What Is Female Sexual Interest and Arousal Disorder?
What Is Female Sexual Interest and Arousal Disorder? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Female sexual interest and arousal disorder (FSIAD), formerly known as sexual arousal disorder in women, is a type of sexual dysfunction or problem in which there is little to no interest in sexual activity and no response to physical or mental stimulation.
Signs and Symptoms of Female Sexual Interest and Arousal Disorder
A reduction or complete lack of arousal response from psychological cues, reading erotica, or remembering a fantasy
A decrease in sexual desire
Limited or no initiation of sexual intimacy in a relationship
A reduction or no sensation in the genitals
Limited or no sexual pleasure during sex
Rarely or never thinking about sex
A person must have at least three of the symptoms mentioned above to be diagnosed with FSIAD. In addition, symptoms must persist for at least six months or more, cause them personal distress, or impact their mental health, notes the Sexual Psychophysiology Lab at the University of Texas at Austin. The symptoms cannot be linked to other medical issues, such as substance use disorder, or another medical condition, such as depression.
Until recently, this type of sexual dysfunction was called female sexual arousal disorder, a condition in which women have trouble getting physically aroused. Today, medical professionals characterize the condition as a merged term for hypoactive sexual desire disorder, a condition where you have no sex drive or low libido, and female sexual arousal disorder after reviewing data that suggests that the distinction between sexual arousal and responsiveness may be difficult to assess. As such, FSIAD is meant to be an umbrella term for all of these symptoms since physical arousal and sexual desire are closely related.
Causes and Risks Factors of Female Sexual Interest and Arousal Disorder (FSIAD)
Although there is a shortage of research on female sexual health, sexual concordance, the relationship between genital response and sexual arousal, has been pointed to as one potential factor in female sexual arousal and interest disorder. A recent study published in The International Journal of Clinical Health and Psychology found that sexual concordance is higher in men than women. Researchers recorded the results of 104 young adults (42 men and 62 women) after exposing them to a film with sexual content. They found that women were more likely to experience sexual nonconcordance, where their minds were unaware of the arousal response occurring in their genitals or vice versa. It’s speculated that a disconnect between both areas could be related to issues with sexual functioning.
The underlying causes of FSAID can vary and differ between individuals due to several factors affecting sexual satisfaction, desire, and arousal. Causes and risk factors of FSIAD include:
Physical issues: Medical conditions such as multiple sclerosis, kidney disease, or diabetes, and medications such as certain antidepressants, blood pressure medications, or antihistamines can reduce the desire for sex and the body’s ability to respond to sexual stimuli, according to Mayo Clinic.
Psychological: Mental health issues such as anxiety and depression can contribute to low or no sexual arousal or interest in sex. In addition, negative thoughts, a history of sexual abuse, or conflicts with a partner may also contribute to this condition.
Hormonal: Low testosterone levels in women have been reported to contribute to low libido and reduced sexual pleasure and responsiveness, according to research. In addition, lower estrogen levels after menopause, giving birth, or breastfeeding may lead to changes in vaginal tissues and decreased blood flow to the pelvic region, notes Mayo Clinic.
How Is Female Sexual Arousal and Interest Disorder Diagnosed?
To diagnose this condition, doctors specializing in sexual dysfunction must rule out any other physical, or psychological reasons to explain the lack of or reduction in sexual arousal or interest. Common problems that can impact sexual health include genitourinary syndrome of menopause (GSM), endometriosis, and STIs such as chlamydia.
Your doctor will ask about your medical history and learn about your attitudes and past experiences with sex. Laboratory tests are generally not used to diagnose this condition. However, in some instances, thyroid dysfunction has been reported to be an underlying cause, so a thyroid-stimulating hormone (TSH) screen could be performed. And Mayo Clinic notes that blood tests may be performed to check for other underlying conditions.
You must report that your symptoms are causing a “significant amount of distress” in your personal life for a period of at least six months. For instance, an asexual person, someone who experiences little to no sexual attraction to others, would not meet the criteria for a diagnosis of FSIAD.
A pelvic exam is performed if penetrative sex is reported to be painful. Imaging studies such as a transvaginal ultrasound may be used in patients with sexual pain to rule out a diagnosis of vaginal diseases such as vaginal prolapse, cysts, fibroids, and cancer, per the American College of Obstetricians and Gynecologists (ACOG) clinical management guidelines for female sexual dysfunction.
Treatment and Medication Options for Female Sexual Interest and Arousal Disorder (FSIAD)
FSIAD is treatable. The recommended treatment for FSIAD depends on your specific symptoms. Sexual dysfunction may be caused by several issues.
Medications That Can Help
Flibanserin (Addyi), a U.S. Food and Drug Administration (FDA)–approved drug for women who have not reached menopause, works by binding with certain receptors in the brain that rely on adequate levels of dopamine, norepinephrine, and serotonin to facilitate sexual desire, according to an article in the Industrial Psychiatry Journal. It is taken orally every day at bedtime. Use of this medication may increase the chances of patients getting hypotension or syncope, so they should be closely monitored by their doctor.
Bremelanotide (Vyleesi) works on the melanocortin receptors (neurotransmitters) to stimulate desire and should only be used by premenopausal women or those who have not reached menopause. The medication is a self-administered injection that is taken 45 minutes before you think you will engage in sexual activity.
Estrogen therapy involves the use of a localized cream or vaginal ring; it increases vaginal blood flow and improves vaginal lubrication. But it’s important to note that hormone therapy has risks, which vary depending on your age and your risk for conditions such as heart disease and cancer, whether estrogen is administered alone or along with progestin, and the dose and type of hormone you’re taking, cautions the Mayo Clinic.
Androgen therapy or testosterone replacement therapy involves using a transdermal spray or patch. This therapy may be considered in postmenopausal women to use for short periods, according to a review of research published in the Journal of Women’s Health, but there is differing research on whether the treatment is effective in premenopausal women. There is some evidence that women who receive testosterone reported improvements in sexual concerns, once other causes have been excluded by a provider. However, this treatment is not FDA approved for women, though some doctors may consider prescribing it for postmenopausal women.
“Testosterone would only be used in women whom there isn’t any other cause for the low sexual desire,” says Stephanie S. Faubion, MD, medical director of the North American Menopause Society (NAMS). “That’s very few women because when you get down to actually talking about it, there’s almost always two to three components to it, like [for example], ‘my vagina is dry and it hurts when I have sex.’ So almost always, there may be a[n] [underlying] medical condition. But if at the end of the day we’ve got nothing else to go on, then that woman would be eligible for a trial of testosterone.”
A consensus statement published by the International Menopause Society (IMS), provided official guidelines for this therapy and warns that testosterone levels must be closely monitored by a clinician for the entire duration of treatment and unregulated formulations or supplements are not safe. High doses of testosterone can result in adverse side effects such as hair loss, acne, oily skin, and hirsutism.
Alternative and Complementary Medicine Treatments
Therapy provided by a sex therapist, counselor, or psychotherapist may be helpful in addition to or in place of medicinal interventions. Methods for treatment may include education on sexual anatomy and function and exercises such as scheduled times for intimacy between partners or masturbation. Methods such as cognitive behavior therapy (CBT) or mindfulness-based cognitive therapy (MBCT) can improve arousal, desire, and orgasm, notes the Merck Manual.
Research and Statistics: Who gets FSIAD?
A systematic review published in the journal Sexual Medicine Reviews found that approximately 40 percent of premenopausal women worldwide reported having sexual problems. This is a significant health problem that may not be preventable. However, limited data from an older survey published in JAMA found low desire among women who had ever been diagnosed with a sexually transmitted disease as well as those with poor physical and emotional health.
Prevention of FSIAD
Maintaining a healthy lifestyle by eating a balanced diet, regular exercise, developing a positive body image, and getting screened for STIs may prevent some instances of FSIAD, although research is ongoing.
Resources We Love
A diagnosis of FSIAD can feel incredibly frustrating and isolating. Fortunately, there are many groups where you can get information and support.
American Association of Sexuality Educators, Counselors and Therapists (AASECT)
This nonprofit group aims to provide education, certification, and lectures for sexuality educators, therapists, and counselors. It provides a national registry listing sex counselors and therapists to contact for treatment.
American Society for Reproductive Medicine
This multidisciplinary group is dedicated to the advancement of reproductive health. You can find information on female sexual dysfunction, patient education videos, and a list of health professionals.
The North American Menopause Society
This nonprofit organization is committed to the advancement of health and quality of life for women in midlife and beyond. They list many resources for sexual health and menopause.
The Pleasure Is All Yours: Reclaim Your Body’s Bliss and Reignite Your Passion for Life
This book by Rachel Allyn, PhD, a licensed clinical psychologist, provides a step-by-step guide for women to connect with their bodies in order to feel sexual pleasure. In addition, Dr. Allyn provides proven techniques for increasing emotional and physical intimacy with a partner.