There are physiological changes that take place in the body when we become sexually aroused. Most women describe themselves as “turned on” when they occur. There are subtle changes that we may not notice along with some that are more obvious. Many women describe vaginal wetness, vulvar swelling, a tingling sensation in the vaginal area, nipple erection or the “goose bump effect”, (raised hair on the skin). In some women the problem is that these physiological changes are not taking place. They are not getting wet and their vulva is not swelling. In other women changes may be taking place but they might not be aware of them. That is why the medical community has split arousal issues into two groups: “objective arousal,” arousal that we can measure (with proper equipment) and “subjective arousal” which is how the woman feels.
Most women who are having arousal problems will say “I just don’t get turned on” or “we start having sex and nothing ‘happens’” or, very typically, “When we get started I have a really difficult time getting the laundry list of things I have to get done out of my head.” These are classic, and fairly accurate descriptions of arousal problems. However, often issues of desire and arousal become mixed up together. A woman says “I don’t want to have sex”, and what she really means is that although she might want to have sex, the sex itself is so disappointing that it hardly seems worth it, and she is disappointed.
The absence of sexual arousal can, after a time, become seriously detrimental to a woman’s sense of sexuality. This may be a chronic condition or something that is just beginning to happen noticeable because it is affecting her relationship. In addition, this arousal disorder may be accompanied by a change in sexual desire and orgasmic dysfunction. With decreased wetness or swelling, sexual intercourse may become painful and may therefore be avoided. One of the things we pride ourselves on at the Center is helping a woman distinguish between low desire and arousal problems. It’s easier to treat the problem when we know what it is
It is not clear what causes problems with arousal and in most cases it can have a number of causes:
- As we age, blood flow slows down and the congestion and wetness which are the result of vaginal blood flow may lessen.
- Sometimes neurological changes may be part of the problem. Trauma (an accident or even just the birth of a child) can contribute to changes in the way the nerves function. Less sensitive nerve response can be a part of the problem.
- Low hormones can often contribute. The vulva and vagina are particularly sensitive to hormonal changes as is the brain. When there are hormonal shifts, both the brain and body are affected and when the hormones drop a woman’s sensitivity can drop as well.
- Stress and distractions (like children, work issues and housekeeping) can keep the brain from doing its part when you are trying to get aroused. The brain is such a large part of sexual functioning.
It is unclear how common arousal problems are because they so often get confused with problems of low desire or pain. We do know that if 43% of women complain of problems with their sexual functioning, a significant portion will be connected to problems with arousal.
In the initial intake we try to understand the way in which the lack of arousal is affecting the woman and/or her relationship. We may try to ascertain when it started and attempt to figure out the initial causes. Treatments may then include:
- Hormones: These might be local hormones (which affect only the local area where needed) or systemic (raising the hormone profile for the entire body.) These may include estrogen, testosterone, DHEA-s or others.
- Other Medications: We may suggest drugs that help with blood flow like Viagra®, Levitra® or Cialis®. We might add in medications that help with neurotransmitters in the brain. There is a new drug which looks like it will be approved by the FDA for this problem, Flibanserin®.
- Devices: We may recommend a particular product or vibrator and explain exactly why we are recommending its use.
- Counseling: Sometimes a woman might need some practical help in regaining her focus. Sometimes an answer as simple as putting a lock on the door or moving the dogs out of the room, or planning and preparing for sexual activity might be part of the solution.
In most cases there will be a number of different approaches taken to help solve the problem.