| Female Sexual Arousal Disorder | |
|---|---|
| Classification and external resources | |
| ICD-10 | F52.2 |
| ICD-9 | 302.72 |
Female sexual arousal disorder (FSAD), commonly referred to as frigidity, is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.
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.
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There are several subtypes of female sexual arousal disorders. They may indicate onset: lifelong (since birth) or acquired. They may be based on context: they may occur in all situations (generalized) or be situation-specific (situational). For example, the disorder may occur with a spouse but not with a different partner.
The length of time the disorder has existed and the extent to which it is partner- or situation-specific, as opposed to occurring in all situations, may be the result of different causative factors and may influence the treatment for the disorder. It may be due to psychological factors or due to a combination of factors.
The DSM-IV (American Psychiatric Association 1994) diagnostic criteria for female sexual arousal disorders are:
Marita P. McCabe has noted that
A number of studies have explored the factors that contribute to female sexual arousal disorder and female orgasmic disorder. These factors include both psychological and physical factors. Psychologically, possible causes of the disorder include the impact of childhood and adolescence experiences and current events - both within the individual and within the current relationship.
Most studies that have assessed the impact of childhood experiences on female sexual dysfunction are considered potentially methodologically flawed. The studies 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. However, there have been some probative links between childhood sexual abuse and having a later sexual dysfunction.
There has been little investigation of the impact of individual factors on female sexual dysfunction. Such factors include stress, levels of fatigue, gender identity, health, and other individual attributes and experiences that may affect sexual desire or response. Over exposure to pornography-style media is also thought to lead to poor body image, self-consciousness and lowered self-esteem. An individual's sexual activity is disrupted by overwhelming emotional distress resulting in inability to attain sexual pleasure.
A substantial body of research has explored the role of interpersonal factors in female sexual dysfunction, 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, while 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.
In addition to past experience and personal psychology, social context plays a factor:
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).
Kenneth Maravilla, Professor of Radiology and Neurological Surgery and Director of MRI Research Laboratory at the University of Washington, Seattle, presented research findings based on neuroimaging of women's sexual function. In a small pilot study of four women with female sexual arousal disorder, Maravilla reported there was less brain activation seen in this group, including very little activation in the amygdala. These women also showed increased activation in the temporal areas, in contrast to women without sexual difficulties, who showed deactivation in similar areas. This may suggest an increased level of inhibition with an arousal stimulus in this small group of women with FSAD.
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. It is also quite important to differentiate it from hypoactive sexual desire disorder.
An existing drug, bremelanotide, has also been found to increase libido in 90% of subjects, and was being developed with the intention of selling as a treatment for sexual arousal disorder. Bremelanotide (formerly PT-141) was in clinical tests until 2007, but was pulled from further testing due to adverse effects to the cardiovascular system.
Apricus Biosciences is currently developing the product Femprox, a topical cream for the treatment of female sexual arousal disorder. It contains Prostaglandin E1 as the active ingredient and a permeation enhancer DDAIP which facilitates the delivery of the drug into the blood stream.[4]
One of the largest criticisms for female sexual arousal disorder is whether it is an actual disorder or an idea put forth by pharmaceutical companies in order to step into a potentially billion dollar industry.
The only mention of female sexual arousal disorder in a peer-reviewed medical journal indicated that 43% of women suffer from FSD, however the survey turned out to not be a rigorous study.
Of the handful of questions, if any respondent answered yes at any time, they were classified as having FSD. Here are the questions asked that respondents could only choose a response of Yes or No[5] :
Lacked interest in having sex Were unable to come to climax Came to climax too quickly Experienced physical pain during intercourse Did not find sex pleasurable even if sex was not painful Felt anxious just before having sex Had trouble lubricating
Furthermore, the author Edward O. Laumann turned out to have financial ties to Pfizer, creator of Viagra.[6]
Another criticism, for example, "the meaningful benefits of experimental drugs for women's sexual difficulties are questionable, and the financial conflicts of interest of experts who endorse the notion of a highly prevalent medical condition are extensive" [7]
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