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Female Sexual Arousal Disorder - (FSAD)
Female Sexual Arousal Disorder - (FSAD)
Definition
Female sexual arousal disorder (FSAD) occurs when a woman is continually unable to attain or maintain arousal and lubrication during intercourse, is unable to reach orgasm, or has no desire for sexual intercourse.
Description
The disorder typically affects up to 25 percent of all American women, or an estimated 47 million women. Three-fourths of women with FSAD are postmenopausal. Women describe it as being "unable to get turned on," or being continually disinterested in sex. It is also called "frigidity." Other terms for the disorder include dyspareunia and vaginismus, both of which involve pain during intercourse.
Female Sexual Arousal Disorder
Female sexual arousal disorder is the condition of decreased, insufficient, or absent lubrication in females during sex. It is sometimes used in reference to, and sometimes differentiated from, hypoactive sexual desire disorder, which is the condition of decreased interest in sexual intercourse, 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.
Subtypes
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.
Diagnostic Features
The DSM-IV (American Psychiatric Association 1994) diagnostic criteria for female sexual arousal disorders are outlined here:
A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Etiology
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 disease's 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).
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.
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