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Sexual Arousal Disorders: Female Arousal Disorder and Persistent Genital Arousal Disorder

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

If you recall, we proposed that sexual arousal may be defined as both subjective and physiological. Subjective sexual arousal simply means feeling "turned on" whereas physiological sexual arousal includes physical changes (increased muscle tension, respiration, heart rate, blood pressure, and vasocongestion). As previously mentioned, men and women experience arousal differently.

Female Arousal Disorder

Within our discussion on gender differences in arousal it became apparent that there are two very different types of arousal for women: subjective and physiological. This has led Basson and colleagues (2004) to propose that Female Sexual Arousal Disorder might be better classified by different subtypes. While the DSM-IV-TR classifies female sexual arousal disorder under one category alone, Basson and colleagues propose that it is best classified under three categories: subjective, genital, and combined sexual arousal disorder. This proposal came about as research has indicated that some women who have been diagnosed with Arousal Disorder still showed healthy physical arousal when exposed to erotic stimulation. Yet, they report they do not feel aroused. Thus the concept of subjective arousal can be defined as feeling "mentally" aroused while physical arousal refers to objective, physical indicators of arousal such as increased blood flow to the vaginal area, vaginal lubrication etc.

According to Basson's proposed classification system, a woman with Subjective Sexual Arousal Disorder would report diminished feelings of sexual arousal when stimulated; yet, vaginal lubrication and other signs of physical arousal would be evident. Genital Sexual Arousal Disorder is described as absent or impaired genital sexual arousal. A woman may report minimal swelling or vaginal lubrication and reduced sexual sensations from any type of sexual stimulation, but subjective sexual excitement still occurs from non-genital stimulation. Women who complain of Genital Arousal Disorder report being aroused by sexual stimulation but report a diminished intensity of any genital response, including orgasm. In Combined Genital and Subjective Arousal Disorder, there are both diminished subjective feelings of sexual arousal and an absence, or impairment, of genital sexual arousal.

Persistent Genital Arousal Disorder

In 2001, Leiblum and Nathan (2001) described a syndrome in women which they provisionally named "persistent sexual arousal syndrome." More recently it has been renamed as Persistent Genital Arousal Disorder and is defined as spontaneous, intrusive, and unwanted genital arousal (tingling, throbbing, and pulsating) in the absence of sexual interest and desire. The subjective awareness of unrelenting sexual arousal is typically unpleasant. With Persistent Genital Arousal Disorder, arousal is unrelieved by one or more orgasms, and the feelings of arousal may persist for hours or days. The arousal is unsolicited and conscious sexual desire or sexual stimulation is absent. It may lead to solitary sexual behavior (masturbation) or sexual activity with a partner, but the sensations do not typically subside despite the experience of one or several orgasms. Because Persistent Genital Arousal Disorder has only recently been discussed, very little is know about the causes or the treatment alternatives. It is important to recognize that this disorder could be very frustrating for the women who experience it because our society sends the message that women are not supposed to be explicitly sexual. In fact, many women have difficulty initiating sexual activity as they perceive that to be the role of the male. Thus, it may be difficult for women to discuss this with health care providers, or even with her partner. Because this disorder is not yet completely understood, there is very little information available for women who experience these symptoms. This may be quite frustrating for women and it may be useful to seek out psychotherapy to process these feelings of frustration.