Introduction
Sexuality is a taboo in most of the societies in this world. Men on one hand consider their sexuality as a jewel of their manhood crown. On the other hand women are forbidden to discuss about their sexuality. It is considered to be their duty and responsibity to fulfil the sexual needs of their male partner. By doing so, their own sexual requirements and problems remain neglected. This is not happening since last few years, but has been a continous problem since the origin of the human race. This article is one step taken towards improvement in the understanding and thus creating awareness about sexual health among females.
What Is Female Sexual Interest/Arousal Disorder (FSIAD)?
It is a common but least discussed sexual health topic among females. In males inability to experience sexual pleasure while having sexual intercourse or sexual practices and reduced desire for such activities is called Male Hypoactive Sexual Desire Disorder (MHSDD). Similar to MHSDD, females experience FSIAD the prevalence of which varies from 16 % to 55 % across different regions. FSIAD improves on its own once the emotional and psychological well-being is established. However, with advancing age this problem increases in prevalence due to hormonal changes. This article throws light on Female Sexual Interest/Arousal Disorder, a common but least discussed sexual health topic among females.
How to Diagnose FSIAD?
FSIAD is diagnosed on the following basis:
- Absent or reduced sexual interest in sexual activity.
- Absent or reduced erotic thoughts or fantasies.
- Absence of or reduced initiation or receptivity to sexual activity.
- Absent or reduced sexual excitement/pleasure during sexual activity in all or almost all (75–100%) encounters in contexts identified as problematic or, if the problem is generalized, in all contexts.
- Absent or reduced sexual interest/arousal to sexual/erotic cues.
- Absent or reduced sensations during sexual activity in all or almost all encounters in contexts identified as problematic or, if the problem is generalized, in all contexts.
At least 3 of the above mentioned criterias should be present to make a diagnosis of FSIAD. It is also associated with painful intercourse, female orgasmic disorder, desire and sexual preferences discrepancies in a couple. Also attention needs to be paid towards assessment of associated mood disturbances, anxiety, physical and sexual abuse, relationship issues, internalization of sexual conflicts.
What Causes FSIAD?
Multiple factors are responsible for FSIAD, which include the following:
- Biological causes - thyroid dysfunction, diabetes mellitus, coronary artery disease, hypertension, arthritis, spinal cord injuries, multiple sclerosis, urogenital/pelvic cancers.
- Medications also result in FSIAD. These include antipsychotics, mood stabilizers, SSRIs (Selective Serotonin Reuptake Inhibitors), antihypertensives, oral contraceptives, reduced steroid hormone levels. Medications might result in reduced estrogen levels, hence resulting in reduced sexual desire.
- Psychological causes includes major depressive disorder, anxiety, relationship issues, conflict related to body self image, substance abuse, physical/sexual abuse.
- Social/environment causes includes reduced partner sexual interest, partner sexual dysfunction, lower socio-economic status.
How to Treat FSIAD?
Like most of the other sexual disorders, FSIAD is also treatable. Treatment includes the following measures:
1. Pharmacological Measures:
- Hormonal replacement is done to increase the estrogen level. Either estrogen supplements alone or estrogen in combination with progesterone can be used. It will increase the lubrication, will reduce the vaginal dryness and atrophy thereby reducing the discomfort associated with coitus (sexual intercourse). It is more effective in menopausal cases. Testosterone supplements can also be used.
- Flibanserin, an agonist and antagonist to serotonin receptors can also be used.
- Bupropion, used for SSRIs induced FSIAD.
- Phosphodiesterase 5 inhibitors (PDE5 inhibitors like Sildenafil, Tadalafil, Vardenafil) can also be used.
2. Psychological Measures:
- Sensate focus therapy which involves sexual exercises that promote awareness of self and partner's needs.
- Sexual skill training.
- Communication skill training.
- Mindfulness based CBT (Cognitive Behavioral Therapy).
3. Combination of both pharmacological and psychological measures can also be used in increasing the response rate.
The main aim of these measures is to increase the reinforcing value of sexual activities via increase in arousal, orgasm, pleasure and physical and emotional satisfaction. This also aims at improving the non sexual conditions such as relationship dynamics, stressors, timing and context so as to facilitate the sexual interactions.
To conclude with, FSIAD is a psychological disorder common to be found. It is not a matter to feel shy and hence has to be discussed. Rather females have equal right to seek pleasure as do the males.
