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Female Sexual Interest and Arousal Disorder

A lack of interest in sex, an inability to be aroused by sex, painful sex, and the avoidance of sex can occur at any point in life and can fluctuate in intensity.  But when any one of these becomes extreme and lasts for six months or more, it may be due to what is now called Female Sexual Interest/Arousal Disorder.  This name represents a more modern understanding of what used to be two separate disorders: Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder. Sexual arousal and the desire to have sex are difficult if not impossible to separate, and this disorder illustrates that.

Persistent problems with response and desire that interfere with sexual activity, pleasure, desire, and excitement for a long time are the key components.  Experiencing a lack of arousal, having less intense, or no orgasms is also common.  Relationship issues often occur alongside these problems, appearing either as a cause or as a result. Women are often ashamed about these issues, so seeking help is difficult.  While it can be extremely frustrating in its own right, they often feel as if they are letting their partners down.

This disorder can start right when women first become sexually active, or several years of healthy sex can pass before problems appear. Age is also a factor when doctors evaluate sexual desire problems, as many people tend to have a lower sex drive in their later years. However, some older people are less disturbed by this change and accept it as a natural part of aging. The length of a relationship matters as well, since people tend to be less sexually driven in long term relationships.

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Causes and Risk Factors

Rates

Depending on how the questions are asked, surveys find that between 10% and 46% of women have sexual desire problems at some point in their lives. Also, somewhere from 6% to 21% of women experience sexual arousal and orgasmic issues.

Medical issues

Doctors treating these women will most likely order multiple blood tests to look for possible medical conditions that could lower libido. Endocrine disorders that alter levels of sex-related hormones are a prime candidate.  Damage to the pelvic organs, bladder, kidneys, or the vagina often cause sexual problems.  In addition to these physical issues, both vascular and neurological problems can be suspected.  Disorders that damage nerves also cause problems, specifically around the physical pleasure of sex and orgasm.  This could be from trauma to the spinal cord, genetic nerve disorders, or diabetes, which damages nerves throughout the body. Finally, Tumors may overproduce hormones, and cancer treatments like radiation can destroy the glands and make hormone levels drop.

Pregnancy and breastfeeding

The hormonal changes of pregnancy and during breastfeeding, as well as the exhaustion that comes with raising a new child, are the two major reasons many women experience a drop in sex drive during these times. Prolactin, the hormone released during breastfeeding, can also cause temporary vaginal dryness and hyper-sensitive breasts, which make sex uncomfortable. Additionally, women may feel less confident about their physical appearance soon after giving birth and be less interested in sex.  While all of this may be perfectly normal during the time of pregnancy and breastfeeding, the degree of intensity and a prolonged state of loss of interest, desire, and arousal may indicate a more serious condition.

Medication side effects

Although antidepressants like Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine) are the most well-known medications that impair sexual desire and pleasure, many others do so as well. Other psychiatric medications including antipsychotics like Haldol (haloperidol) and anti-seizure medications such as Topomax (topiramate) and Neurontin (gabapentin) all decrease sexual desire and lower the physical sensations of sex and orgasm. The same goes for birth control pills and the birth control shot (Depo-Provera).

Sex Hormones

Levels of sex hormones like estrogen, progesterone, and testosterone go down naturally during menopause. Surgical menopause such as oophorectomy (removal of ovaries) can create a higher risk factor for endocrine disturbance.  Some people may accept the decreased sex drive that can accompany lower levels of sex hormones, for many others, it is a disturbing and unwanted change. Hormone replacement or supplementation has been seen to positively affect desire and drive.

Psychological factors

Several psychiatric disorders can cause problems with sex drive and sexual functioning. These include depression, anxiety, and substance use disorders. One of the main symptoms of depression is called anhedonia, meaning difficulty feeling pleasure or enjoyment. This often appears as a decreased sex drive and less pleasure felt during sex. Heavy drug and alcohol use can seriously lower libido in a similar way to depression and may alter the sensations of sex. Life stressors, such as career challenges and financial issues, and the exhausting anxiety that accompanies them sap energy that people would normally devote to intimacy.

Diagnosing Female Sexual Interest and Arousal Disorder

The criteria

Women with this disorder suffer from a very low (or completely missing) interest in sex and other sexual behaviors. They have fewer sexual thoughts or fantasies and daydream about sexual encounters much less than other women. Additionally, they are much less interested in sex with their partners. They don’t begin sexual encounters and don’t react positively to their partners’ advances either.

When they do get into sexual situations, they are much less aroused and feel less sexual satisfaction than usual. They are unlikely to be aroused by sexual subjects, such as pornography – be it movies, images, or stories – or sexually suggestive conversations with others. Even their physical experience of sex is altered and numbed.

There are a couple exceptions to this disorder, however. If a woman has these symptoms but doesn’t find them disturbing or troublesome, she may identify as “asexual.” Additionally, women suffering in abusive and violent relationships may withdraw from sex, but that is not a disorder either. The disorder can be present when a woman first becomes sexually active or appear suddenly later in life. Either way, it lasts for at least six months.

Treating Female Sexual Interest and Arousal Disorder

Therapy options

For people whose sexual problems come from psychological issues, treatments like Cognitive Behavioral Therapy (CBT) and couples therapy offer effective options. CBT, especially mindfulness-based CBT, can help women learn to focus on being in the moment and disarming the distracting thought patterns that can derail sexual encounters. Couples therapy can also help work through any relationship problems that may be affecting the couples’ sex life.

Issues with antidepressants and other medications

One of the first steps in treating this disorder is to make sure antidepressants aren’t the culprit. Between 30% and 50% of people taking SSRIs (selective serotonin reuptake inhibitors) experience side effects that see their sex drives drop, along with less intense and less frequent orgasms. Fortunately, people can switch to one of several antidepressants that do not negatively affect sex, such as Wellbutrin (buproprion), Remeron (mirtazapine), Viibryd (vilazodone), or Trintellix (vortioxetine). Another option is to add Wellbutrin, which can restore sex drive in people who wish to keep taking the medication they are already using. For people who experience sexual side effects from birth control, non-hormonal alternatives include the copper IUD (ParaGuard) and condoms.

Menopause and hormonal treatments

Women who have developed these issues after menopause may benefit from taking testosterone. Scientific studies disagree about how effective testosterone is for most people in these situations, but some, especially those who have hormonal conditions that cause early menopause, may see a benefit. This can be combined with other supplemental female hormones, such as estrogen and progesterone. These other hormones help treat related issues of menopause, such as vaginal dryness and inflammation, reducing the painful intercourse problems that often accompany menopause.

Addyi

Addyi (flibanserin) is a drug recently approved by the FDA that directly treats Female Sexual Interest/Arousal Disorder. Originally developed as an antidepressant, Addyi increases sexual drive in affected women who have not yet gone through menopause.

Managing Female Sexual Interest and Arousal Disorder

Sexual Education

Simply learning about healthy sexual functioning goes a long way in helping a lot of women with this disorder. Many don’t understand how important emotional connections are for creating a base for satisfying physical intimacy. Additionally, many women are surprised to learn that their sexual maturity – that is, discovering what they want and need regarding sexual activity – often doesn’t come until their 20s. Furthermore, media and social trends can put pressure on women to be satisfied from certain types of sex. However, what actually brings them pleasure varies greatly from woman to woman. In fact, only about a quarter of women can orgasm from regular intercourse. The majority need some other kind of activity, such as oral sex or clitoral stimulation.

Women who grew up in a conservative environment may be hesitant to explore their own bodies, which prevents them from discovering the kind of stimulation they want or need. A visit to an understanding OB/GYN can help these women start to understand their anatomy. Similarly, a sex therapist may assign homework that involves masturbation focused on discovering one’s specific sources of pleasure. Discovering one’s individual sexual needs and learning to communicate those needs to a partner are critical for addressing this disorder.

Intimacy without sex

Some couples struggle to separate the emotional sensations of intimacy from the physical act of sex. Women put a lot of value on emotional connections that are separated from sex itself, and a low sex drive can signal a growing emotional divide in the relationship. The men in heterosexual couples might need some gentle coaching about emotional intimacy, and this often occurs as part of couples therapy. Couples who make a point of carving out time to spend together without interruptions find that their sex lives improve. These can be date nights, secluded walks, or just time to talk to one another with their televisions, phones, and computers turned off and put away.

Lifestyle changes

Working towards a healthier lifestyle is one of the most accessible ways potentially to restore a low sex drive. Exhaustion from long work hours or a high pressure job are a potential source of issues. Although it can be difficult for those with high career aspirations, cutting down hours even a little may aid a struggling sex life. If stress and anxiety are issues, getting regular exercise can combat their effects. Cutting down on alcohol and other drug use can also help.

Types of Sexual Dysfunctions

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