FEMALE AROUSAL DISORDER

In recent years more then ever women are being studied for problems with sexual disorders and

dysfunction’s "Sexual disorders and dysfunction's refer to difficulties individuals experience in their

sexual functioning." (O’Donohue, Geer) In the past when sexual problems were studied amongst women

the focus was on the orgasmic phase, with such problems as Vaginismus, Dyspareunia and Anorgasmia,

rather than on the arousal phase. Even in 1970 when Masters and Johnson published their famous book

Human Sexual Inadequacy, they omitted form their finding associated with arousal disorder in

women for reasons unknown. However many contemporary sex researchers, reason that arousal

problems with women were more difficult to diagnose. Therefore in the past women's sexual problems

were associated with inability to reach orgasm. This however would change in 1978, with publication of

Frank, Anderson and Rubinstein's finding on arousal problems amongst women.

According to the American Psychiatric Association, 1983 (DSM-III-R), for female sexual arousal

disorders to exist two aspects must be present. Persistent or recurrent failure to attain or maintain the

lubrication and the swelling response of sexual excitement until completion and second persistent or

recurrent lack of subjective sense of sexual excitement and pleasure in female during sexual activity.

"Until recently, researchers believed that most sexual dysfunction were psychological in origin."(Tollison,

Adam) however in the light of new research such things as psycho-biological life stages can effect

women’s ability to reach arousal prior to intercourse. Therefore there are many aspects to consider

throughout a women's life. Various stages throughout a women lifetime have specific and significant

effects on sexual arousal potential. This can be associated with both physiological changes

that occur during these psycho-biological stages.(Strong, Devault) Current research indicates as more is

learned about the intricacies of sexual physiology, such things as the subtle influences of hormones effect

how a woman and the arousal process work. (Strong, Devault) Therefore it is imperative when

researchers conduct their study they are aware if their subjects are menstruating, pregnant, breast

feeding or postmenopausal. However other factors must also be examined. Intrapersonal relationships

based on childhood and adolescent experiences and personality characteristics of the subjects in

question. Interpersonal relationships also play a significant role in whether or not women will have arousal

problems. These life stages are very important to consider since they involve psychosocial, hormonal and

reproductive organ changes. (Strong, Devault)

From the time a young girl reaches puberty and begins her menstrual cycle till she goes through

menopause in midlife she will experience many hormonal changes. The hormonal changes that take

place in a woman's body when she is menstruating can be associated with three hormones present in the

blood stream during this process: estrogen, androgen and testosterone. When tested it was reported by

Persky et al in 1978 that estrogen did not effect sexual arousal in women, however the presence of

different levels of anodrogen could be associated with different stages of sexual arousal. It was also

reported that when testosteron levels presented themselves during menstruation that significant

relationships did exist between different sexual responses and the hormone being present in the body.

"Although hormone levels may not directly predict sexual arousal levels, it is possible that mood and state

of well-being , may be related to some aspects of sexuality."(Masters, Johnson) in 1984 and 1987,

Bancroft reported, that "women's sexual feelings are attributed to variations in general well-being, based

on the finding that well-being is strong predictor of the composite factor of sexuality.(Masters and

Johnson)

As with the menstrual cycle, documented cases regarding sexual arousal during pregnancy are

incomplete. However as early as 1966, Master's and Johnson examined physiological responses “that

occurred during pregnancy and they found that "pregnancy itself produced pelvic vasocongestion, and the

vasocongestive response of sexual arousal was altered." with pregnancy several new hormones

present themselves in extremely high levels. The combination of estrogen and progesterone during

pregnancy will surely effect sexual desire and arousal. The physical changes that accompany pregnancy

such as vasocongestion, edema and pressure of the fetus have also been known to hamper the sexual

arousal process for women. "Other physical symptoms such as morning sickness; changes in body

image tend to also play a significant role in whether women are able to become sexually aroused or not."

(Master, Johnson) As Falicov reported in 1973 many of his subjects feared engaging in sexual activities,

while pregnant, for the simple fact they believed that they might injure the maturing fetus. As one patient

put it "I think my husband and I unconsciously are both concerned about harming the baby, even though

we both know better. Not only do we make love less often now but also we spend less time at it."

Postpartum and breast-feeding following the birth of a child can have a negative affect on the

sexual arousal phase for women. Unfortunately many changes are taking place and the hormonal

environment can play a major role in why women may experience lower levels of arousal. "The period of

time before normal cycling and menstrual bleeding returns is extremely different amongst women.”

(Strong, Devault) The major reason behind this is the duration in which a woman will breast feed her new

born child. However if lactation is suppressed a woman cycle can return to normal in as little as 36 days

following the birth of her child. However as long as a new mother continues to lactate, ovarian cyclicity

will continue to be suppressed creating lower levels of the follicle stimulating hormone, and luteinizing

hormone, while prolactin will increase creating a decrease in sexual arousal. Another hormone that one

should consider in regards to women's sexual arousal is the decreased presence of estrogen. It has been

documented that "estrogen deprivation results in thinning of vaginal mucosa and vaginal fluid therefore

creating problems with sexual arousal.”Masters, Johnson)

After the birth of a child other non hormonal factors should be taken into consideration such as

noted by Pertot in 1981 he states that a variety of predictors of postpartum loss of sexual enjoyment.

"Fatigue, stress associated with the care of the newborn, and the transition to motherhood for first-time

mothers or with caring for more than one child, episiotomy pain, amount of help with child care from the

mother's partner and conflicts between partners"(O’Donohue) are all contributing aspects of why a

women might have a decrease in sexual arousal.

In 1966 Master's and Johnson concluded that age does affect sexual arousal. That older women

had less labial vasocongestion and vaginal vasocongestion developed at a slower place. The also

documented that vaginal lubrication also diminished with age.(Masters, Johnson) Studies also indicate

that once older women reach menopause sexual behavior is less frequent, and there is a decreased

appetite for sexual

pleasure and orgasms are more difficult to achieve.

With the development of the psychodynamic theory new thought are being brought to the table in

regards to human sexuality and the arousal period for women. As presented by Chasseguet and Smirgel

in 1970 and Lerner in 1988 unconscious wishes and desires may also play an important role in human

sexuality. "Psychoanalytic theory predicts and violation of internal standards for sexual behavior will lead

to guild, which tends to inhibit sexual arousal." as tested by Green and Mosher in 1985 both sex guilt

and masturbation guilt and masturbation guilt had an indirect effect on subjective sexual arousal.

Probably the most common determinant of sexual arousal disorder is associated with women's

interpersonal relationships with her partner. If a partner is unwilling to stimulate her prior to intercourse

arousal problems will occur. However this is a common occurrence that happens more often then not.

But if communication lines are open then the problem can be corrected by effectively communicating to

the other person.

Research on sexual arousal disorder in women has made remarkable progress in the last 30

years, however there is still much to be learned in regards to fully understanding the complex stages of

female sexual arousal disorder. However in understanding the culture, psychobiological life stages and

the way women interact in their interpersonal relationships will significantly help the cause. In

understanding this complex disorder, doctors will be able to accurately diagnose their patients and

futhermore be able to prescribe the correct treatment.