Sexual Arousal Disorder

Sexual arousal disorder refers to inadequate response to an adequate sexual stimulation. In other words, individual who suffer from sexual arousal disorder often face a hard time in getting sexually charged, which may deter the intensity and quality of gratification. Poorly addressed cases of sexual arousal syndrome may present with sexual dysfunction and other related issues. The key to understanding sexual arousal syndrome is the fact that individuals have normal sexual desires but the arousal phase is slow, delayed or incomplete.

What are key Features of Sexual Arousal Disorder?

The key features of Sexual Arousal Disorder are:

• Inability to maintain an adequate penile erection (males) or lack of adequate lubrication to accomplish the act of intercourse (females) are the hallmark signs of SAD.
• Partial or complete absence of sexual fantasies or imagination
• Lack of capacity to reciprocate sexual advances or respond appropriately to sexual stimulation.
• Approximately 50% of the entire US adult population experiences infrequent episodes of delayed arousal, while clinically significant arousal dysfunction is reported in approximately 1 in 8 to 1 in 16 Americans. The risk increases with physiological aging.

Sexual Arousal disorder can be classified as:

• Primary SAD: The individual has never achieved adequate erection to maintain sexual activity
• Or Secondary SAD: This is marked by a sudden/ gradual onset arousal dysfunction after a significant period of normal sexual function. Most secondary cases are associated with a gradual decline in the sexual arousal (unless there is a relevant history of severe injury or a debilitating illness)

Treatment of secondary impotence is usually more successful than that of primary impotence because the patient has some history of normal penile function in the past.

Physiology of Normal Arousal

Normal sexual arousal (or penile erection in males) is dependent on several factors; such as:

• Adequate emotional reception and activation of certain parts of brain (that are associated with sexual response)
• Intact pituitary gland
• Sufficient testosterone levels
• Sufficient blood perfusion to the penis

Sign and symptoms of Sexual arousal dysfunction are characteristic for; lack of interest in maintaining sexual relations with the partner, a partial or absolute lack of sexual excitement despite adequate stimulation, painful intercourse and infertility. In addition, specific symptoms in men are:

• Inadequate erection
• Delayed or absent ejaculation
• Uncontrolled timing of ejaculation

In Women:

• Taut vaginal muscles that may interfere with intercourse
• Problematic lubrication prior to and during intercourse
• Difficulty attaining female orgasm

Sexual arousal disorder is a result of impaired androgen production. Advancing age, pharmacological agents and abrupt shifts in the serum level of hormones can worsen SAD.Some risk factors that are implicated in the pathogenesis of SAD are:

• Chronic Tobacco abuse
• Uncontrolled hypertension
• Hormone deficiency syndromes
• Advanced liver diseases
• Pathology in the circulation system
• Neurological deficits
• Urological surgery
• Ill-fitting penile implants
• Depression or other psychiatric ailments

Diabetes, neurological diseases, psychiatric problems, alcohol ingestion, drug overuse, bad social history are some of the predisposing factors.

How to Minimize the Risk of Developing Sexual Disorder?

• Maintaining healthy communication between partners is the key to a fulfilling relationship
• Avoid medications/ drugs that may affect your sexual response cycle. It is highly recommended to discuss the side effect profile with the primary care provider before initiating a drug regimen for a medical indication.
• In case of a major marital conflict or issue, seek the help of a counselor to sort things out.
• Refrain from engaging in dangerous or hazardous sexual practices to minimize the risk of sexually transmitted infections (that may lead to pain and discomfort in the pelvic region).

How to Manage Sexual Arousal Disorder?

Treatment option should directly address the cause of the sexual dysfunction. Most popular treatment options are:

• Viagra (sildenafil) is used widely to help the SAD due to organic and psychological causes. The over-the-counter remedy increases the flow of blood to the penis. However, do not take Viagra with certain medications (such as nitrates) to minimize the risk of life threatening complications. It is imperative to mention that Viagra is safe for consumption in female subjects as well for the management of SAD (3).
• Topical testosterone preparations are available for use in both males and females. Low dose testosterone is known to boost sexual function and arousal.
• Couples are advised to sit in with a counsellor for a joint session to discuss interpersonal issues. Make sure to address communication barriers for the resolution of SAD due to psychological causes.
• Physical causes are easier to cure while organic causes are difficult to treat in the case of sexual arousal dysfunction. Severe cases of SAD may lead to infertility.
• To cope with the fear of hygiene while having sex, seek professional help. to explore options for safe sex methodologies. Sexual intercourse has no exacerbating effect whatsoever on the coexistent heart conditions

Sexual arousal disorder is a bar on the relationships and may affect the personal, social and sexual aspects of a person’s life. It is highly recommended to seek professional advice in order to resolve the condition adequately.References:

1. 1.Bloemers, J., van Rooij, K., Poels, S., Goldstein, I., Everaerd, W., Koppeschaar, H., ... & Tuiten, A. (2013). Toward personalized sexual medicine (part 1): Integrating the “dual control model” into differential drug treatments for hypoactive sexual desire disorder and female sexual arousal disorder. The journal of sexual medicine, 10(3), 791-809.
2. Giraldi, A., Rellini, A. H., Pfaus, J., & Laan, E. (2013). Female sexual arousal disorders. The journal of sexual medicine, 10(1), 58-73.
3. Basson, R., McInnes, R., Smith, M. D., Hodgson, G., & Koppiker, N. (2002). Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder. Journal of women's health & gender-based medicine, 11(4), 367-377.