Arousal Disorder In Women Research Articles

Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review

BackgroundPersistent genital arousal disorder (PGAD) is characterized by elevated discomfort associated with persistent genital arousal in the absence of sexual desire. AimTo perform a scoping review of the proposed treatments for PGAD and their efficacy. MethodsA scoping review was carried out (PRISMA-Scr) that included articles on PGAD as the main disorder, only in women, which explained, in detail, the treatment and its efficacy, was empirical, was written in English and Spanish. No prior filtering by years was performed. OutcomesThree different effective treatments were found (physical therapies, pharmacological therapies, and psychotherapeutics in combination with other therapies). ResultsThirty-eight articles were selected. From physical therapies, treatments using neuromodulation, transcutaneous electrical stimulation, Botox, surgery, electroconvulsive therapy, manual therapy, pelvic floor therapy, dietary changes, and transcranial magnetic stimulation showed effectiveness. Using the pharmacological approach, paroxetine, duloxetine, pramipexole, ropinirole, and clonazepam treatments were effective. Psychotherapy treatments showed effectiveness only in combination with other types of treatments, specifically a combination of cognitive–behavioral strategies with pharmacological treatment. Clinical implicationsPharmacological treatment, specifically SSRIs, have proven to be the therapy of choice for different subtypes of patients. Strengths and limitationsThis study analyzed treatment effectiveness with different approaches and took into consideration those articles where psychotherapy was used as a combination treatment with pharmacological and physical therapy. The main limitation is that it was focused exclusively on women, and the results cannot be generalized to include men. ConclusionsTo date, a combination of pharmacological interventions with physical therapy and, in some occasions, with psychological therapy is main strategy followed to accomplish effective treatment of PGAD.Martín-Vivar M, Villena-Moya A, Mestre-Bach G, et al. Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review. J Sex Med 2022;19:961–974.

Arousal disorder in women

Recurrent / persistent inability to attain/ maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual arousal. Recurrent inability to get aroused. Your response to stimulation is physiologically / somatically maladaptive. And your perceptions about your inability to get aroused are distorted. The disturbance causes distress. The disturbance causes marked distress or interpersonal difficulty. Worldwide prevalence of arousal disorder in women is 26-43% and can be maintained depending on partner, stimulation, situation or regardless partner, stimulation, situation etc. The disorder may emerge from the beginning of the sexual life or begin after a period of relatively normal sexual function. Keywords: arousal disorder in women, s-on, therapy, testing, evaluation, sexual disorders.

Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part III

IntroductionIn 2016 the International Society for the Study of Women’s Sexual Health (ISSWSH) published an expert consensus report on new nomenclature that addressed the need for comprehensive, evidence-based criteria for new diagnoses in desire, arousal, and orgasm, with the definition on arousal focusing exclusively on female genital arousal disorder (FGAD). AimA new expert panel solely focused on mechanisms of arousal disorders convened to revise the nomenclature to include female cognitive arousal disorder (FCAD) and FGAD. MethodsThe ISSWSH co-chairs identified experts on arousal disorders in women. The 10 participants included clinicians, researchers, and educators, representing a diverse, multidisciplinary group. Pre-meeting preparation included evidence-based literature review as the basis of presentations panelists made at the meeting on the current knowledge in cognitive arousal. Consensus was reached using a modified Delphi method. Writing assignments were made as a basis of manuscript development. Main Outcome MeasuresThe new definition of FCAD is characterized by distressing difficulty or inability to attain or maintain adequate mental excitement associated with sexual activity, as manifested by problems with feeling engaged and mentally turned on or sexually aroused for a minimum of 6 months. ResultsFemale sexual arousal disorder encompasses both FGAD (revised definition) and FCAD (new definition). Recommendations regarding diagnosis include a clinical interview to assess for FCAD using targeted questions. Patient-reported outcomes that contain questions to assess FCAD are described, including limitations for differentiating between cognitive arousal, genital arousal, and sexual desire. Laboratory measures of cognitive and genital arousal are discussed, including the relationships between genital and cognitive arousal patterns. Biopsychosocial risk factors for FCAD and FGAD, as well as exclusionary conditions, are presented. Clinical ImplicationsThe revision of the ISSWSH nomenclature regarding the criteria for the 2 arousal categories, FCAD and FGAD, and the recommended diagnostic strategies offers a framework for management of women with arousal disorders. Strengths & LimitationsThis nomenclature allows for basic science and clinical research in subtypes of arousal in order to develop better diagnostic and treatment options for use by clinicians, scientists, and regulatory agencies. There are limited validated measures of cognitive arousal, including the Female Sexual Function Index, the most commonly used measure, which does not effectively distinguish between cognitive excitement, genital sensations, and event-related desire. ConclusionFuture directions include the refinement of FCAD and FGAD and development and validation of patient-reported outcomes that distinguish between the cognitive processes and genital responses to enhance clinical care and research in this area.Parish SJ, Meston CM, Althof SE, et al. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part III. J Sex Med 2019;16:452–462.

Возможности применения ударно-волновой терапии в комплексной коррекции сексуальных дисфункций у женщин

In recent decades, interest in the quality of sexual life has significantly increased all over the world, not only among men but also among women, especially in low-birth-rate European countries. Improving this quality will not only resolve health issues in men and women, but will also improve the demographic situation in these countries. Scientific research in the field of both male and female sexual dysfunction is developing at a rapid pace. Both men and women go through the same phases of sexual reactions cycle: sexual desire, sexual arousal, and, as a result, orgasm and resolution phase. During the phase of sexual arousal, in both men and women, the blood flow to pelvic organs increases, but in the event of erectile dysfunction in men and frigidity in women, this process weakens or does not occur at all. Furthermore, the innervation of genital organs in male and female organisms is identical. Activation, which enables genital innervation, launches the activation of blood circulation in the target organs. Therefore, in case of ED in men, and in case of female sexual arousal disorder in women, along with other specific treatment methods, it is useful to perform non-invasive stimulation of insufficiently active physiological mechanisms of sexual arousal. However, for the treatment of ED in men, such stimulation has already been successfully used for a long time – that is the low-intensity extracorporeal shock wave therapy, which allows to restore the erection mechanism itself. Studies from throughout the world, including those conducted by Ukrainian scientists, have established that low-intensity extracorporeal shock wave therapy induces neovascularization and therefore improves blood circulation. The intensity of the basal and sexually stimulated genital blood flow is a necessary physiological tool of sexual arousal and orgasmic discharge, which makes the subject of artificial stimulation of this indicator by means of shock wave therapy in both men and women particularly important. The use of shock wave therapy can have a number of advantages not only due to the increased blood and lymph flow in the genitals, but also due to the powerful stimulation of the release of neurotransmitters and hormones which provide emotional coloring to the sexual feeling and increase libido (serotonin, dopamine, endorphins etc.). Therefore, along with combined therapy, the method of low-intensity extracorporeal shock wave therapy can be successfully used in the treatment of female sexual dysfunction. Key words: shock wave therapy, sexual dysfunction, female sexual arousal disorder, erectile dysfunction, DSM-5.

A Comparison of DSM-IV-TR and DSM-5 Definitions for Sexual Dysfunctions: Critiques and Challenges

The diagnostic criteria of sexual dysfunctions (SDs) are paramount for the development of sexual medicine as reliable diagnoses are essential to guide treatment plans. Prior Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications based definitions of SD mostly on expert opinions and included imprecise terms. The validity of diagnoses of SD has only recently been challenged, and efforts are made to make more operational definitions. This paper aims to compare and contrast the recently released Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of SD with that of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) and explains the rationale for making changes in the new DSM-5. It also aims to address some issues to be considered further for the future. Online proposed American Psychiatric Association website DSM-5, the new released DSM-5, and DSM-IV-TR diagnostic criteria for SD were thoroughly inspected, and an extensive literature search was performed for comparative reasons. Changes in diagnostic criteria of DSM-5 were detected, and DSM-IV-TR and DSM-5 diagnostic criteria for SD were compared and contrasted. Diagnostic criteria were more operationalized, and explicit duration and frequency criteria were set up in DSM-5 for purposes of good clinical research. Classifications based on simple linear sexual response were abandoned, and diagnostic classifications were separately made for males and females. Desire and arousal disorders in women were merged. Drifting apart from linear sexual response cycle may be an advancement in establishing specific diagnostic criteria for different genders. However, it is still a question of debate whether there is enough evidence to lump sexual interest and arousal disorders in females. Making more precise definitions is important to differentiate disorders from other transient conditions. However, there is still room to improve our definitions and find a way to include gay and lesbian individuals. Further discussions and debates are expected to be continued in the future.

Should Sexual Desire and Arousal Disorders in Women Be Merged? A Response to DeRogatis, Clayton, Rosen, Sand, and Pyke (2010)

We are grateful for the opportunity to reply to the Letter to the Editor entitled‘‘Should Sexual Desire and Arousal Disorders in Women Be Merged?’’by DeRogatis, Clayton, Rosen, Sand, and Pyke (2010). Considerable debate has emerged since the publication of our proposed revisions for Hypoactive Sexual Desire Disorder (HSDD) and Female Sexual Arousal Disorder (FSAD) for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Brotto, 2010; Graham, 2010).Published commentariesand our response (Binik, Brotto, Graham, & Segraves, 2010) appeared in a recent issue of the Journal of Sexual Medicine. At the outset, we wish to respond to a statement made by DeRogatis et al. regarding the basis for our proposed revisions. DeRogatis et al. argued that fundamental changes to psychiatric nomenclature ‘‘...should be based on confirmed data— preferably from multiple clinical trials or observational studies—rather than on theoretical speculations or expert opinion, as in the current proposal.’’The published guidelines for making changes to DSM-5 (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009) clearly state that recommendations should be guided by research evidence but that, unlike DSM-IV,‘‘there will be no a priori constraints on the degree of change between DSM-IV and DSM-V.’’ There is simply no justification for asserting that the proposal for Sexual Interest/Arousal Disorder was based on‘‘theoretical speculations or expert opinion.’’ Comprehensive and critical reviews of the empirical literature wereundertaken(Brotto,2010;Graham,2010)and these formed the basis for the proposals. It should also be noted that the DSMIV-TR diagnoses of HSDD and FSAD were not based on any systematically collected body of data. The diagnosis of HSDD was the result of the expert opinion of Helen Singer Kaplan and Harold Lief: FSAD appears to have initially resulted from the early theorizing concerning the human sexual response cycle by Masters and Johnson and was probably saved from extinction by the hope that PDE-5 inhibitors would be effective for women. In their letter, DeRogatis et al. reported on data from two nontreatment studies funded by Boehringer Ingelheim (BI). In one study, women with primary HSDD and primary FSAD (n = 143) differed significantly from each other in terms of symptom profile. The women with HSDD had better sexual functioning, as measured by the Female Sexual Function Index (FSFI), compared to women with FSAD (total mean FSFI scores of 23.7 and 20.2, respectively). On the basis of these two groups showing ‘‘different symptom profiles,’’ DeRogatis et al. argued that the diagnostic categories ofHSDDand FSAD should not be merged in DSM-5. We believe that DeRogatis et al.’s findings of distinct symptom patterns among women with HSDD and those with FSAD are due to how the samples were recruited. As women were diagnosed using DSM-IV criteria (which separate deficient or absent desire for sex [HSDD] from impaired lubrication [FSAD], one would expect different symptom profiles in L. A. Brotto (&) Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC V5Z 1M9, Canada e-mail: lori.brotto@vch.ca

Should Sexual Desire and Arousal Disorders in Women Be Merged?

Should Sexual Desire and Arousal Disorders in Women Be Merged?

CS05-04 - Reconsidering the definitions of sexual disorders in DSM-V

The research of neurobiology and treatment of various disorders requires certain degree of homogeneity of the studied entities. In an ideal word, common etiology and/or pathogenesis would help to define homogenous entities. As our understanding of etiology and/or pathogenesis of mental disorders and diseases is lacking, we rely on various diagnostic systems to help us reach some degree of homogeneity.The diagnostic criteria of sexual dysfunction(s) in the DSM-IV are rather vague and imprecise. Interestingly, we are not even clear when a sexual problem becomes a sexual dysfunction. As the new versions of the diagnostic systems (e.g., DSM-V) are being prepared, the classification and definitions of sexual disorders/dysfunctions are being considered.The general classification issues that need to be and are addressed are specific duration of sexual dysfunctions, use of distress s a diagnostic criterion and quantification of severity and frequency. Strengthening and clarifying these three classification issues would probably help in defining more homogenous entities.The broader yet more specific issues to be considered are inclusions of new diagnostic entities (persistent genital arousal disorder in women; adjustment disorder with disturbed sexual functioning; coercive paraphilic disorder), possible removal or reclassification of some sexual dysfunctions (e.g., sexual aversion disorder - remove or reclassify as specific phobia); collapsing some entities into one (dyspareunia and vaginismus into genitor-pelvic pain/penetration disorder) changing the names of some dysfunctions (premature ejaculation to rapid ejaculation); and redefining some dysfunctions (e.g. sexual desire and subjective sexual arousal in women).

Interaction of organic and psychological factors in persistent genital arousal disorder in women: a report of six cases

There have been a number of case reports published recently describing women who complain of persistent genital arousal. Most of these papers do not report medical data or observations from genital examination. We report in such detail on six cases of persistent genital arousal disorder (PGAD) in women. We further advance the hypothesis that in many cases the objective genital component may be induced by a variety of psychophysiological and pathological factors such as anxiety, genital prolapses and dermatoses. Genital engorgement so produced may not be continuous but when present may be enhanced and perpetuated by both anxiety focussed on the genitals and masturbation used in an attempt to relieve the sensations. Premorbid affective psychological illness negatively colours the subjective perception of this genital engorgement, leading to either elicitation or maintenance of PGAD. We discuss this hypothesis in relation to our six cases.

A Mindfulness-Based Group Psychoeducational Intervention Targeting Sexual Arousal Disorder in Women

Despite their widespread prevalence, there are no existing evidence-based psychological treatments for women with sexual desire and arousal disorder. Mindfulness, the practice of relaxed wakefulness, is an ancient eastern practice with roots in Buddhist meditation which has been found to be an effective component of psychological treatments for numerous psychiatric and medical illnesses. In recent years, mindfulness has been incorporated into sex therapy and has been found effective for genital arousal disorder among women with acquired sexual complaints secondary to gynecologic cancer. The aim of this study was to adapt an existing mindfulness-based psychoeducation (PED) to a group format for women with sexual desire/interest disorder and/or sexual arousal disorders unrelated to cancer. Twenty-six women participated in three 90-minute sessions, spaced 2 weeks apart, with four to six other women. Group PED was administered by one mental health trained provider and one gynecologist with post graduate training and experience in sexual medicine. Prior to and following the group, women viewed audiovisual erotic stimuli and had both physiological (vaginal pulse amplitude) and subjective sexual arousal assessed. Additionally, they completed self-report questionnaires of sexual response, sexual distress, mood, and relationship satisfaction. There was a significant beneficial effect of the group PED on sexual desire and sexual distress. Also, we found a positive effect on self-assessed genital wetness despite little or no change in actual physiological arousal, and a marginally significant improvement in subjective and self-reported physical arousal during an erotic stimulus. A follow-up comparison of women with and without a sexual abuse history revealed that women with a sexual abuse history improved significantly more than those without such history on mental sexual excitement, genital tingling/throbbing, arousal, overall sexual function, sexual distress, and on negative affect while viewing the erotic film. Moreover, there was a trend for greater improvement on depression scores among those with a sexual abuse history. These data provide preliminary support for a brief, three-session group psychoeducational intervention for women with sexual desire and arousal complaints. Specifically, women with a history of sexual abuse improved more than women without such a history. Participant feedback indicated that mindfulness was the most effective component of the treatment, in line with prior findings. However, future compartmentalization trials are necessary in order to conclude this more definitively.

Persistent Genital Arousal Disorder in Women: What is Known and What is Unknown

Persistent Genital Arousal Disorder (PGAD) is a relatively newly identified and perplexing condition characterized by high levels of unrelenting genital arousal occurring in the absence of subjective interest or desire. This arousal can persist for hours, days or even weeks, despite attempts to relieve it with sexual activity or orgasm which at best provide only brief attenuation of the symptoms. The PGAD diagnosis is made based on the presence of four features (persistent genital arousal, genital arousal unrelated to subjective desire, arousal which persists despite one or more orgasms, arousal feels intrusive). Subjective distress is rated as at least moderate or severe (a score of 2 or 3 on a scale where 0= no distress and 3= extreme distress). The shame and embarrassment attached to the symptoms most likely has contributed to the phenomenon going unrecognized nd underreported until recently. Complaints by sufferers can include clitoral tingling, irritation, vaginal congestion, vaginal contractions, throbbing, pressure and pain, as well as spontaneous orgasms in some cases. Attempts to quell the genital arousal by engaging in masturbation or sexual activity often leads to brief relief, no relief, or even more arousal and activation. Compared to non-PGAD women, PGAD patients exhibit overall lower levels of sexual satisfaction, lower desire and greater pain on the Female Sexual Functioning Inventory (FSFI). They also evidence a higher incidence of anxiety, depression and obsessive symptoms than non-PGAD women. These conditions seem to pre-date rather than result from their symptoms No definitive physical, hormonal or neurological associations have been identified as causing the disorder and there is no evidence of any particular medical condition associated with PGAD with the exception that women complaining of PGAD are more likely to report chronic fatigue. A relatively high percentage of women with PGAD than non-PGAD women report having used selective serotonin reuptake inhibitors, atypical anti-depressants or tricyclic antidepressants either in the past or currently although there is no clear evidence linking the use or discontinuation of these agents with the syndrome. Although psychological factors are clearly implicated in the maintenance, if not always the genesis of the condition, there is evidence that there are brain changes associated with the report of genital arousal. Specifically, preliminary fMRI data on a small pilot sample of women indicate that there is a high level of brain activity in and extending into the posterior cingulated cortex, a region of the brain that is reported to respond to pain and itch. The fact that these fMRI findings occur in the absence of direct physical stimulation of the genitalia suggest that the symptoms of PGAD are “real” and “physiological” rather than “imaginary.” At this time, there are many unknowns about PGAD: prevalence figures are uncertain, although it is likely that there are more cases than are reported. The etiology is unknown although there are many hypotheses including a) central neurological changes (e.g., post-injury, specific brain lesion anomaly), b) peripheral neurological changes (e.g., pelvic nerve hypersensitivity or entrapment), c) vascular changes (e.g., pelvic congestion), d) mechanical pressure against genital structures, e) medication-induced changes, and f) psychological changes (stress) or some combination of all of the above. There is no generally accepted treatment for PGAD and current interventions focus largely on symptom management. Anesthetizing agents may be used initially to numb the area and pelvic massage or stretching exercises may help reduce or eliminate pelvic tension and disrupt connective tissue strictures that may contribute to the condition. Medication treatment is largely achieved by trial and error, as certain medications may be associated paradoxically with either alleviation or exacerbation of the symptoms. Cognitive-Behavioral interventions have been used to enhance coping skills and assist in interrupting the cycle of anxiety and catastrophizing of the symptoms. This cycle plays a significant role in PGAD, for anxiety worsens the symptoms by leading to increased autonomic activation, which may, in turn, lead to greater genital arousal. More research is clearly needed to clarify the prevalence, etiology and treatment of this perplexing and distressing condition.

Persistent Genital Arousal Disorder in Women: Case Reports of Association with Anti-Depressant Usage and Withdrawal

Little is known with certitude about the triggers of persistent genital arousal disorder (PGAD) in women, although there appears to be certain common features of the disorder. Women complain of unbidden feelings of genital arousal that are qualitatively different from sexual arousal that is preceded by sexual desire/and or subjective arousal. The majority of women find PGAD distressing and report only brief relief with orgasm. In this article, we describe five women who believe they developed PGAD either after withdrawing from selective serotonin reuptake inhibitor (SSRI) anti-depressants or while using them. We discuss these sexual symptoms in relation to what is already known about prolonged SSRI withdrawal syndromes and the possible etiologies of these conditions. While not a common cause of PGAD, it is possible that use of, and withdrawal from, pharmacological agents contributes to the development of PGAD.

Sexual Desire and Arousal Disorders in Women

A 46-year-old woman, married for 16 years, reports having had a low level of sexual desire and minimal sexual arousal during sexual activity for the past 10 years. Sexual thoughts, fantasies, and orgasms are all extremely rare. Lubrication is sufficient to allow painless intercourse. She and her husband have an eight-year-old son who was born after in vitro fertilization for unexplained infertility. How should this patient be assessed and treated?

Arousal disorders in women: complaints and complexities

Female sexual arousal disorders constitute a varied spectrum of difficulties, ranging from the total absence of genital or subjective pleasurable arousal to feelings of persistent genital arousal in the absence of sexual desire. Arousal disorders can be associated with physical factors (eg, vaginal dryness) or psychological factors (eg, anxiety, distraction), or a combination of both. The most common complaint is the absence of subjective sexual excitement or pleasure despite adequate physical arousal (eg, lubrication). Pharmacological and physical treatments include the use of oestrogen, lubricants and vibrators. There may be a place for drugs that increase vasocongestion and vasodilation. Psychological therapy addresses inhibitions, and interpersonal and motivational factors.

Prevalence and risk factors of sexual dysfunction in men and women.

Sexual dysfunctions are highly prevalent, affecting about 43% of women and 31% of men. Hypoactive sexual desire disorder has been reported in approximately 30% of women and 15% of men in population-based studies, and is associated with a wide variety of medical and psychologic causes. Sexual arousal disorders, including erectile dysfunction in men and female sexual arousal disorder in women, are found in 10% to 20% of men and women, and is strongly age-related in men. Orgasmic disorder is relatively common in women, affecting about 10% to 15% in community-based studies. In contrast, premature ejaculation is the most common sexual complaint of men, with a reporting rate of approximately 30% in most studies. Finally, sexual pain disorders have been reported in 10% to 15% of women and less than 5% of men. In addition to their widespread prevalence, sexual dysfunctions have been found to impact significantly on interpersonal functioning and overall quality of life in both men and women.