Sexual arousal disorder is defined as the persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress.

Estrogen, testosterone, and sildenafil (Viagra), have been shown to increase the production of nitric oxide and its active metabolite cGMP.

Etiology

Pain (dyspareunia, vaginismus), psychosexual factors (e.g. insufficient or inadequate stimulation), falling serum estradiol as well as testosterone levels (e.g. in the perimepausal years), postmenopausal urogenital atrophy, small vessel atherosclerotic disease of the genitalia, as well as the use of medications, including antidepressants (SSRI's & tricyclic), birth control pills, tranquilizers, antihypertensives, and anticonvulsants, can be associated with sexual arousal disorder.

Therapy

Relief of sexual pain, through treatment of dyspareunia, is often enough to restore sexual desire & arousal to their normal levels.

Water based liquid lubricants such as astroglide, applied, can be helpful in alleviating pain during vaginal penetration.

Estrogen deficiency in menopausal women can cause not only mood alterations, but also a decrease in vasocongestion and lubrication as well as atrophy of the vagina. These changes may impair the physiological and psychosexual arousal response and cause dyspareunia. Estrogen supplementation in these cases, either orally or locally to the genitalia, has been associated with restoration of sexual arousal.

Testosterone transdermal cream application has been shown to increase clitoral sensitivity and increase vaginal lubrication through increased vasocongestion, thus resulting in heightened state of sexual arousal.

Pelvic muscle relaxation/contraction exercises can provide not only "distraction" from pain in patients with introital dyspareunia, but also increase vasovongestion of the genitalia, thus improving sexual arousal.

Viagra (Sildenafil) inhibits the metabolism of cGMP, prolonging clitoral tumescence, genital vasocongestion and vaginal lubrication. It seems therefore to be helpful, not only in enhancing sexual arousal but also inhibited orgasm.

L-arginine, a precursor of nitric oxide, enhances genital vasocongestion, clitoral engorgement and vaginal lubrication, thus heightening sexual arousal & facilitating orgasm. It exists as an oral supplement (Arginmax), or menthol cream base (Viacreme). Significant improvement in sexual responsiveness has been reported after 4 weeks of daily use. (perpetuation of oral & genital herpes may occur).

EROS-CTD, one of the first FDA-approved treatments of female sexual dysfunction, is a small hand-held, battery-operated device, with a small cup that stimulates clitoral and labial vasocongestion through vacuum suction. Clinical studies have shown a significant increase in arousal and ability to achieve orgasms.