Download Female Sexual Arousal Disorder

Tina Howard and Angela Thomas
COAD 7404-Craven Cohort
June 3, 2013
Disorder Snapshot: Female Sexual Arousal Disorder
I.
Disorder Name: Female Sexual Arousal Disorder (FSAD)
II.
General Description & Clinical Presentation:
Female Sexual Arousal Disorder is described as the inability of a woman to
complete sexual activity with adequate lubrication. Swelling of the external
genitalia and vaginal lubrication are generally absent. These symptoms must cause
problems in the interpersonal relationship to be considered a disorder. It is not
unusual for the woman with female sexual arousal disorder to have almost no
sense of sexual arousal. Often, these women experience pain with intercourse and
avoid sexual contact with their partner. The prevalence varies and increases with
age, especially at the time of menopause, while distress decreases with age.
Arousal disorders are often combined with other sexual problems and are of a
biopsychosocial etiology. Recommended examinations during assessment include
a thorough medical and gynecological history along with a sexological history.
Treatment should be based on the symptoms, clinical findings and, if possible, on
the underlying etiology (Giraldi, 2013).
III.
Etiology
a. Biological Factors: Some medical conditions may contribute to the
disorder such as “menopausal or postmenopausal reductions in estrogen
levels, atrophic vaginitis, diabetes mellitus, and radiotherapy of the pelvis.
Reduced lubrication has also been reported in association with lactation."
Burnett, J.A., Long, L.L., & Thomas, R. V. p. 108).
b. Physiological Factors: “Sexual myths (e.g., a larger penis provides more
stimulation), lack of knowledge about one’s body, interpersonal as well as
relational conflict between partners, anger fear, and guilt” could all be
contributing factors. Inadequate sexual stimulation may be another reason
for arousal problems. (Burnett, J.A., Long, L.L., & Thomas, R. V. p. 108).
IV.
Differential Diagnosis: Some disorders have similar or even the same symptoms.
The clinician, therefore, in his/her diagnostic attempt has to differentiate against
the following disorders which need to be ruled out to establish a precise diagnosis:
Inadequate Genital Stimulation. Drug Abuse.
V.
Prevalence: Female sexual complaints are common and can occur in up to onethird of women. (Morrison, J., p. 341). The most common objection with women is
the decreased desire followed by orgasmic dysfunction. (Frank, Mistretta, Will, p.
635)
VI.
DSM IV Diagnostic Criteria:
Criterion A: Persistent or recurrent inability to attain, or to maintain until
completion of the sexual activity, an adequate lubrication-swelling response of
sexual excitement.
Criterion B: The disturbance causes marked distress or interpersonal difficulty.
Criterion C: The sexual dysfunction is not better accounted for by another Axis I
disorder (except another Sexual Dysfunction) and is not due exclusively to the
direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a
general medical condition. (American Psychiatric Association, 2000, Diagnostic
and Statistical Manual of Mental Disorders, 4th ed., text revision).
a. Changes present in DSM-V Diagnostic Criteria
Hypoactive Sexual Desire Disorder (HSDD) and Female Sexual Arousal
Disorder (FSAD) are combined into female sexual interest/arousal disorder.
DSM-5 has gender-specific sexual dysfunctions. Sexual dysfunctions (except
substance-/medication-induced sexual dysfunction) now require duration of
approximately 6 months and more exact severity criteria. In DSM-5, genderspecific sexual dysfunctions have been added, and, for females, sexual desire
and arousal disorders have been combined into one disorder: female sexual
interest/arousal disorder.
VII. Pharmacological Interventions: Hormone therapy and the use of lubricants
may be prescribed for individuals diagnosed with Female Sexual Arousal Disorder.
(Burnett, J.A., Long, L.L., & Thomas, R. V. p. 108).
VIII. Counseling Interventions: 1) Couples counseling with communication skills
training 2) Psychoeducational training 3) Masturbation training with an emphasis
on self-focus and assertiveness 4) sensate focus activities 5) desensitization 6)
sexual fantasies (Burnett, J.A., Long, L.L., & Thomas, R. V. p. 109).
IX.
Perceptions/Reflections from Contemporary Media: The newest edition of the
Diagnostic and Statistical Manual of Mental Disorders, the DSM - V, will identify
problems with the critical feature of the DSM-IV-TR diagnosis of Female Sexual
Arousal Disorder – “an inability to attain, or to maintain…an adequate lubricationswelling response of sexual excitement”. It highlights the important overlap
between “arousal” and “desire” disorders. Additional revisions to the DSM-V also
contain the use of a polythetic approach to the diagnosis and the addition of
duration and severity criteria. (Graham, 2009).
X.
Additional Resources for Therapeutic Support
Female sexual arousal disorder. (n.d.). Retrieved from
http://www.allaboutcounseling.com/library/female-sexual-arousal-disorder/
Female sexual arousal disorder. (n.d.). Retrieved from http://www.psychnetuk.com/x_new_site/DSM_IV/female_sexual_arousal_disorder.html
Frank, Jennifer E., Mistretta, Patricia, Will, Joshua. (2008). Diagnosis and treatment of
female sexual dysfunction. American Family Physician, 77(5), 635-642.
Kingsber, S. A., Iglesia, C. B., Kellogg, S., & Krychman, M. L. (n.d.). Handbook on
female sexual health and wellness. Retrieved from
http://www.arhp.org/uploadDocs/ARHP_ACOG_SexualityHandbook.pdf
Sexual arousal disorder (treatments). (n.d.). Retrieved from
http://www.psychologytoday.com/conditions/sexual-arousaldisorder?tab=Treatments
XI.
Additional Scholarly Resources
(2013). Highlights of changes from dsm-iv-tr to dsm5. (pp. 1-19). DSM-5 Collection
DOI: 1.http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web
&cd=5&ved=0CFsQFjAE&url=http://www.psychiatry.org/File%20Library/Practi
ce/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf&ei=7F2tUey
8MezA4APz14GQDg&usg=AFQjCNFx7tNG0y6MvA6I_ZLGeCuzOG1xmQ&si
g2=CsDqxLqQd9KBBnpu9eWyLg&bvm=bv.47244034,d.dmg
Blink, Yitzchak M., Brotto, Lori A., Graham, Cynthia A., & Segraves, Taylor R.
(2010). Response of the DSM-V sexual dysfunctions subworkgroup to
commentaries published in JSM. The Journal of Sexual Medicine, 10(7), 23822387. doi: 10.1111/j.1743-6109.2010.01899.x
Boyer, B. A., & Paharia, M. I. (2007). Comprehensive handbook of clinical health
psychology. (p. 445). Hoboken, NJ: John Wiley and Sons. Retrieved from
http://books.google.com/books?id=bSJz2mY0mAC&pg=PA445&lpg=PA445&dq=physician%20desk%20reference%20fe
male%20sexual%20arousal%20disorder&source=bl&ots=vtLVQWp04j&sig
=bzG8eRyB_NP4ruMLWRdayajjfI&hl=en&sa=X&ei=tgGsUe6ZNYiS9gTj4YDwBw&ved=0C
DIQ6AEwAQ#v=onepage&q=physician%20desk%20reference%20female%2
0sexual%20arousal%20disorder&f=false
Giraldi, A., Rellini, A. H., Pfaus, J., & laan, E. (2013). Female sexual arousal disorders.
The Journal of Sexual Medicine, 10(1), 58-73. doi: 10.1111/j.17436109.2012.02820.x
Graham, Cynthia A. (2009). The DSM diagnostic criteria for female sexual arousal
disorder. American Psychiatric Association, doi: 10.1007/s.10508-009-9535-I
Long, L., Burnett, J., & Thomas, V. (2006). Sexuality counseling. (pp. 108-109). Upper
Saddle River, NJ: Pearson Education Inc.
Phillips, N. (2000). Female sexual dysfunction: Evaluation and treatment. American
Family Physician, 62(1), 127-136. Retrieved from
http://www.aafp.org/afp/2000/0701/p127.html
Sexual arousal disorder. (n.d.). Retrieved from
http://www.psychologytoday.com/conditions/sexual-arousal-disorder