or relationship problems can all impact interest or arousal.
Relationship problems and mood disorders are commonly associated with this disorder. Women in longer relationships are more likely to report engaging in sex despite no feelings of sexual desire or interest compared with women of shorter relationships.
A number of psychosocial factors interfere with women's capacity for arousal and interest such as negative perceptions about sexuality and past history of psychological disorders. Difficulties in sexual arousal are associated with relationship dissatisfaction, partner conflict, and early childhood relationship stressors with caregivers. Some medical conditions such as diabetes mellitus and thyroid dysfunction can be a risk factor for the disorder. Sexual arousal, in particular vaginal dryness, is associated with older women and related to age and menopausal status.
As described above, not all incidents of interest or arousal dysfunction in women warrants a diagnosis of Female Sexual Interest/Arousal Disorder. Therefore, not all treatments for interest or arousal dysfunction are psychiatric. If a diagnosis is warranted, there are treatment options available. Published treatment recommendations for female sexual interest/arousal disorder include those from the International Journal of Women's Health, American College of Obstetricians and Gynecologists, and American Family Physician.
First Line Treatments
Second Line Treatments
Additional Treatments to Consider
The following strategies are in the clinical trial stages. Preliminary evidence suggests that the following medications, pending FDA approval, might be considered.