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 be 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 pinpoint exactly 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 a very 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. Learn more
- 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 such as Flibanserin (or Addyi), which was recently approved by the FDA.
- 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. The answer may be as simple as putting a lock on the door, moving the dogs out of the room, or planning and preparing for sexual activity.
In most cases there will be a number of different approaches taken to help solve the problem.
In A Patient’s Own Words:
“The last time I was in the office I told Dr. Marcus that she will be remembered for her contribution to Female Sexuality the way that Margaret Sanger was with birth control.
I read the article and I could not agree more. It took a great deal of courage for me to pick up the phone and make that first appointment.
I had spoken with a psychotherapist at length about the problem itching, discomfort and pain in my vagina; loss of desire that had nothing to do with my attraction to and love for my partner and finally my inability to achieve orgasms after being someone who previously had no sexual problems and certainly no problems achieving and orgasm.
As I was in a new relationship my therapist said it was just a matter of getting comfortable with a new person. I know my body and I knew she was wrong. I tried the ‘herbal cures”, specifically Thandia from Native Remedies. Three months and I felt no difference.
I have been on Dr. Marcus’ s treatment regime for less than a month. The vaginal dryness and discomfort ended the first week. My level of sexual desire has returned almost to the level it was before I noticed a change and this weekend I had an orgasm that was as good as some of the ones I had at 30.
So, I am a firm believer that there is no “magic pill” but a complex mixture of supports that Dr. Marcus has developed for each patient. You saved my sexuality and thus my relationship which is a huge part of my ongoing happiness.”
– M, Age 66 –
Click Here to read more patient Arousal Disorder testimonials.