Table 1 Categories of female sexual arousal disorder However, in most cases, both factors contribute to FSAD (combined). In subjective FSAD, the woman’s emotional response to sexual stimuli is altered but the physical response still occurs, while genital phenomena are impaired in objective FSAD. 4 To sum up, Basson et al 5 categorized FSAD into three main classes: subjective, genital, and combined ( Table 1). Moreover, FSADs are frequently associated with other FSDs concerning desire, orgasm, and pain. Thus, such factors as sexual inhibition, depression or anxiety, inadequate sexual stimulation, or interpersonal problems may impair women’s arousal. In fact, women very often relate arousal to the subjective feeling of been “sexually involved” more than to the physiological response to erotic stimuli (ie, vaginal lubrication and engorgement of sexual tissues such as nipples, vulva, clitoris, and vaginal walls). However, a modern definition of FSDs should not focus only on genital phenomena without considering the psychological aspect of arousal. 4 Thus, iatrogenic factors (eg, chronic antidepressant treatments, surgical procedures, radiotherapy of the pelvis), along with endocrine, vascular, and neurological disorders can cause female sexual dysfunction. In fact, genital congestion and lubrication strictly depend on the hormonal balance (ie, arousal disorders during the menopausal transition) and require adequate vascular function and an efficient nerve transmission of mechanical stimuli.
3 Such a clinical condition may depend either on local or general factors. FSAD is traditionally defined as a persistent or recurrent inability to attain or maintain adequate lubrication and genital swelling until completion of sexual activity. In particular, female sexual arousal disorder (FSAD) belongs to the so-called “female sexual interest/arousal disorder” and is one of the most prevalent subcategories of FSDs.
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The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-V) 2 defines FSDs as disturbances in the female sexual response cycle, resulting in marked distress and interpersonal difficulties.
How should FSD be diagnosed and treated? A more thorough understanding of female sexual problems is needed to ensure appropriate clinical management of sexual difficulties.Ĭlinical features of female sexual arousal disorder On the contrary, women have begun to complain about sexual troubles only recently and have caught their doctors off-guard. 2 Even general practitioners are used to dealing with male sexual dysfunction and often prescribe easily available drugs such as sildenafil citrate (Viagra ®). 1 For years, studies have focused mainly on erectile dysfunction while female sexual disorders (FSDs), although more frequent than male sexual disturbances, have been hardly considered. According to recent estimates, sexual dysfunction has occurred in 40%–45% of women and 20%–30% of men at least once in their lifetime. In clinical practice, not only gynecologists but also generalists are often asked to solve specific questions about sexual diseases. Keywords: phosphodiesterase type 5 inhibitors, female sexual arousal disorder (FSAD), sildenafil citrate The clinician should pursue a global approach to the patient with sexual difficulties, while non-hormonal treatment such as phosphodiesterase type 5 inhibitors (ie, sildenafil citrate) should be kept as the last option. Furthermore, female sexual arousal disorder is a heterogeneous condition whose underlying causes are difficult to diagnose and appropriate treatment requires a thorough sexual, psychological, and medical history along with specialist consultations. The results are still conflicting and the drug is not devoid of adverse effects. Due to the similarities between male and female sexual response, several studies have assessed the effects of sildenafil citrate (Viagra ®) in women affected by female sexual arousal disorder. Giuseppe Lo Monte, Angela Graziano, Isabella Piva, Roberto Marciĭepartment of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, ItalyĪbstract: For years, phosphodiesterase type 5 inhibitors have been used for the treatment of erectile dysfunctions.