Female sexual arousal disorder
Synonyms and keywords: Female sexual interest/arousal disorder

# Overview
Female sexual arousal disorder is the condition of decreased, insufficient, or absent lubrication in females during sexual activity, and sexual contact in females.
Loss of interest in sex occurs most commonly in women as they age and approach menopause.
Although female sexual dysfunction is currently a contested diagnostic, pharmaceutical companies are beginning to promote products to treat FSD, often involving low doses of testosterone.

# Classification
Subtypes are provided to indicate onset (Lifelong versus Acquired), context (Generalized versus Situational), and etiological factors (Due to Psychological Factors, Due to Combined Factors) for Female Sexual Arousal Disorder.

# Causes
A number of studies have explored the factors that contribute to female sexual arousal disorder and female orgasmic disorder. The data relating to both the psychological and the physical domain will be evaluated below. In the psychological domain, the impact of past (childhood, adolescence) and current events - both within the individual and within the current relationship - will be considered.

## Impact of Events During Childhood and Adolescence
Most studies that have assessed the impact of childhood experiences on female sexual dysfunction are methodologically flawed. They rely on retrospective recall, which is particularly problematic when emotional responses to the event as well as the actual occurrence of the event are being reported.

## Individual Factors
There has been little investigation of the impact of individual factors on sexual dysfunction in women. Such factors include stress, levels of fatigue, gender identity, health, and other individual attributes and experiences that may alter sexual desire or response.

## Relationship Factors
A substantial body of research has explored the role of interpersonal factors in sexual dysfunction among women, particularly in relation to orgasmic response. These studies have largely focused on the impact of the quality of the relationship on the sexual functioning of the partners. Some studies have evaluated the role of specific relationship variables, whereas others have examined overall relationship satisfaction. Some studies have explored events; others have focused on attitudes as an empirical measure of relationship functioning. Subject populations have varied from distressed couples to sexually dysfunctional clients to those in satisfied relationships.

## Physical Factors
Estimates of the percentage of female sexual dysfunction attributable to physical factors have ranged from 30% to 80%. The disorders most likely to result in sexual dysfunction are those that lead to problems in circulatory or neurological function. These factors have been more extensively explored in men than in women. Physical etiologies such as neurological and cardiovascular illnesses have been directly implicated in both premature and retarded ejaculation as well as in erectile disorder (Hawton 1993), but the contribution of physiological factors to female sexual dysfunction is not so clear. However, recent literature does suggest that there may be an impairment in the arousal phase among diabetic women. Given that diabetic women show a significant variability in their response to this medical disorder, it is not surprising that the diseases influence on arousal is also highly variable. In fact, the lack of a clear association between medical disorders and sexual functioning suggests that psychological factors play a significant part in the impact of these disorders on sexual functioning (Melman et al. 1988).

# Differential Diagnosis
- Other medical condition
- Diabetes mellitus
- Endothelial disease
- Thyroid dysfunction
- Central nervous system disease
- Interpersonal factors
- Severe relationship distress
- Intimate partner violence
- Stressors
- Inadequate or absent sexual stimuli
- Nonsexual mental disorders
- Other sexual dysfunctions
- chronic genital pain
- Lack of interest and arousal during sexual activity
- Substance/medication use

# Epidemiology and Demographics

## Prevalence
The prevalence of female sexual interest/arousal disorder is unknown.

# Risk Factors
- Childhood stressors
- Diabetes mellitus
- Genetic predispoition
- Negative cognitions and attitudes about sexuality
- Past history of mental disorders
- Propensity for sexual excitation and sexual inhibition
- Relationship difficulties
- Relationships with caregivers
- Sexual functioning of partner
- Thyroid dysfunction

# Diagnostic Criteria

## DSM-V Diagnostic Criteria for Female Sexual Interest/Arousal Disorder 

# Treatment
Although the way in which female sexual arousal disorder and female orgasmic disorder are expressed shows a wide degree of variation, there is no evidence to suggest either that different factors contribute to the two disorders or that different treatment strategies should be used. In fact, the same treatment strategies are generally applied for both disorders. These strategies may need to be supplemented with additional techniques to resolve specific problems for individual women, but they are generally good starting points for resolving the issues that contribute to the development and maintenance of the sexual problem. Because the relationship between the woman and her partner has been shown to play a significant role in both the development and the maintenance of sexual problems, most programs are designed to be implemented by the couple, although there may also be additional strategies that focus on the individual.
An existing tanning drug, bremelanotide, has also been found to increase libido in 90% of subjects, and therefore is being developed with the intention of selling as a treatment for sexual arousal disorder.

# Source
- Female Sexual Arousal Disorder and Female Orgasmic Disorder