APA, American Psychological Association, classifies sexual disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) as disturbances tend to interrupt the mutual relations and cause psychological distress. All disorders listed in DSM interfere in any way arousal and the sexual response cycle. Although they are controversial, it is the standard used for female sexual problems by many psychiatrists and doctors in the U.S. and other countries.

Hypoactive sexual desire disorder is characterized by an absence of libido. There is no interest for sex and little stimulation needs. Sexual aversion is characterized by an aversion to or avoidance of sexual advances and sexual contact. It may be sexual or physical abuse or trauma and may be for life. The main feature of female sexual arousal disorder is the inability to achieve and implement the various phases of “normal” female arousal. Female orgasmic disorder is defined as a delay or absence of orgasm after “normal” arousal. Dyspareunia is characterized in genital pain before, during and after intercourse. Vaginismus is the involuntary contraction of the pelvic floor muscles around the vagina as a response to attempted penetration. Contraction makes vaginal penetration difficult or impossible. These disturbances may be due to personal problems and you do not seek medical attention for it. A distinction is made disturbances that lasts a lifetime and those that are acquired, and the disturbances caused by the situation and the present always.


In cases where you suspect a medical condition as the underlying cause, whether it is due to insufficient blood flow, nerve-related sensitivity loss or reduced hormone levels, a specialist an appropriate diagnosis. Sexual problems can be symptoms of diseases that require treatment, such as diabetes, endocrine disorders of the hypothalamic-pituitary-gonadal axis, and neurological disorders.

American Foundation of Urologic Disease (AFUD) characterizes APA criteria in these four types of disturbances:

  • Hypoactive sexual desire disorder; include sexual aversionFemale-Sexual-Dysfunction
  • Sexual arousal disorder
  • Orgasm disorder
  • Sexual pain; include vaginismus, dyspareunia

Contrary to APA standards, dyspareunia (pain during intercourse) diagnosed as a result of inadequate vaginal lubrication, which can be seen as an arousal disorder and treated like that. Pain associated with recurrent health conditions, including cystitis.

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 Physiological Diagnostic Tests

Vaginal blood flow and engorgement (swelling of the vaginal tissue) can be measured by vaginal photoplethysmography, where an acrylic fiber instrument is inserted into the vagina, reflect light and measures the flow and temperature. It cannot be used to measure levels of arousal, such as during orgasm, as it needs to be completely still for the measurements to be performed. Also, information about normal vaginal engorgement is limited and one can only speculate on what is normal when it comes down to such matters. A vaginal pH testing, usually performed by gynecologists and urologists to detect bacteria that cause vaginitis, can be useful. A probe is inserted into the vagina to measure. Decreased hormone levels and diminished vaginal secretion associated with menopause causes a rise in pH (over 5) which is easily detected by the test. A biothesiometer, a small cylindrical instrument, is used to measure the sensitivity of the clitoris and labia to pressure and temperature. Measurements are made before and after the subject watches erotic movies and masturbates with a vibrator about 15 minutes.

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Since there is not enough reliable information with varying definitions of sexual dysfunction, and even normal sexual activities, a clear understanding of the prevalence of women’s sexual problems is impeded.

 A survey conducted by the Australian Medical Association in 2008 shows that sexual dysfunction affects approximately 43% of all women in Australia. Age need not be a significant factor, as women under 20 and over 50 experience problems with arousal, orgasm and satisfaction. But there is evidence that the majority of female sexual dysfunction occurs after menopause, when hormone production drops and vascular conditions are more common.

tumblr_inline_mn3hpbycH21qz4rgpThe clinical definition of the female sexual response cycle consists of four stages of arousal, marked by physiological and psychological changes. The first stage is excitement, which can be triggered by psychological or physical stimulation, and is marked by emotional changes, increased heart rate, breathing, and vaginal swelling and lubrication of the vagina due to increased blood flow. Sustained arousal called the plateau, the second phase. Vaginal swelling, heart rate, and muscle tension may increase as long as stimulation continues. Breasts enlarge, the nipples become erect and uterus drops. The third phase is orgasm, which involves synchronized vaginal, anal and abdominal muscle contractions, loss of involuntary muscle control and increased pleasure. The final phase presupposes that the blood rushes away from the vagina, breasts and nipples, and a heart rate, respiration and blood pressure.

A normal and healthy response cycle can be as poorly defined as a dysfunctional. It varies how women experience these phases. For example, some quickly go from arousal to orgasm and other exchanges between the plateau and orgasm several times before reaching resolution.

However, when a woman experiences a problem during whichever of the three first phases, there is a talk about the so called female sexual arousal disorder. This condition has been approached from many angles, but a universal remedy and the only panacea covering both physiological and psychological aspect remains Female Viagra.

Female Viagra is an oral drug used in women unable to achieve sexual desire, orgasm, or both. The drug is produced in form of a tablet and needs to be taken approximately one hour before a planned sexual intercourse. Female Viagra stimulates blood flow in pelvic area thus insuring sufficient arousal and lubrication.

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The causes of female sexual dysfunction are poorly defined. Many different factors can impair the sexual response cycle, which requires physical and psychological stimulation:


  • Anxiety
  • Alcohol
  • Depression
  • Emotional problems, distractions
  • Nausea
  • Negative body image
  • Stress


Recently, controversy has produced two different medical perspective on the causes (and treatment) for female sexual dysfunction. A concept that is known as the vascular theory, that diminished blood flow to the pelvic region, because of various health conditions, age, stress, or hypoactive sexual desire, which reduces sensitivity (especially the clitoris) and dry, and impairs arousal. Decreased blood flow associated with medical conditions such as diabetes and atherosclerosis. This concept has fuelled clinical studies and led to topical creams that cause vascular dilation, increased blood flow and vascular congestion associated with the excitement, when applied. Sensitivity increases and can cause arousal.

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Another concept is the hormone theory that focuses on decreased levels of sex hormones, such as oestrogen and testosterone, because of age. For some women, hormone therapy may lead to increased sexual desire. Oestrogen is the primary female hormone associated with sexual desire. Testosterone is the primary male sex hormone that plays a role in women’s sexual development and function, including the breasts and clitoris sensitivity. Some women experience a decrease in sexual desire, lack of sexual fantasies, and impaired sensitivity after menopause or hysterectomy because of decreased oestrogen levels.

Other medical causes include the following:

  • Cycling (long narrow seats associated with perineal pressure and reduced blood flow)4198_3692
  • Drugs and medications; pill
  • Smoking
  • Spinal cord injury (can cause nerve damage; paralysis)
  • Surgical (or near reproductive and urinary organs or abdomen, may damage the nerves)
  • Urinary incontinence (can cause embarrassment: an avoidance behavior)
  • Vaginal atrophy (slemhinneförtunning)

Antidepressants and bezodiazepiner are used to treat depression and anxiety are the drugs most commonly associated with sexual desire and inability to achieve orgasm. Buproprion (Wellbutrin, an antidepressant) is sometimes prescribed to those experiencing drug-related loss of sexual desire. Some evidence suggests that it restores libido. Chemotherapy drugs used to treat cancer are also associated with lack of sexual desire. Some evidence suggests that extended use of oral contraceptives leads to reduced libido. Spinal cord injury, pelvic trauma, and other conditions that affect the peripheral nervous system, such as diabetes, can weaken the genital sensitivity, as surgery involving the pelvic floor, bladder, abdomen, and genitals.

A third approach might be called the dissatisfaction theory, is neither psychological nor medical. A lot of women’s sexual dysfunction is not due to hormonal deficiency or diminished pelvic blood flow, but on insufficient genital stimulation. The fact that young, healthy women experience sexual dysfunction is evident. Poor communication from both parties can result in men not knowing how to stimulate a woman so that she gets excited. This leads to unsatisfactory sex and can cause arousal, loss of sexual interest, depression and aversion to sex.

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