Female Sexual Arousal Disorder

The DSM-IV-TR defines female sexual arousal disorder as the inability to attain or maintain a genital lubrication-swelling response during sexual activity. The American Foundation for Urologic Disease recommended division of this diagnosis into subjective, genital, and combined subtypes. It also urged recognition of "persistent" sexual arousal disorder characterized by "spontaneous, intrusive, and unwanted genital arousal . . . unrelieved by one or more orgasms" (Basson et al., 2003).

With the exception of persistent sexual arousal disorder, evaluation should include assessment for hypoactive sexual desire disorder. Neurologic and vascular causes should be considered when adequate genital vasocongestion and swelling do not occur but subjective arousal and lubrication are intact.

Treatment is based on the suspected cause of the sexual arousal disorder. Supplemental water-soluble lubrication may be needed. Off-label use of PDE-5 inhibitors (e.g., sildenafil) may be helpful in restoring the vascular response (Kaplan et al., 1999). The FDA-approved Eros Clitoral Therapy Device uses a silicon cup to apply a vacuum to increase blood flow to the clitoris and surrounding tissue. The device appears effective in women without detectable disease and after radiation treatment for cervical cancer (Munarriz et al., 2003, Schroder et al., 2005), although sample sizes have been small. Herbal supplements and botanical genital massage oil showed some effect in small studies (Ito et al., 2001, Ferguson et al., 2003). Partner issues and situational factors may need to be addressed.

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