Chapter 17 – Female Sexual Interest and Arousal Disorder (FSIAD)

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Decreased arousal

The most common clinical presentation for decreased arousal is genital sexual arousal disorder of menopause. This responds clinically to the use of systemic and/or topical oestrogen for genital symptoms of vaginal dryness and dyspareunia.

In premenopausal women it is more common to have combined subjective and genital arousal disorder. Subjective arousal is the change in a woman’s feelings and interest in initiating or continuing sexual activity, whereas genital arousal is the physical response to stimuli such as engorgement of the clitoris on clitoral touch, vaginal expansion or ballooning and erection of nipples following nipple stimulation.

In younger women, a lack of initial desire can often be overridden during foreplay and the genital response will allow penetrative sex to be pleasurable, whereas in older women the genital response may be diminished or lacking as well as the subjective interest.

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