Skip to main content
SpringerLink
Log in

Evaluation of Female Sexual Interest/Arousal Disorder

  • Chapter
  • First Online:
Book cover The Textbook of Clinical Sexual Medicine

Abstract

In this chapter, we review current conceptualizations of female sexual interest/arousal disorder, which is new to DSM-5, with a focus on recent empirical and theoretical advances. In particular, we refer to the results of epidemiological and clinical studies and to the current controversy surrounding this new diagnosis. We provide a detailed description of the many biological and psychosocial factors that contribute to decreased sexual interest and arousal in women. Finally, we suggest that a comprehensive assessment is critical to the development of a strong treatment plan for women with this disorder.

Within the context of this chapter, sexual interest refers to the motivation to engage in sexual activity. Interest is commonly referred to as “desire,” “sex drive,” and “sexual appetite,” and it describes the sexual feelings motivating a person to seek some type of sexual activity, whether partnered or alone. Sexual arousal is defined by both physical and mental readiness for sexual activity. Mental sexual arousal refers to the psychological state of feeling “turned on,” and physiological arousal involves changes that occur in the body to prepare for a sexual interaction (vaginal swelling and lubrication). The absence of either mental or physiological arousal may cause significant distress.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Laumann EO, Paik A, Rosen RC, Page P. Sexual dysfunction in the United States. JAMA. 1999;282(13):1229.

    Article  Google Scholar 

  2. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the global study of sexual attitudes and behaviors. Int J Impot Res. 2005;17(1):39–57.

    Article  CAS  PubMed  Google Scholar 

  3. Bancroft J, Loftus J, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav. 2003;32(3):193–208.

    Article  PubMed  Google Scholar 

  4. Witting K, Santtila P, Varjonen M, Jern P, Johansson A, Von Der Pahlen B, et al. Female sexual dysfunction, sexual distress, and compatibility with partner. J Sex Med. 2008;5:2587–99.

    Article  PubMed  Google Scholar 

  5. Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E, et al. Epidemiology/risk factors of sexual dysfunction. J Sex Med. 2004;1(1):35–9.

    Article  PubMed  Google Scholar 

  6. Mercer CH, Fenton KA, Johnson AM, Wellings K, Macdowall W, McManus S, et al. Sexual function problems and help seeking behaviour in Britain: national probability sample survey. BMJ. 2003;327(7412):426–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dunn KM, Croft PR, Hackett GI. Sexual problems: a study of the prevalence and need for health care in the general population. Fam Pract. 1998;15:519–24.

    Article  CAS  PubMed  Google Scholar 

  8. Rosen R, Taylor JF, Leiblum SR, Bachmann GA. Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic. J Sex Marital Ther. 1993;19(3):171–88.

    Article  CAS  PubMed  Google Scholar 

  9. Shifren JL, Monz BU, Russo PA, Segreti A. Sexual problems and distress in United States women. Obstet Gynecol. 2008;112(5):970–8.

    Article  PubMed  Google Scholar 

  10. Dennerstein L, Koochaki P, Barton I, Graziottin A. Hypoactive sexual desire disorder in menopausal women: a survey of Western European women. J Sex Med. 2006;3:212–22.

    Article  PubMed  Google Scholar 

  11. Leiblum SR, Koochaki PE, Rodenberg CA, Barton IP, Rosen RC. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women’s International Study of Health and Sexuality (WISHeS). Menopause. 2006;13(1):46–56.

    Article  PubMed  Google Scholar 

  12. Diamond LM, Wallen K. Sexual minority women’s sexual motivation around the time of ovulation. Arch Sex Behav. 2011;40(2):237–46.

    Article  PubMed  Google Scholar 

  13. Pillsworth EG, Haselton MG, Buss DM. Ovulatory shifts in female sexual desire. J Sex Res. 2004;41(1):55–65.

    Article  PubMed  Google Scholar 

  14. Schmidt PJ, Rubinow DR. Sex hormones and mood in the perimenopause. Ann N Y Acad Sci. 2009;1179:70–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sandhu KS, Melman A, Mikhail MS. Impact of hormones on female sexual function and dysfunction. Female Pelvic Med Reconstr Surg. 2011;17(1):8–16.

    Article  PubMed  Google Scholar 

  16. Van Anders SM, Brotto LA, Farrell J, Yule M. Associations among physiological and subjective sexual response, sexual desire, and salivary steriod hormones in healthy premenopausal women. J Sex Med. 2009;6:739–51.

    Article  PubMed  Google Scholar 

  17. Van Anders SM, Gray PB. Hormones and human partnering. Annu Rev Sex Res. 2007;18:60–93.

    Google Scholar 

  18. Van Anders SM. Testosterone and sexual desire in healthy women and men. Arch Sex Behav. 2012;41(6):1471–84.

    Article  PubMed  Google Scholar 

  19. McCall KM, Meston CM. Cues resulting in desire for sexual activity in women. J Sex Med. 2006;3(5):838–52.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Davison SL, Bell RJ, LaChina M, Holden SL, Davis SR. Sexual function in well women: stratification by sexual satisfaction, hormone use, and menopause status. J Sex Med. 2008;5:1214–22.

    Article  PubMed  Google Scholar 

  21. Wallwiener CW, Wallwiener LM, Seeger H, Muck AO, Bitzer J, Wallwiener M. Prevalence of sexual dysfunction and impact of contraception in female German medical students. J Sex Med. 2010;7:2139–48.

    Article  PubMed  Google Scholar 

  22. Wexler BE. Review article neuroplasticity , cultural evolution and cultural difference. World Cult Psychiatry Res Rev. 2010;Summer:11–22.

    Google Scholar 

  23. Wittenberg GF. Experience, cortical remapping, and recovery in brain disease. Neurobiol Dis. 2010;37(2):252–8 .Elsevier B.V

    Article  PubMed  Google Scholar 

  24. Stahl SM. Targeting circuits of sexual desire as a treatment strategy for hypoactive sexual desire disorder. J Clin Psychiatry. 2010;71(7):821–2.

    Article  PubMed  Google Scholar 

  25. Pfaus JG. Pathways of sexual desire. J Sex Med. 2009;6(6):1506–33.

    Article  CAS  PubMed  Google Scholar 

  26. Clayton AH, El Haddad S, Iluonakhamhe J-P, Ponce Martinez C, Schuck AE. Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf. 2014;13(10):1361–74.

    Article  CAS  PubMed  Google Scholar 

  27. Keks NA, Hope J, Culhane C. Management of antidepressant-induced sexual dysfunction. Australas Psychiatry. 2014;22(6):525–8.

    Article  PubMed  Google Scholar 

  28. Dennerstein L, Lehert P. Women’s sexual functioning, lifestyle, mid-age, and menopause in 12 European countries. Menopause. 2004;11(6 Pt 2):778–85.

    Article  PubMed  Google Scholar 

  29. Gerber JR, Johnson JV, Bunn JY, O’Brien SL. A longitudinal study of the effects of free testosterone and other psychosocial variables on sexual function during the natural traverse of menopause. Fertil Steril. 2005;83(3):643–8.

    Article  CAS  PubMed  Google Scholar 

  30. Exton NG, Chau Truong T, Exton MS, Wingenfeld SA, Leygraf N, Saller B, et al. Neuroendocrine response to film-induced sexual arousal in men and women. Psychoneuroendocrinology. 2000;25:187–99.

    Article  CAS  PubMed  Google Scholar 

  31. Sipski ML, Alexander CJ, Rosen RC. Physiological parameters associated with sexual arousal in women with incomplete spinal cord injury. Arch Phys Med Rehabil. 1997;78:305–13.

    Article  CAS  PubMed  Google Scholar 

  32. Sipski ML, Alexander CJ, Rosen R. Sexual arousal and orgasm in women: Effects of spinal cord injury. Ann Neurol. 2001;49(1):35–44.

    Article  CAS  PubMed  Google Scholar 

  33. Meston CM, Gorzalka BB. Differential effects of sympathetic activation on sexual arousal in sexually dysfunctional and functional women. J Abnorm Psychol. 1996 Nov;105(4):582–91.

    Article  CAS  PubMed  Google Scholar 

  34. Meston CM, Gorzalka BB. The effects of immediate, delayed, and residual sympathetic activation on sexual arousal in women. Behav Res Ther. 1996;34(2):143–8.

    Article  CAS  PubMed  Google Scholar 

  35. Meston CM, Gorzalka BB. The effects of sympathetic activation on physiological and subjective sexual arousal in women. Behav Res Ther. 1995;33(6):651–64.

    Article  CAS  PubMed  Google Scholar 

  36. Meston CM, Heiman JR. Ephedrine-activated physiological sexual arousal in women. Arch Gen Psychiatry. 1998;55(7):652–6.

    Article  CAS  PubMed  Google Scholar 

  37. Meston CM, Gorzalka BB, Wright JM. Inhibition of subjective and physiological sexual arousal in women by clonidine. Psychosom Med. 1997;59:339–407.

    Article  Google Scholar 

  38. Lorenz TA, Harte CB, Hamilton LD, Meston CM. Evidence for a curvilinear relationship between sympathetic nervous system activation and women’s physiological sexual arousal. Psychophysiology. 2012;49(1):111–7.

    Article  PubMed  Google Scholar 

  39. Stanton AM, Lorenz TA, Pulverman CS, Meston CM. Heart rate variability: a risk factor for female sexual dysfunction. Appl Psychophysiol Biofeedback. 2015;40(3):229–37.

    Article  PubMed  Google Scholar 

  40. Xhyheri B, Manfrini O, Mazzolini M, Pizzi C, Bugiardini R. Heart rate variability today. Prog Cardiovasc Dis. 2012;55(3):321–31.

    Article  PubMed  Google Scholar 

  41. Hulter, B. (1999). Sexual function in women with neurological disorders (Doctoral dissertation, Acta Universitatis Upsaliensis).

    Google Scholar 

  42. Lew-Starowicz M, Rola R. Prevalence of sexual dysfunctions among women with multiple sclerosis. Sex Disabil. 2013;31(2):141–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Schover LR, Jensen SB. Sexual problems and chronic disease: a comprehensive approach. New York, NY: Guilford Press; 1988.

    Google Scholar 

  44. Spector IP, Leiblum SR, Carey MP, Rosen RC. Diabetes and female sexual function: a critical review. Ann Behav Med. 1993;15(4):257–64.

    Google Scholar 

  45. Frohlich PF, Meston CM. Evidence that serotonin affects female sexual functioning via peripheral mechanisms. Physiol Behav. 2000;71(3–4):383–93.

    Article  CAS  PubMed  Google Scholar 

  46. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009;29(2):157–64.

    Article  CAS  PubMed  Google Scholar 

  47. Smith NK, Jozkowski KN, Sanders SA. Hormonal contraception and female pain, orgasm, and sexual pleasure. J Sex Med. 2014;11(2):462–70.

    Article  PubMed  Google Scholar 

  48. Murray SH, Milhausen RR. Sexual desire and relationship duration in young men and women. J Sex Marital Ther. 2012;38(1):28–40.

    Article  PubMed  Google Scholar 

  49. Nobre PJ, Pinto-Gouveia J. Dysfunctional sexual beliefs as vulnerability factors to sexual dysfunction. J Sex Res. 2006;43(1):68–75.

    Article  PubMed  Google Scholar 

  50. Nobre PJ, Pinto-Gouveia J. Differences in automatic thoughts presented during sexual activity between sexually functional and dysfunctional men and women. Cognit Ther Res. 2008;32(1):37–49.

    Article  Google Scholar 

  51. Woo JST, Brotto L. a, Gorzalka BB. The relationship between sex guilt and sexual desire in a community sample of Chinese and Euro-Canadian women. J Sex Res. 2012;49(2–3):290–8.

    Article  PubMed  Google Scholar 

  52. Richgels PB. Hypoactive sexual desire in heterosexual women: a feminist analysis. Women Ther. 1992;12(1–2):123–35.

    Article  Google Scholar 

  53. Barlow DH. Causes of sexual dysfunction: The role of anxiety and cognitive interference. J Consult Clin Psychol. 1986;54(2):140–8.

    Article  CAS  PubMed  Google Scholar 

  54. Dove NL, Wiederman MW. Cognitive distraction and women’s sexual functioning. J Sex Marital Ther. 2000;26(1):67–78.

    Article  CAS  PubMed  Google Scholar 

  55. Wiederman MW. Women’s body image self-consciousness during physical intimacy with a partner. J Sex Res. 2000;37(1):60–8.

    Article  Google Scholar 

  56. Rellini A. Review of the empirical evidence for a theoretical model to understand the sexual problems of women with a history of CSA. J Sex Med. 2008;5(1):31–46.

    Article  PubMed  Google Scholar 

  57. Andersen BL, Cyranowski JM. Women’s sexual self-schema. J Pers Soc Psychol. 1994;67(6):1079–100.

    Article  Google Scholar 

  58. Meston CM, Rellini AH, Heiman JR. Women’s history of sexual abuse, their sexuality, and sexual self-schemas. J Consult Clin Psychol. 2006;74(2):229–36.

    Article  PubMed  Google Scholar 

  59. Stanton AM, Boyd RL, Pulverman CS, Meston CM. Determining women’s sexual self-schemas through advanced computerized text analysis. Child Abuse Negl. 2015;46:78–88.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bensley LS, Van Eenwyk J, Simmons KW. Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. Am J Prev Med. 2000;18(2):151–8.

    Article  CAS  PubMed  Google Scholar 

  61. Leonard LM, Follette VM. Sexual functioning in women reporting a history of child sexual abuse: review of the empirical literature and clinical implications. Annu Rev Sex Res. 2002;13(1):346–88.

    PubMed  Google Scholar 

  62. Goldstein I, Fisher WA, Sand M, Rosen RC, Mollen M, Brock G, et al. Women’s sexual function improves when partners are administered vardenafil for erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial. J Sex Med. 2005;2(6):819–32.

    Article  CAS  PubMed  Google Scholar 

  63. Bancroft J, Janssen E. The dual control model of male sexual response: a theoretical approach to centrally mediated erectile dysfunction. Neurosci Biobehav Rev. 2000;24(5):571–9.

    Article  CAS  PubMed  Google Scholar 

  64. Graham CA, Sanders SA, Milhausen RR, Mcbride KR. Turning on and turning off: a focus group study of the factors that affect women’s sexual arousal. Arch Sex Behav. 2004;33(6):527–38.

    Article  PubMed  Google Scholar 

  65. Sarin S, Amsel R, Binik YM. A streetcar named “Derousal”? A psychophysiological examination of the desire–arousal distinction in sexually functional and dysfunctional women. J Sex Res. 2015;53(6):711–29.

    Article  PubMed  Google Scholar 

  66. Basson R, Leiblum SR, Brotto LA, Derogatis LR, Fourcroy JL, Fugl-Meyer KS, et al. Definitions of women’s sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynecol. 2003;24:221–9.

    Article  CAS  Google Scholar 

  67. Brotto LA, Heiman JR, Tolman DL. Narratives of desire in mid-age women with and Without arousal difficulties. J Sex Res. 2009;46(5):387–98.

    Article  PubMed  Google Scholar 

  68. Mitchell KR, Wellings KA, Graham C. How do men and women define sexual desire and sexual arousal? J Sex Marital Ther. 2014;40(1):17–32.

    Article  PubMed  Google Scholar 

  69. Basson R. The female sexual response: a different model. J Sex Marital Ther. 2000;26(1):51–65.

    Article  CAS  PubMed  Google Scholar 

  70. Laan E, Van Driel EM, Van Rik H.W. Van Lunsen. Genital responsiveness in healthy women with and without sexual arousal disorder. J Sex Med. 2008;5(6):1424–35.

    Google Scholar 

  71. Graham CA. The DSM diagnostic criteria for female sexual arousal disorder. Arch Sex Behav. 2010;39(2):240–55.

    Article  PubMed  Google Scholar 

  72. Clayton AH, Derogatis LR, Rosen RC, Pyke R. Intended or unintended consequences? The likely implications of raising the bar for sexual dysfunction diagnosis in the proposed DSM-V revisions: 2. For women WITH loss of subjective sexual arousal. J Sex Med. 2012;9(8):2040–6.

    Article  PubMed  Google Scholar 

  73. Balon R, Clayton AH. Female sexual interest/arousal disorder: a diagnosis out of thin air. Arch Sex Behav. 2014;43(7):1227–9.

    Article  PubMed  Google Scholar 

  74. Burri A, Greven C, Leupin M, Spector T, Rahman Q. A multivariate twin study of female sexual dysfunction. J Sex Med. 2012;9(10):2671–81.

    Article  PubMed  Google Scholar 

  75. Meston CM, Buss DM. Why women have sex. New York: St. Martin’s Press; 2009.

    Google Scholar 

  76. Guay AT, Spark R. Pathophysiology of sex steroids in women. In: Goldstein I, Meston CM, Davis SR, Traish AM, editors. Women’s sexual function and dysfunction: study, diagnosis, and treatment. New York: Taylor & Francis Group; 2006. p. 218–27.

    Google Scholar 

  77. Bachmann G, Braunstein G, Burger H, Dennerstein L, Leiblum S. Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment. Fertil Steril. 2002;77(4):661–5.

    Article  Google Scholar 

  78. Taylor JF, Rosen RC, Leiblum SR. Self-report assessment of female sexual function: psychometric evaluation of the brief index of sexual function for women. Arch Sex Behav. 1994;23:627–43.

    Article  CAS  PubMed  Google Scholar 

  79. Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33:371–45.

    Google Scholar 

  80. Derogatis L. The Derogatis interview for sexual functioning (DISF/DISF-SR): an introductory report. J Sex Marital Ther. 1979;23:291–04.

    Article  Google Scholar 

  81. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.

    Article  CAS  PubMed  Google Scholar 

  82. Meston C, Trapnell P. Development and validation of a five-factor sexual satisfaction and distress scale for women: the SEXUAL Satisfaction Scale for Women (SSS-W). J Sex Med. 2005;2(1):66–81.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Meston CM, Derogatis LR. Validated instruments for assessing female sexual function. J Sex Marital Ther. 2002;28:155–64.

    Article  PubMed  Google Scholar 

  84. Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38:15–28.

    Article  Google Scholar 

  85. Fletcher G, Kininmonth L. Measuring relationship beliefs: an individual differences scale. J Res Pers. 1992;26:371–97.

    Article  Google Scholar 

  86. Locke H, Wallace K. Short marital adjustment and prediction tests: their reliability and validity. J Marriage Fam Living. 1959;2:251–5.

    Article  Google Scholar 

  87. Flynn KE, Lin L, Cyranowski JM, Reeve BB, Reese JB, Jeffery DD, et al. Development of the NIH PROMIS® sexual function and satisfaction measures in patients with cancer. J Sex Med. 2013;10(01):43–52.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Weinfurt KP, Lin L, Bruner DW, Cyranowski JM, Dombeck CB, Hahn EA, et al. Development and initial validation of the PROMIS® sexual function and satisfaction measures version 2.0. J Sex Med. 2015;12(9):1961–74.

    Article  PubMed  Google Scholar 

  89. Stewart E. Physical examination and female sexual dysfunction. In: Goldstein I, Meston CM, Davis S, Traish A, editors. Women’s sexual function and dysfunction: study, diagnosis, and treatment. Boca Raton: Taylor & Francis Group; 2005. p. 347–55.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, The University of Texas at Austin, 108 E. Dean Keeton Stop A8000, Austin, TX, 78712, USA

    Cindy M. Meston & Amelia M. Stanton

Authors
  1. Cindy M. Meston
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amelia M. Stanton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cindy M. Meston .

Editor information

Editors and Affiliations

  1. Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Waguih William IsHak

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Meston, C.M., Stanton, A.M. (2017). Evaluation of Female Sexual Interest/Arousal Disorder. In: IsHak, W. (eds) The Textbook of Clinical Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-52539-6_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-52539-6_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52538-9

  • Online ISBN: 978-3-319-52539-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation