Female arousal disorder

Question 1

Definition

Answer 1

Lack of or significantly reduced sexual interest/arousal.

Question 2

Diagnostic criteria

Answer 2

3/6 of the following:

1. absent or reduced sexual activity
2. absent or reduced sexual thoughts or fantasies
3. no or reduced initiation of sexual activity and typically unreceptive to a partner’s attempts to initiate
4. absent or reduced sexual excitement or pleasure in almost all or all sexual encounters
5. absent or reduced sexual genital or non-genital sensations during sexual activity in all or almost all sexual encounters
6. absent or reduced sexual interest/arousal in response to any internal or external sexual cue

Question 3

General issue

Answer 3

There is a failure of a genital response, the principle problem is vaginal dryness or failure of lubrication.

Question 4

How long do the sx need to last?

Answer 4

6 months and cause clinically significant distress

Question 5

Physiological causes

Answer 5

Chronic medical conditions:
o CVD, DM, neurological disease, connective tissue disease

Hormonal disorders:
o oestrogen deficiency e.g. thyroid disorders, post menopause

Iatrogenic:
o Prescribed medicine e.g. antidepressants

Lactation:
o Breastfeeding women can suffer

Vaginal dryness is a common presenting problem and can also be caused by local irritants and douching.

Question 6

Psychological causes

Answer 6

Psychiatric conditions:
o depression, anxiety, binge eating disorders, excessive dieting

Previous abuse

Couple script problems

Decreased intimacy

Couples relationship problems

Question 7

Investigations

Answer 7

Bloods - oestrogen, diabetes screen, ESR and CRP, FBC, thyroid screen, testosterone

Full sexual history

Question 8

Medical treatment

Answer 8

if low testosterone - give testosterone

if low oestrogen give oestrogen

Question 9

Behavioural interventions

Answer 9

Sensate focus:

• A staged programme of exercises to enable the couple to identify own and other sexual likes/dislikes and explore new techniques
• Work with therapist to understand and overcome negative beliefs and unhelpful thinking patterns in relation to sexual behaviour

New sexual routines, lubricant and vibrators

Eros therapy device:

• A small handheld device used in the home
• It is the first clinically proven treatment for arousal and orgasmic disorder
• Greater clitoral and genital engorgement
• Increased vaginal lubricant
• Enhanced ability to achieve orgasm
• Improved overall sexual satisfaction

Question 10

What is the hierarchy of interventions

Answer 10

• Timetabling
• Communication
• Negotiation/contracting
• Addressing intimacy
• Being sexual
• Adjusting to difficulties