Arousal Disorders

Arousal Disorders - Defining Desire's Dimming

• Characterized by persistent/recurrent difficulty in achieving or maintaining adequate sexual arousal (e.g., lubrication, genital swelling) until sexual activity completion, causing significant distress.
• Female Sexual Interest/Arousal Disorder (FSIAD) as per DSM-5:
  • Marked deficiency (≥3 symptoms) for ≥6 months:
    • Absent/reduced sexual interest.
    • Absent/reduced sexual thoughts/fantasies.
    • Reduced initiation or unreceptiveness.
    • Absent/reduced excitement/pleasure during 75-100% of sexual encounters.
    • Absent/reduced arousal to sexual cues.
    • Absent/reduced genital/non-genital sensations during 75-100% of sexual encounters.
• Etiology: Multifactorial (psychological, physiological, relational, medications like SSRIs).

⭐ FSIAD (DSM-5) integrates previous Hypoactive Sexual Desire Disorder (HSDD) and Female Sexual Arousal Disorder (FSAD).

Arousal Disorders - Why the Spark Fades

Persistent/recurrent inability to attain or maintain sufficient sexual arousal (subjective excitement, genital lubrication/swelling). Classified as Female Sexual Interest/Arousal Disorder (FSIAD) in DSM-5.

• Etiology (Biopsychosocial Model):
  • Biological:
    • Hormonal: ↓Estrogen (menopause), ↓androgens, hyperprolactinemia.
    • Vascular: Atherosclerosis, diabetes.
    • Neurological: MS, spinal cord injury, neuropathy.
    • Medications: SSRIs, anti-hypertensives, OCPs.
  • Psychological:
    • Mental health: Depression, anxiety disorders.
    • Stress, body image issues, history of sexual abuse.
  • Sociocultural & Relational:
    • Relationship discord, lack of communication.
    • Cultural/religious inhibitions, performance anxiety.

⭐ FSIAD diagnosis requires symptoms for ≥6 months causing significant distress, not better explained by nonsexual mental disorder, severe relationship distress, other stressors, or substance/medication.

Arousal Disorders - Spotting the Signs

• Core: Difficulty attaining/maintaining sexual excitement (subjective, genital response).
• Look for these Signs:
  • ↓ Subjective arousal ("not feeling turned on" by cues).
  • ↓ Genital response (e.g., poor lubrication, lack of engorgement).
  • Reduced or absent genital/non-genital sensations.
• Key Criteria: Symptoms for ≥6 months AND causing significant distress.

⭐ In women, arousal issues often co-exist with desire problems; DSM-5 combines them as Female Sexual Interest/Arousal Disorder (FSIAD).

Arousal Disorders - Rekindling the Flame

• Female Sexual Interest/Arousal Disorder (FSIAD): Persistent lack of, or significantly reduced, sexual interest/arousal (e.g., excitement, sensations), causing distress.

• 📌 Key Causes: Medications (SSRIs), Endocrine (↓estrogen), Depression/Anxiety, Stress/Relationship, Chronic illness (diabetes), Atrophy (vaginal).

• Core Management: Tailored biopsychosocial approach.

• Key Pharmacotherapies:

  • Flibanserin: Daily oral, premenopausal. ⚠️ Avoid alcohol (hypotension/syncope).
  • Bremelanotide: SC PRN, premenopausal.
  • Local Estrogen: Postmenopausal VVA.
  • Ospemifene: Oral SERM for VVA-dyspareunia.

• ⭐ > Flibanserin, for premenopausal FSIAD/HSDD, acts as a multifunctional serotonin agonist antagonist (MSAA); ⚠️ avoid alcohol.

High‑Yield Points - ⚡ Biggest Takeaways

• Arousal disorders: Persistent difficulty achieving/maintaining sexual excitement, causing significant distress.
• FSIAD (Female Sexual Interest/Arousal Disorder) in DSM-5 combines desire/arousal.
• Distinguish from hypoactive sexual desire disorder (HSDD), though often comorbid.
• Etiology: Multifactorial - psychological, physiological (↓estrogen, SSRIs), relationship issues.
• Diagnosis: Thorough history (sexual, medical, psychosocial) is key; exclude organic causes.
• Treatment: Psychosexual therapy (CBT) is primary; manage underlying conditions; consider lubricants.
• Local estrogen for postmenopausal vaginal atrophy can improve arousal_._