Sexual Arousal Disorder

Persistent or recurrent inability to attain or to maintain the response of sexual excitement until the completion of sexual activity.

Sexual arousal disorder may occur during and after menopause, when vaginal lubrication and elasticity decrease because of decreased estrogen levels. Menopausal women who regularly engage in sexual intercourse maintain a greater degree of vaginal lubrication and tissue integrity, even without estrogen replacement therapy, than women who do not.

One cause of sexual arousal disorder is use of certain drugs (eg, anticholinergic drugs, tricyclic antidepressants, many forms of chemotherapy), which may decrease vaginal lubrication. Altered (decreased) cholinergic effect may be involved in some women with diabetes. Pelvic radiation therapy or surgery, stress, and anxiety can also cause loss of lubrication. Although vascular disease is a primary cause of erectile dysfunction in men, its effects in women (eg, decreased vaginal lubrication, decreased clitoral and genital engorgement) are less clear; these effects do not fully explain sexual arousal disorder in women, and therapy with sildenafil directed at improving blood flow to the vagina does not necessarily improve sexual function.

For menopausal women with inadequate lubrication, the use of oral or transdermal estrogen therapy may provide relief. If this approach is contraindicated or inadequate, use of a water-soluble lubricant that simulates natural lubrication or use of an intravaginal estrogen ring may be of benefit. The use of erotic materials (eg, books, movies) or sex toys (eg, vibrators) may enhance arousal.