Sexual Arousal Disorder
Sexual arousal disorder is the persistent or recurring inability to attain or to maintain adequate vaginal lubrication and other physical responses of sexual excitement before or during sexual intercourse.
Usually, when a woman is sexually stimulated, the vagina releases lubricating secretions, the labia and clitoris of the vulva swell, and the breasts enlarge slightly. In sexual arousal disorder, these responses do not occur despite sufficiently long and intense sexual stimulation.
If the disorder has been present since puberty, the woman may not know how the genital organs (particularly the clitoris) function or what arousal techniques are effective. The lack of knowledge leads to anxiety, which worsens the problem. Many women who have sexual arousal disorder associate sex with sinfulness and sexual pleasure with guilt. Fear of intimacy and a negative self-image may also contribute.
If the disorder develops after a period of adequate sexual functioning, it may be due to a problem in the current sexual relationship, such as constant fighting or arguing. Depression is a common cause, and stress may contribute.
Physical causes include inflammation of the vagina (vaginitis), inflammation of the bladder (cystitis), endometriosis, an underactive thyroid gland (hypothyroidism), diabetes mellitus, multiple sclerosis, and muscular dystrophy.
Sexual arousal disorder may develop as women age. As menopause approaches, the lining of the vagina thins and becomes dry because the estrogen level decreases. As a result, the ability to become aroused declines, partly because sexual intercourse may be painful.
Taking drugs such as oral contraceptives, antihypertensives, antidepressants, or sedatives can cause sexual arousal disorder. Surgical removal of the uterus (hysterectomy) or breast (mastectomy) may damage a woman's sexual self-image, contributing to sexual arousal disorder.
Many women with sexual arousal disorder also lack sexual desire. Because the vagina does not become lubricated, sexual intercourse is usually painful or uncomfortable.
Diagnosis and Treatment
The diagnosis is based on the woman's description of the problem. To determine the severity of the disorder and identify the cause, a doctor asks the woman about her sexual and medical history (including use of drugs) and performs a physical examination. Tests to detect physical disorders, if thought to be the cause, may be performed.
If the cause is psychologic, counseling for the woman, usually with her partner, often helps. Individual psychotherapy or group therapy is sometimes useful. Physical disorders, if present, are treated. Postmenopausal women may benefit from treatment with estrogen or male hormones such as testosterone. Estrogen creams and suppositories reduce the thinning and drying of the lining of the vagina and thus may help with lubrication during intercourse. The use of testosterone in treating women with sexual arousal disorder is controversial.
Sensate focus exercises for couples can help relieve a couple's anxiety about intimacy and sexual intercourse. Learning about how the genital organs function can help. A woman can learn which arousal techniques are effective for her and her partner. Performing Kegel exercises can help because they strengthen the muscles involved in sexual intercourse.
 See the sidebar Sex Therapy: Sensate Focus Technique.
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