Female Sexual Interest-Arousal Disorder DSM-5 302.72 (F52.22)
DSM-5 Category: Sexual Dysfunctions
Introduction
Female sexual dysfunction in general is a complex and hardly understood condition affecting women of all ages and ethnicities. It may be the cause of a multiplicity of factors including biologic, social, psychological, environmental and hormonal. Comorbidity may present as mood and/or anxiety disorders; panic attacks, depression, phobias or bipolar disorder. Specific knowledge of this is extremely relevant in developing a treatment plan for the disorder; with an expectation of improvement in the enjoyment of sexual activity by the patient. Often overlooked is the role that a closeted memory or secret can play in inhibiting sexual enjoyment. For example, extramarital affairs or preoccupations may inhibit sexual enjoyment. As well, general sexual dysfunction takes a variety of forms; but Female Sexual Interest/Arousal Disorder is much more specific (American Psychiatric Association, 2013).
Symptoms of Female Sexual Interest/Arousal Disorder
According to the DSM-5 this disorder is defined by a complete lack of or significant reduction in sexual interest or sexual arousal. It is diagnosed with three or more of the following symptoms are manifested. These include the absence of an interest in sexual activity; or a decided reduction of such; and an absence of fantasizing or even thinking sexual or erotic thoughts. As well, the female is disinclined to initiate sexual encounters with her partner; and exhibits no sense of pleasure during sexual acts. These symptoms must have persisted for a minimum of six months and result in distress on the part of the patient. Too, there is no evidence of a physical, biological or substance induced cause of the condition. The problem may be lifelong or only acquired; and its severity may fall on a continuum of mild to moderate or severe. Finally, the problem may be situational – occurring only in some instances and not others; or generalized – with no apparent limitations.
Prior to a final diagnosis it is recommended that a female who presents with complaints regarding sex should undergo a complete physical examination to ensure the source of the problem is not physiological. Abnormal physical examination findings or suspected comorbidities should be addressed. This may require a pharmacological intervention; and should occur prior to recommendations of psychotherapy.
One treatment option available for prescription by the medical professional is call the Eros Clitoral Therapy Device - designed to improve arousal by increasing blood flow to the clitoris with gentle suction. This and/or lubricants have been found to be beneficial (Fenner, 2012).
Daily Life
As is the case in many instances where a person is suffering from a disorder; the first response should be a complete physical; and all recommendations from a medical professional should be taken into consideration. However, all too often the development of and adherence to a healthier lifestyle can also improve a number of conditions – which may also be true for the presence of Female Sexual Interest/Arousal Disorder as characterized in the DSM-5.
It is always a good idea to reduce or forgo the use of substances such as alcohol, nicotine, caffeine, and prescription medications; this last under doctor’s supervision of course. Smoking may directly affect libido because it restricts blood flow to the sexual organs and can directly decrease sexual arousal. Too, physical activity is a natural mood elevator and can increase stamina as well; both are important to all areas of one’s life including sexual activity. Physical activity also combats stress – yet another inhibitor to an active and fulfilling sex life. But, perhaps most important of all is to maintain open communication with your sex partner. Women are often embarrassed to discuss sex and this alone may be the root of one’s problems.
Equally as important is creating a schedule that includes time for the couple to be together; alone and away from distractions. Do you have a television in the bedroom? Remove it. Do you have exercise equipment there? Put it in the den or basement. The bedroom should be a private haven where a couple can go to enjoy each other’s company. A clean, warm and inviting environment is a great foundation for sexual possibilities.
If psychotherapy has been recommended; it should become a part of the routine. Appointments shouldn’t be missed in favor of some last minute decision to pursue another activity. Therapy is important; and it will usually require sessions individually and as a couple separately.
Finally, don’t be judgmental. If you are the person who is suffering from Female Sexual Interest/Arousal Disorder do not be too hard on yourself; this will only exacerbate the problem. If you are the partner of a person with this disorder then patience and supportiveness will be important to the healing process.
Treatment of Female Sexual Interest/Arousal Disorder
Treating Female Sexual Interest/Arousal Disorder is complicated by the fact there is rarely a single causative factor that can be traced as the reason for the problem; and this is exacerbated by the fact that there are few viable treatment options. The reason for this can be traced to the fact there has been little research on the subject and severely limited expertise in its treatment as well. This has slowly begun to change.
Frankly, treatment should begin with patient education. Often women have no expectation of what is ‘normal’ or how to express themselves. Therefore, it might be best to begin by educating the patient about normal anatomy as a precursor to psychotherapeutic interventions. It is suggested that a physician provide a handheld mirror during a gynecologic examination so the patient is able to see normal and abnormal physical findings and facilitate a discussion about the physiologic basis of sexual functioning (Brotto, Petkau, Labrie, & Basson, 2011).
Treatment of patients who meet the DSM-5 criteria for Female Sexual Interest/Arousal Disorder requires an individualized approach that may include a combination of counseling (office-based advice), cognitive-behavioral interventions, pharmacotherapy, and/or remedies for concomitant medical or psychiatric conditions (Graham, 2010). Most family doctors will refer a patient to a qualified specialist. This may be a sexuality counselor or sex therapist or a psychotherapist specializing in behavior modification; cognitive behavior therapy or other psycho therapies. Therapy often includes education about how to optimize the body's sexual response, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises (Palacios, Castaño, Grazziotin, 2009).
Finally, pharmacologic treatments may be options for treating physiologic needs, imbalances, or symptomatic complaints, and comprise only one part of the overall management of patients with female sexual disorders.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Brotto, L.; Petkau, A.; Labrie, F.; Basson, R. (2011). Predictors of sexual desire disorders in women.The journal of sexual medicine, Vol. 8, Iss. 3, pp. 742 – 753.
Fenner, A. (2012). Experts debate--should DSM-V raise the bar for female sexual dysfunction diagnosis? Nature Reviews Urology, Vol. 9, Iss. 9, p. 475
Graham, C. (2010). The DSM Diagnostic Criteria for Female Sexual Arousal Disorder. Archives of Sexual Behavior, Vol. 39, Iss. 2, pp. 240 – 255.
Palacios, S.; Castaño, R.; Grazziotin, A. (2009). Epidemiology of female sexual dysfunction. Maturitas, Vol. 63, Iss. 2, pp. 119 – 123.
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