table of contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Sometimes, it’s hard to get aroused. Between stressors at work, family obligations, and a seemingly endless to-do list, getting in the mood can be hard to do. And while it’s true that once schedules, stressors, or relationships improve, feelings of attraction and arousal often return, that’s not always the case.
About 40% of women have sexual concerns, and low desire is a common complaint. For many women, sexual interest and arousal may not be an urge that rises and falls. It may never have existed, or it has decreased and not returned (Clayton, 2019).
If this sounds familiar, you may be experiencing female sexual interest/arousal disorder. Here’s a look at what it is and how medical providers diagnose and treat it.
What is female sexual arousal disorder?
For years, female sexual arousal disorder (FSAD) was used to describe a woman’s inability to become aroused in response to sexual excitement, potentially leading to a lack of vaginal lubrication and painful or less enjoyable sex (FDA, 2014).
In 2013, because there is a lot of overlap between desire and arousal, the diagnosis expanded to include a lack of desire for sex (formerly hypoactive sexual desire disorder) and was named “female sexual interest/arousal disorder (FSIAD).”
FSIAD is part of a group of conditions known as female sexual dysfunction (FSD). Aside from FSIAD, pain during intercourse and delayed or absent orgasms (anorgasmia) also fall into this grouping (Wheeler, 2020).
FSD affects more than 40% of premenopausal women globally—with more than 20% reporting vaginal lubrication issues and 28% saying they lack sexual desire (McCool, 2016).
It’s worth noting that healthcare providers will only diagnose someone with FSD or FSIAD if the symptoms are causing them personal distress and impacting their mental health. In other words, if you’re not bothered by a lack of desire or arousal, it shouldn’t be deemed a disorder, and there’s no need for treatment (FDA, 2014).
FSAID symptoms and diagnosis
To receive an FSIAD diagnosis, at least three of the following symptoms have to be present (FDA, 2014):
- Reduced or no interest in sexual activity
- Reduced or no sexual thoughts
- Reduced or no initiation of sexual activity (and typically unreceptive to a partner’s attempts)
- Reduced or no sexual excitement/pleasure during sex (75%+ of the time)
- Reduced or no sexual interest in erotic cues (written, verbal, or visual)
- Reduced or no genital (or other) sensations during sex (75%+ of the time)
A diagnosis also requires that symptoms cause significant distress, last six months or longer, and cannot be explained by other issues like substance abuse, medications, or a separate medical condition.
The reason healthcare providers want to know if sexual issues are causing personal distress is that, for years, the term sexual dysfunction was used too broadly, leading to overtreatment. The bottom line is that there is a wide variation in how women experience sex, and healthcare providers should base your treatment on what you need or want and not what others expect (FDA, 2014).
Causes of low desire and arousal
The exact cause of FSIAD is not well understood, but a range of medical, psychological, and lifestyle factors have been linked to problems with sexual interest and desire (Faubion, 2015).
Medical conditions and medications
Certain medical conditions and medications can cause side effects that lead to reduced desire or arousal, including:
- Hormonal conditions (menopause, pregnancy, post-partum)
- Decreased vaginal lubrication
- Gynecological conditions
- Bladder or vaginal infection
- Heart disease or hypertension
- Antidepressants (especially selective serotonin reuptake inhibitors (SSRIs)
- Anti-seizure medications
- Antipsychotic medications
- Birth control pills (hormone changes may affect desire)
Aside from physical or pharmaceutical causes of FSIAD, situational and psychological factors or social conditions may be the cause, including:
- Relationship problems
- Cultural messages about sex
- Low self-esteem
- Poor body image
- Life stage stressors (retirement/children leaving)
- Sexual abuse
As you can see, many things can impact desire and arousal. And experiencing lower desire and arousal is often normal. For instance, lower estrogen levels at menopause lead to a decrease in vaginal lubrication. This is a natural part of aging and is not a disorder, but it can factor into a broader issue that you may be looking to solve.
This is why it’s important to sort out what’s bothering you and see if it’s just a normal variation in sexual response (Faubion, 2015).
Treating female sexual interest/arousal disorder
Treating FSIAD focuses on the underlying cause. To start, it’s important to rule out medical conditions. Checking your medications is another key step to take. If your healthcare provider changes your medications or identifies and treats other health conditions, your problems with desire and arousal may go away.
Sometimes, a combination of treatments works best. Many women prefer to start with topical treatments and sexual stimulation devices, such as vibrators. Medications and various types of psychotherapy, sex therapy, or counseling may also be key in tackling problems with sexual desire and arousal (Faubion, 2015).
Here’s a look at some common treatment options for FSIAD:
Over-the-counter lubricants aren’t going to affect desire, but they typically make vaginal sex more enjoyable, especially if arousal is an issue. This can be a start for women experiencing vaginal dryness and a lack of natural arousal.
The EROS is a small hand-held stimulation device that may increase vaginal lubrication and sensation by using suction to increase blood flow in the clitoral and labial area (Wilson, 2001).
There are so many emotions linked to desire and arousal that good medication options are limited. Your healthcare provider may prescribe the following medications in certain cases:
- Low-dose testosterone has shown some effectiveness in improving desire and orgasms. However, it’s not FDA-approved for treating low sexual desire in women due to a lack of long-term safety data (Vegunta, 2020).
- Vaginal hormone therapy treatments: Topical estrogen, estradiol, and dehydroepiandrosterone (DHEA) treatments (prasterone) don’t improve desire but can reduce vaginal skin dryness, restore skin thickness, and increase natural lubrication. (Kroll, 2018; Vegunta, 2020).
- Sildenafil (Viagra; see Important Safety Information) is typically used to treat erectile dysfunction in men. Though clinicians prescribe it off-label for some women with FSIAD, studies have not shown it to be very effective, though it may help in some cases (Brown, 2009).
- Flibanserin (Addyi), an oral pill, and bremelanotide (Vyleesi), an injection, are FDA-approved medications to treat FSIAD and are sometimes dubbed “female Viagra” (FDA, 2019-a; FDA, 2019-b).
- Bupropion (Wellbutrin; see Important Safety Information) (non-hormonal) is an antidepressant that can be used instead of selective serotonin reuptake inhibitors (SSRIs), which can have negative effects on sexual function (Montejo, 2019).
Changing the way you think about sex
Because the brain is key to desire and arousal, a lot of research focuses on cognitive ways to approach FSIAD, often alone or in combination with medications. Some of these approaches include:
- Cognitive behavioral therapy (CBT): There are various types of psychotherapy and counseling approaches that can improve sexual issues. CBT approaches have gained popularity in helping to treat FSIAD (Meyers, 2020).
- Cognitive restructuring of what to expect from sex: There are different ways to view sex; taking the pressure off of having an orgasm can, in some cases, make it easier to enjoy sex and reach orgasm (Metz, 2017).
- Letting go of distracting thoughts: Identifying potential distracting thoughts and letting them go during sexual activity—a practice usually linked to meditation—may help boost arousal. Studies show that women who meditate weekly report higher levels of arousal and lubrication during sex, suggesting the ability to focus may boost your sex life (Dascalu, 2018).
- Mindfulness-based approaches: Mindfulness is a popular way of calming the mind by focusing on the present. If the focus is on body awareness and sex, it can improve desire, arousal, and orgasm. Research shows that mindfulness-based approaches, which boost awareness of the body and sensations in a non-judgmental way, may help with FSIAD (Velten, 2019)
This may involve self-care, taking time for yourself, reducing stress, and other ways of boosting your health.
When to see a healthcare provider
If an issue with sexual interest, arousal, or any other problem is bothering you, consider reaching out to a healthcare provider. Once they rule out underlying medical issues and you discuss your options, your healthcare provider may refer you to a sex therapist or another type of specialized therapist.
Often, medical, mental, and social concerns overlap when it comes to FSIAD. Working with more than one professional may help you increase your levels of desire and arousal so you can have a more fulfilling sex life.
- Brown, D. A., Kyle, J. A., & Ferrill, M. J. (2009). Assessing the clinical efficacy of sildenafil for the treatment of female sexual dysfunction. Annals of Pharmacotherapy, 43(7-8), 1275–1285. doi: 10.1345/aph.1l691. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19509350/
- Clayton, A. H. & Valladares Juarez, E. M. (2019). Female sexual dysfunction. Medical Clinics of North America, 103(4), 681–698. doi: 10.1016/j.mcna.2019.02.008. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31078200/
- Dascalu, I. & Brotto, L. (2018). Sexual Functioning in Experienced Meditators. Journal of Sex & Marital Therapy, 44(5), 459-467. doi: 10.1080/0092623X.2017.1405311. Retrieved from https://med-fom-brotto.sites.olt.ubc.ca/files/2019/03/Iulia-Dascalu-Lori-A.-Brotto-2018-Sexual-Functioning.pdf
- Faubion, S. S. & Rullo, J. E. (2015). Sexual dysfunction in women: A practical approach. American Family Physician, 92(4), 281–288. Retrieved from https://www.aafp.org/afp/2015/0815/p281.html
- Kroll, R., Archer, D. F., Lin, Y., Sniukiene, V., & Liu, J. H. (2018). A randomized, multicenter, double-blind study to evaluate the safety and efficacy of estradiol vaginal cream 0.003% in postmenopausal women with Dyspareunia as the most bothersome symptom. Menopause, 25(2), 133–138. doi: 10.1097/gme.0000000000000985. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28926514/
- McCool, M. E., Zuelke, A., Theurich, M. A., Knuettel, H., Ricci, C., & Apfelbacher, C. (2016). Prevalence of female sexual dysfunction among premenopausal women: A systematic review and meta-analysis of observational studies. Sexual Medicine Reviews, 4(3), 197–212. doi: 10.1016/j.sxmr.2016.03.002. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S2050052116000810?via%3Dihub
- Metz, M. E., Epstein, N. B., & McCarthy, B. (2017). Cognitive-behavioral therapy for sexual dysfunction. doi: 10.4324/9780203863459. Retrieved from https://www.researchgate.net/publication/326544841_Cognitive-Behavioral_Therapy_for_Sexual_Dysfunction
- Meyers, M., Margraf, J., & Velten, J. (2020). Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments. JMIR Research Protocols, 9(9), e20326. doi: 10.2196/20326. Retrieved from https://www.researchprotocols.org/2020/9/e20326/
- Montejo, A. L., Prieto, N., de Alarcón, R., Casado-Espada, N., de la Iglesia, J., & Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10), 1640. doi: 10.3390/jcm8101640. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832699/
- U.S. Food and Drug Administration (FDA). (2014). Current regulatory framework: Female sexual interest. Retrieved Jan. 22, 2022 from https://www.fda.gov/media/130001/download
- U.S. Food and Drug Administration (FDA). (2019-a). FDA approves new treatment for hypoactive sexual desire disorder in premenopausal women. Retrieved Jan. 22, 2022 from https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-hypoactive-sexual-desire-disorder-premenopausal-women
- U.S. Food and Drug Administration (FDA). (2019-b). FDA orders important safety labeling changes for addyi. U.S. Food and Drug Administration. Retrieved Jan. 23, 2022 from https://www.fda.gov/news-events/press-announcements/fda-orders-important-safety-labeling-changes-addyi
- Vegunta, S., Kling, J. M., & Kapoor, E. (2020). Androgen therapy in women. Journal of Women’s Health, 29(1), 57–64. doi: 10.1089/jwh.2018.7494. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31687883/
- Velten, J., Brotto, L. A., Chivers, M. L., Hirschfeld, G., & Margraf, J. (2019). The power of the present: Effects of three mindfulness tasks on women’s sexual response. Clinical Psychological Science, 8(1), 125–138. doi: 10.1177/2167702619861394. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2167702619861394
- Wheeler, L. J. & Guntupalli, S. R. (2020). Female sexual dysfunction. Obstetrics & Gynecology, 136(1), 174–186. doi: 10.1097/aog.0000000000003941. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32541291/
- Wilson, S. K., Delk, J. R., 2nd, & Billups, K. L. (2001). Treating symptoms of female sexual arousal disorder with the Eros-Clitoral Therapy Device. The Journal of Gender-Specific Medicine, 4(2), 54–58. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11480099/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.