Treatment Options for the Patient with Sexual Arousal Concerns

CLINICAL ACTIONS:

Arousal problems occur when women do not experience the usual sexual response to the introduction of sexual stimulation.

• Obtain a history to better understand the problem
• Ascertain that the problem is arousal, rather than desire/libido
• Clarify woman’s arousal response by asking about lubrication, mental interest, tingling or swelling normally experienced by the patient
• Consider treatment with medications, but benefit may also be gained by simultaneous referral to a sex therapist

SYNOPSIS:

Women describe problems with sexual arousal in a variety of ways: an inability to “quiet the laundry list” in their brains, or a marked absence of the swelling and tingling often felt with sexual arousal.  Absent too may be the lubrication that women have experienced in the past. Often they will describe it as “nothing happening down there.”  Once the possibility of the problem being desire rather than arousal has been excluded (see differential diagnosis desire/arousal) there are a number of treatments that can be effective.

KEY POINTS:

• Assess whether the problems with arousal is due to side effects of medications and if that is the case, consider whether those medications should be reduced or discontinued under the guidance of the prescribing physician
  • SSRIs and SNRIs can often cause arousal problems in women
  • Oral contraceptive pills can also affect a woman’s ability to become aroused. Sometimes women will describe the feeling as “being covered in a slipcover”
• Treatment options include:
  • Bupropion xl 150 mg daily, increase if needed, to twice daily up to 300 mg per day
  • Testosterone Treatment
  • Introduction of strong vibrator
  • While some advocate for the use of PDE5 (phosphodiesterase type 5) inhibitors, used for male erectile dysfunction, ACOG does not recommend use of these drugs without further study
• Education is needed in those cases where, due to medication or age, more direct or higher levels of stimulation are needed and perfectly natural
• Consider referral to a sex therapist to recommend or discuss practical solutions to increasing mental and physical stimulation
  • A sex therapist may help the patient to take more time and can suggest use of erotica, fantasy or vibrators

Learn More – Primary Sources:

Management of antidepressant-induced sexual dysfunction

Reversal of SSRI-induced female sexual dysfunction by adjunctive bupropion in menstruating women: a double-blind, placebo-controlled and randomized study

Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction

AAFP: Sexual Dysfunction in Women – A Practical Approach

Cochrane Review: Strategies for managing sexual dysfunction induced by antidepressant medication

Related ObG Topics:

A Patient Complains of Anorgasmia – What Next?

Bupropion for Sexual Dysfunction

Female Sexual Dysfunction Explained