Female sexual arousal disorder, or FSAD, is a medical condition defined by a persistent inability to attain or maintain sexual excitement, which results in personal distress. This condition involves both the mental and physical aspects of arousal, meaning a woman might struggle to become aroused even when she desires to be sexually active. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now combines it with what was once known as hypoactive sexual desire disorder, referring to the condition as female sexual interest/arousal disorder (FSIAD).
Identifying the Symptoms
The signs of female sexual arousal disorder can be categorized into physical and subjective experiences. Physical symptoms often include a lack of vaginal lubrication or an absence of genital swelling and sensation, even with direct stimulation. This can lead to discomfort or pain during sexual activity. For some, there is a mental feeling of being “turned on,” but the body’s physical response is absent, a subtype known as genital arousal disorder.
Subjective symptoms involve a mental and emotional disconnect from the sexual experience. A person may feel mentally absent or unengaged despite physical touch that would typically be arousing. This is the reverse of genital arousal disorder, where a physical response occurs without the corresponding mental feeling of excitement, and is termed subjective arousal disorder. When both physical and mental arousal are lacking, it is referred to as combined arousal disorder.
With FSAD, a woman may still have the desire for sexual intimacy, but her body or mind fails to respond with arousal. This distinction helps clarify that the issue lies in the arousal response itself, not necessarily in the initial interest in sex.
Exploring the Underlying Causes
Physical factors play a significant role in the ability to become aroused. Hormonal changes, particularly those occurring during menopause, pregnancy, or postpartum, can directly impact sexual response. Chronic health conditions such as diabetes, heart disease, and multiple sclerosis may affect nerve function or blood flow to the genital area, diminishing sensation and physical arousal. Certain medications, including some antidepressants (especially SSRIs), blood pressure drugs, and hormonal contraceptives, are known to have side effects that can reduce sexual arousal.
Psychological elements are frequently intertwined with arousal difficulties. Conditions like anxiety, depression, and chronic stress can significantly interfere with a person’s ability to feel sexually responsive. A history of sexual trauma, negative body image, or dysfunctional beliefs about sex can also create powerful mental barriers to arousal. The emotional state during a sexual encounter is a large determinant of the arousal response.
The quality of a relationship and communication with a partner are also influential. Unresolved conflicts, a lack of emotional intimacy, or poor communication about sexual needs and preferences can all contribute to difficulties with arousal. When a partner also experiences sexual dysfunction, it can further impact the dynamic. An unrewarding or unsatisfying sexual experience can create a cycle that lessens interest and arousal over time.
The Path to Diagnosis
Receiving a formal diagnosis for female sexual arousal disorder begins with a conversation with a healthcare provider, such as a gynecologist or primary care physician. This step is centered on a thorough discussion of the patient’s medical, surgical, and sexual history. The provider will ask questions about the specific nature of the arousal difficulties, when they began, and the situations in which they occur.
A physical examination, including a pelvic exam, is a standard part of the diagnostic process. This helps the clinician rule out any underlying physical issues, such as vaginal atrophy or other anatomical changes that could be contributing to the symptoms. In some cases, blood tests may be ordered to check hormone levels, such as estrogen and testosterone, which can influence sexual response.
To be formally diagnosed with FSIAD according to the DSM-5, a person must experience at least three specific symptoms for a minimum of six months, causing them significant distress. These symptoms include:
- Reduced interest in sex
- Fewer sexual thoughts
- Decreased initiation of sex
- Diminished pleasure or physical sensations during sexual activity
Because psychological factors are often involved, a referral to a mental health professional or a sex therapist may be recommended to fully evaluate the emotional and relational components of the issue.
Approaches to Management and Treatment
Medical interventions may be recommended when a physical cause is identified. For postmenopausal women, hormone therapy, such as topical estrogen or prasterone, can help with vaginal dryness and discomfort that may interfere with arousal. In some cases, transdermal testosterone therapy may be considered for postmenopausal women to improve sexual function. If a medication is suspected to be the cause, a doctor may adjust the prescription or suggest an alternative, such as adding bupropion for SSRI-induced sexual dysfunction.
Therapeutic approaches are effective for addressing the psychological and relational factors contributing to FSAD. Sex therapy, either for an individual or a couple, can provide education about sexual function and help improve communication. Cognitive-behavioral therapy (CBT) can help individuals identify and change negative thought patterns and behaviors related to sex, while mindfulness-based techniques have also shown benefits in improving sexual response.
Lifestyle adjustments and personal strategies can also play a part in managing symptoms. Using high-quality, water-based lubricants can alleviate dryness and make sexual activity more comfortable. Openly communicating with a partner about likes and dislikes, exploring different types of stimulation, and practicing stress-reduction techniques can improve mood and create a more positive sexual environment. Additionally, regular exercise can boost energy and mood, which may positively impact sexual arousal.