This is also called female arousal disorder, it is characterized by minimal vaginal lubrication or no lubrication at all during sexual excitation along with the absence of feeling of excitation. In one study many women complained of lack of sexual arousal so that they get very little lubrication & vagina does not relax so that sexual intercourse is painful. In population, many women complain of difficulty in getting excited. Many such women complain of the absence of orgasm & sex may even be painful. It can be from the beginning of sexual life or may start later in life. In some arousal may be absent with one partner whereas it is normal with another partner.

Lack of arousal in Women

Causes of Lack of enjoyment during intercourse

  • Disorder of sex center: So that vagina & muscles around it goes into painful spasm at the point of penis entry rather than relaxing.
  • Hormones Disorder: Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies) Hypogonadisms, Hypothyroidism, Testosterone deficiency, hyperprolactinemias, Hypogonadotropic states: Hypothalamic-pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, Ovarian Dysfunctions Hypothyroidisms Untreated endocrinopathies & Diabetics Glucorticoids excess, Cushing’s disease, Addisons disease
  • Excess asthenia i.e. chronic asthenia is also a significant cause of low sexual excitation & arousal.
  • chronic vulvovaginitis, and chronic urethritis.
  • Addiction as chronic alcoholism, chronic smoker, heroin or cannabis use.
  • Drugs: Sedative: Narcotics, tranquilizers, amphetamine, cocaine, many antidepressants, and anti-psychotics, anti-hypertensives, many other drugs.
  • Psychiatric disorder as depression, neurosis, & many other psychiatric disorders.
  • Any kind of sexual dysfunction in man leading to non-enjoyment of sexual act by a female may lead to absent arousal & excitement.
  • Any cause of painful sexual intercourse (as due to vaginismus or dyspareunia) will also lead to secondary loss of excitation in women whether married or unmarried.
  • Decreased blood supply to the vagina due to various medical conditions can lead to diminishing vaginal lubrication, pain during intercourse
  • Infections: In genital tract or vulvae vestibule, vulvovaginitis
  • Less lubrication due to various reasons as hormone deficiency
  • Connective tissue diseases leading to dryness
  • Psychological problems: as depression & other psychiatry disorders
  • Sicca syndrome
  • Idiopathic
  • Decreased blood supply to the vagina due to various medical conditions can lead to diminishing vaginal lubrication, pain during intercourse
  • Vulvar vestibulitis
  • Restrictive upbringing, Inadequate sexual information, early insecurity in the psychosexual role.
  • Obstructive vaginal lesions: Vaginal stenosis, vaginal scarring, post-surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum
  • Idiopathic vulvodynia

Disorders of sex center

In the brain, there is a particular center in the hippocampus part of the fore brain, which regulates the desire of sex. Sex center has some well-defined portion, which controls different component of normal sexuality These are as follows as one part of sex center controls sexual desire other parts controls excitation i.e. lubrication in response to sexual excitation, time is taken in orgasm & enjoyment of sexual act including enjoyment of orgasm. So any disorder of sex center due to various causes can lead to less excitation in response to sexual stimuli. This occurs due to arousal & excitation-controlling portions of the sex center do not work properly so that in spite of \not having any physical or mental disorders the patient does not gets sexually excited. Beside absent excitation, the patient may sexually otherwise be fit or may be suffering from some other sexual disorder.

The causes of sex center dysfunction can be divided into two groups:

    • Immediate cause
    • Remote causes.

Such a classification is helpful in the treatment of absent excitation. If the absent excitation & arousal is due to immediate causes, a removal of these factors results in adequate excitation & lubrication & enjoyment by women. If it is due to remote causes, then detailed sex therapy may be necessary for a more lasting cure.

DIAGNOSIS OF CAUSE

The first step in proper treatment of absence of sexual excitation & arousal is an accurate diagnosis of the cause of her absence of sexual excitation & arousal. So we first try to find out the cause. We take a detailed history, thorough sex counseling and physical examination by a sexologist in Delhi, examination genitals. After that depending on the likelihood of particular, cause relevant tests are done at our center. Thus you may consult us at our center & at the same time, you may get all the test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

DETAILED HISTORY

Onset: We take a detailed history, as for the duration of absence of sexual excitation & arousal whether it is from the beginning or of recent onset, whether it is mild, moderate or severe. Then we decide whether it occurs all the time or only occasionally. How is the response of previous treatment? Response to previous therapy, pain during sex, Stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

EXAMINATION OF GENITALS

We examine whether any Sexual Development defect is present or not. The vagina is examined for some local problem. If the vaginal examination is very painful with accompanied spasm is proof of some local cause. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoea & features of other hormones disorders are checked up. Blood supply of vagina is assessed by, palpating texture of the vaginal wall. Nerves supplying the female genitals examined by sensation testing & Deep Tendon reflexes. Then other systems of the body are also examined.

DIAGNOSTIC TESTS

At our sex clinic in Delhi, we have all the facility for a complete investigation of the cause of the absence of sexual excitation & arousal & other difficulties. So we perform following tests, step by step depending on their need based on history & examination.

The various diagnostic tests needed/performed are as follows: –

Complete sex hormones profile as Estradiol, SHBG, etc.

      • Thyroids test
      • Serum prolactin
      • Androgen levels
      • Investigation of systemic diseases
      • Other tests which may be required depending on the likelihood of any of the above causes.
      • Detailed Sex Counseling: detailed sex counseling session, in which our male & female sex counselors meet with the respective patient, talking in detail resulting in the detection of primary cause leading to the absence of sexual excitation & arousal.
      • In biochemistry Tests as the liver function or kidney function tests are done.

These tests confirm the diagnosis of absence of sexual excitation & arousal confirmed.

TREATMENT

After the diagnosis of the cause of the absence of sexual excitation & arousal is made, treatment includes medicines to cure the basic cause.

The various treatment options are:

      • Hormone Therapy: When female sex hormone deficiency is found or disorder of other glands the correction of hormone dysfunction is done. Hormone therapy is very effective in curing the absence of sexual excitation & arousal when a hormone is a cause for the absence of sexual excitation & arousal. It is given in the form of oral tablets. Skin cream, local application of gels. These medicines are given in well tested prescribed doses as described in authentic textbooks. Some hormone precursors have also been used for increasing sexual excitation in many patients in whom no hormone disorder is found.
      • Sex therapy is offered in which we teach the patient about the various techniques in such a way that it increases the enjoyment of body touch better excitation & arousal in a female. This leads to good lubrication of vagina thus women enjoy the sex more pleasurable. Due to this more enjoyment of sex leads to women getting orgasm more often. All this improves the desire of sex as well as the enjoyment of sex.
      • Treatment of chronic asthenia is done by replacement of antiasthenic drug with good results.
      • Treatment of Urogenital infection balanitis, prostatitis, and epididymitis gives immediate relief & very dramatic increase in absence of sexual excitation & arousal.
      • Stop Offending drugs which patients are consuming is identified after detailed history & drug challenge is discontinued permanent cure of the absence of sexual excitation & arousal.
      • Treatment of psychiatric disorder are diagnosed & treated.
      • Oral supplement of DHEAS is also effective.
      • Treatment of sex center disorder: In cases of absence of sexual excitation & arousal due to sex center disorder there are many drugs, which improve the sexual excitation & arousal like hormone precursors, sex center stimulator drugs. These drugs act on the sex center & correct the biochemical defect in the sex center, leading the return of the sexual excitation & arousal.
      • Treat other systemic diseases when they are detected.

Response of Treatment

When treatment is started after the diagnosis of the cause. After appropriate drug therapy, sex education & sex therapy patient recover in two months time. The sexual excitation & arousal of patient recovers. After the return of libido to normal her family relationship also normalizes.

Side Effects

It has no side effects if given in proper doses and in-patients when it is really indicated. This is absolutely safe when given by our qualified doctors, in proper doses.