Female Sexual Dysfunction Part 2: Increasing Sexual Desire and Arousal

Interview with Taylor Segraves, M.D., Ph.D., lead investigator for the Wellbutrin study and professor of psychiatry at Case Western Reserve University School of Medicine

Q. What is the difference between sexual arousal and sexual desire?

A. In most women who are not experiencing sexual problems, libido and arousal are closely related and difficult to separate. Libido refers to a baseline interest in sex and might be redefined as sexual appetite. Arousal refers to the physiological response to sexual stimuli. Women with higher libidos generally have a greater response to sexual stimuli, or greater arousal. Physical manifestations of sexual arousal include vaginal lubrication and increased blood flow to the labia, clitoris and vagina.

Q. What can increase sexual arousal in women?

A. One of the symptoms of decreased sexual arousal in women, is a reduced amount of vaginal lubrication. Over-the-counter vaginal lubricants can augment lubrication.
If a decrease in vaginal lubrication has been caused by menopause, hormone replacement therapy can help. This is the only approved drug therapy for this disorder.

and a class of medications called alpha-adrenergic blockers, such as Regitine (phentolamine), can also increase the vaginal lubrication response to sexual stimulation. However, it should be mentioned that study after study of Viagra for various female sexual problems have not shown an increase in sexual pleasure in women.

Aside from pharmacologic solutions, women can also choose behavioral therapy to help increase sexual arousal. Such therapy is aimed at enhancing sexual fantasies and focusing one's attention on sexual stimuli. For women in on-going relationships, the therapist would also look into the possibility of communication problems in the relationship, or lack of sexual stimulation by the woman's partner.

Q. What can increase sexual desire in women?

A. At this time, there are no approved drug treatments for low sexual desire. However, a recent study of 66 women, ages 23 to 65, with HSDD for an average of six years, found that Wellbutrin SR may be an effective treatment. Approximately one-third of women experienced doubled interest in sexual activity, sexual arousal, and sexual fantasies. Although Wellbutrin SR is an antidepressant, the women in this study did not suffer from depression and they did not have relationship difficulties. More studies are needed to support this preliminary data.

There have also been studies that indicate that testosterone can increase sexual desire in women whose low sex drive is a result of the surgical removal of their ovaries. Continual treatment with testosterone does have side effects and may lead to "masculine" side effects in some women (i.e., lower voice, hair loss, enlarged clitoris).

Another factor to consider is that for some women, feelings of guilt and shame learned in early childhood may interfere with adult sexual function and may affect one or more phases of the sexual response cycle. In these instances, as well as in cases of sexual abuse, psychotherapy may be beneficial. Marriage counseling or couples therapy can also be of value.