What is Female Sexual Interest/Arousal Disorder?
Female sexual interest/arousal disorder (FSIAD) is characterized by a lack of interest in sexual activities and the absence of physical arousal during sexual stimulation. The condition differs from simple, typical low sex drive in that the symptoms of FSIAD cause distress in the person experiencing it.
Until 2013, hypoactive sexual desire disorder was described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as gender-nonspecific, meaning it could be diagnosed in women or men. However, the latest edition of the DSM has been changed to include female sexual interest/arousal disorder (FSIAD) as a female-only diagnosis and a separate disorder, male hypoactive sexual desire disorder (MHSDD), to describe similar symptoms in men.
Symptoms of FSIAD
Common signs of FSIAD include:
- Little or no desire for sexual activity
- Absence of sexual thoughts or fantasies
- Failure to initiate sexual activity or respond to initiation from a partner
- Lack of physical arousal or pleasure during sex
- Failure to orgasm
- Distress or relationship problems caused by lack of interest in sex
Types of FSIAD
FSIAD is categorized into subtypes depending on the way that symptoms manifest. The subtypes include:
- Subjective. In this type, the woman may experience physical signs of arousal but does not feel sexual desire during any kind of stimulation.
- Genital. In this type, the woman may be aroused non-genital forms of stimulation but is not physically aroused by direct genital stimulation.
- Combined. In this type, the woman feels no arousal from subjective, non-physical stimulation and also has a lack of physical arousal from genital stimulation.
What Causes Female Sexual Interest/Arousal Disorder?
The cause of FSIAD is unknown, but different factors likely trigger it in different cases. Scientists believe that physical, medical, and psychological factors may all play a role in producing the disorder’s decreased sex drive. Possible risk factors include:
- Low levels of the hormones, estrogen, or testosterone
- High levels of the hormone prolactin
- Reaction to SSRI antidepressant medications, blood pressure medicines, or other medications
- Neurological disorders such as multiple sclerosis
- Mental health-related issues such as depression or anxiety
- Heart disease
- Bladder infections
- Infections or conditions that cause pain during sex
- Alcohol use
- History of abuse, sexual assault, or other trauma
- Relationship difficulties
- Low self-esteem or body-image issues
Is Female Sexual Interest/Arousal Disorder Hereditary?
Scientists have not yet discovered any definitive evidence that genes determine the strength of a person’s sex drive. However, some scientists believe that specific genes influence behaviors such as risk-taking and attention and that these genes may also play a role in determining a person’s sexual behavior. However, this research is preliminary, and any genetic component of FSIAD that may be discovered is likely only one of many factors that work together to produce the disorder.
How Is Female Sexual Interest/Arousal Disorder Detected?
Changes in a woman’s sexual desire or behavior may be warning signs of FSIAD. Possible early symptoms of the disorder include:
- Decrease in sex drive from previous levels
- Failure to be aroused by sexual stimulation, including non-physical stimulation
- Lack of spontaneous desire or the desire to initiate sex
- Loss of interest in masturbation
How Is Female Sexual Interest/Arousal Disorder Diagnosed?
Diagnosis of FSIAD begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that FSIAD is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.
Diagnostic steps may include:
- A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.
After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for FSIAD. These criteria include:
- The patient has little or no desire for sexual activity, sexual thoughts, or sexual fantasies.
- The symptoms have been present 75%-100% of the time for at least six months.
- The symptoms cause significant distress or interpersonal difficulties.
- Symptoms aren’t caused by substance use or a medical condition.
- The symptoms are not better explained by any other mental condition.
It is important to note that low sex drive alone is insufficient to diagnose FSIAD. Doctors will consider the diagnosis only if the symptoms cause distress.
Low sex drive can also result from unsatisfactory sexual experiences or lack of adequate stimulation from a partner. A diagnosis of FSIAD can’t be made if the symptoms result from distress in a relationship.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Female Sexual Interest/Arousal Disorder Treated?
It is important to note that low sex drive is not a clinical condition requiring treatment. FSIAD can only be diagnosed if it causes distress for the woman experiencing it. A lack of interest in sex that doesn’t cause distress is not a disorder.
Treatment of FSIAD varies depending on the underlying condition that seems to be causing it. Potential treatment options include:
- Hormone replacement therapy
- Medications that can improve problems with physical arousal
- Changes in dosage of antidepressants or other medications that may be causing FSIAD symptoms
- Lifestyle changes (exercise, diet, etc.)
- Cognitive-behavioral therapy (CBT)
- Relationship skills and communication training
- Mindfulness techniques
How Does Female Sexual Interest/Arousal Disorder Progress?
When FSIAD causes distress and goes untreated, it can result in long-term complications, including:
- Depression or other mental health-related issues
- Loss of healthy interpersonal relationships
- Low self-esteem
How Is Female Sexual Interest/Arousal Disorder Prevented?
There is no known way to prevent FSIAD. However, prompt treatment may relieve the effects of the disorder and make it less likely that the sufferer will experience severe complications over time.
Female Sexual Interest/Arousal Disorder Caregiver Tips
Some people with FSIAD also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with FSIAD:
- Many people with FSIAD also suffer from depression.
- Some people with FSIAD have a co-existing anxiety disorder.
- Women with psychotic disorders such as schizophrenia are at increased risk of FSIAD.
Female Sexual Interest/Arousal Disorder Brain Science
Scientists don’t yet fully understand what types of brain activity control sexual desire and arousal. But, in general, researchers believe that low sex drive results from lower than usual activity in brain areas that produce excitement, higher than normal activity in the regions that produce inhibition, or a combination of the two.
The chemical mechanisms behind this activity are quite complex. Certain chemicals (neurotransmitters and hormones) trigger the production of other brain chemicals that, in turn, influence behavior. These secondary chemicals include those that cause excitement or arousal (dopamine, oxytocin, norepinephrine, etc.) and those that inhibit excitement (serotonin, opioids, etc.). When the chemical balance leans toward the inhibitory chemicals and away from the excitatory chemicals, a low sex drive may result.
Female Sexual Interest/Arousal Disorder Research
Title: Bremelanotide in Premenopausal Women With Female Sexual Arousal Disorder and/or Hypoactive Sexual Desire Disorder
Study Director: Jeffrey Edelson, MD, FRCPC
Palatin Technologies, Inc.
This trial is designed to evaluate the efficacy and safety of 3 fixed-dose levels of bremelanotide, administered subcutaneously on an as-needed basis under conditions of home use, for the treatment of female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), or mixed FSAD/HSDD in premenopausal women.
Title: Ginkgo Biloba: Antidepressant-Induced Sexual Dysfunction
Principal investigator: Cindy Meston, PhD
University of Texas
Virtually all antidepressant medications are associated with a high incidence of adverse sexual side effects. In women, the side effects most commonly reported include decreased sexual arousal with decreased lubrication, delayed or inhibited orgasm, and decreased sexual desire. To date, there are no effective pharmacological antidotes for treating these sexual side effects. Ginkgo biloba extract (GBE), a naturally occurring substance from the ancient Chinese Ginkgo tree, has properties proven to increase peripheral blood flow and facilitate the relaxation of smooth muscle tissue. Its effectiveness in this regard has been demonstrated in numerous clinical trials that show ginkgo Biloba to be highly efficient in treating peripheral vascular disorders. Female sexual arousal involves a complex interplay of these same actions – the relaxation of smooth muscle tissue and the inflow of blood to the genital region. Hence, pharmacologically, it is feasible that GBE may effectively enhance female sexual arousal.
Moreover, given that the mechanisms hypothesized to facilitate female sexual function are operative at a peripheral rather than a central (i.e., neurotransmitter) level, it is unlikely that GBE would adversely impact the mood-alleviating therapeutic effects of antidepressant medications that are believed to be centrally mediated. Limited, uncontrolled studies lend support to this hypothesis. The purpose of the present study is to provide the first empirical examination of the effects of both acute and chronic GBE on subjective and physiological measures of sexual function in women who are experiencing clinically diagnosable hypoactive sexual desire disorder, female sexual arousal disorder, and/or inhibited female orgasm secondary to either to fluoxetine, sertraline, or paroxetine use. Women (N = 110) stabilized on antidepressant medication and free of a current Axis I disorder will be randomized to 8 weeks of daily treatment with either GBE (200 mg) or placebo. Sexual functioning will be assessed through (a) daily patient diary recordings, (b) patient-rating scales completed each week, and (c) blind independent evaluator ratings. The acute effects of GBE will also be assessed using vaginal photoplethysmograph techniques to assess genital blood flow, both before and following chronic GBE treatment. The findings from the present study will (a) help determine whether chronic and/or acute GBE facilitates sexual function in women with antidepressant-induced sexual dysfunction and (b) examine whether acute GBE influences vaginal measures of sexual arousal. If effective, GBE could play a significant adjunctive role in treating clinical depression and other psychological disorders commonly treated with antidepressant medications.
Title: Phase 1b/2a Unblinded Study of Responses in Premenopausal Women With HSDD to Lorexys Evaluating Efficacy and Safety (PURPLE)
Principal investigator: Robert T. Segraves, MD, PhD
Levine, Risen & Associates, Inc.
Women are diagnosed with Hypoactive sexual desire disorder (HSDD) if they experience chronic loss of desire for sex together with significant distress or interpersonal difficulties due to this lack of desire. HSDD can have a serious effect on emotional well-being and interpersonal relationships.
There are no US Food and Drug Administration-approved treatments for HSDD. Off-label treatments include testosterone, which is not always effective and can be accompanied by side effects such as excess hair growth, acne, and decreases in high-density lipoprotein (HDL) cholesterol levels.
Research in laboratory animals and clinical observations in humans suggest that re-balancing chemical messengers in the brain may stimulate sexual desire. S1 Biopharma’s Lorexys® is a novel use, fixed-dose combination (FDC) in an oral pill. Lorexys® combines two agents intended to restore balance to the brain’s centers that control sexual function. Such effects are hoped to help women with HSDD.
The compound is Phase 2-ready without prior trials (Phase I safety studies) because the two agents have often been used together; individually, they are FDA-approved for treating other disorders (depression, for example), and in a large US survey, the two were taken together in about 23% of patients who were prescribed one of the two agents.
This research study requires subjects to take three different study medications for four weeks each, with at least a one-week “wash-out” period after each, and to report on rating scales how they feel. The medication is open-label (the subjects can see which medication they are receiving). That should not interfere with the evaluations or cause a significant “placebo effect” because only a low proportion of women with HSDD have responded to placebo in prior research studies of other compounds when using the same measures of efficacy.
Participation lasts 16 weeks, with eight clinic visits. A weekly, but no daily, self-rating is required between visits.