Defining and Diagnosing Female Sexual Interest/Arousal Disorder

Female sexual interest/arousal disorder (FSIAD) is defined as absent/significantly reduced sexual interest or arousal in women. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), FSIAD is manifested by at least three of the following symptoms:

1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies.
3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate.
4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
6. Absent/reduced genital or non-genital sensations during sexual activity in almost all or all (approximately 75%–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

Symptoms must persist for at least 6 months and cause clinically significant distress in the patient for a diagnosis of FSIAD to be given. To warrant a FSIAD diagnosis, the symptoms cannot be better explained by a nonsexual mental disorder, severe relationship distress, or other significant life stressors. Lastly, the patient’s complaints cannot be related to another medical condition, substance, or medication to receive a FSIAD diagnosis.

When diagnosing FSIAD in a patient, there are a few things that a medical professional should consider.

1. It is important to determine whether the condition is lifelong (i.e., it has been present since the individual became sexually active) or acquired (i.e., it began after a period of relatively normal sexual functioning).
2. The provider should identify whether the condition is generalized or situational.
   1. Generalized FSIAD occurs regardless of the type of stimulation, situation, or partner.
   2. Situational FSIAD occurs with certain types of stimulation, situations, or partners.
3. FSIAD should be classified as mild, moderate, or severe, in accordance with the level of distress the patient exhibits regarding their symptoms.

FSIAD and other medical conditions that decrease a person’s sexual desire can have a negative impact on a patient’s sexual health and overall quality of life. Accurately diagnosing sexual interest and arousal disorders can be the first step towards improving sexual health outcomes for patients.

References:

Both S. (2017). Recent Developments in Psychopharmaceutical Approaches to Treating Female Sexual Interest and Arousal Disorder. Current sexual health reports, 9(4), 192–199. https://doi.org/10.1007/s11930-017-0124-3

Clayton, A.H., & Valladares Juarez, E.M. (2019). Female Sexual Dysfunction. The Medical clinics of North America, 103(4), 681–698. https://doi.org/10.1016/j.mcna.2019.02.008

Faubion, S.S., & Rullo, J.E. (2015). Sexual Dysfunction in Women: A Practical Approach. American family physician, 92(4), 281–288.