Female Sexual Interest/Arousal Disorder: Causes, Myths, Treatment Options, and Sex Therapy
What is Female Sexual Interest/Arousal Disorder
Sexual arousal and desire are distinct concepts but heavily integrated and intertwined. They often overlap in a inseparable relationship. While arousal is the brain and body’s readiness for sexual activity (the sense of being “turned on” in body and mind), desire is the mental motivation towards sexual activity.
To understand more on this foundational sexual concepts read my blog on:
Due to arousal and desire often occurring simultaneously, rather than treating these separately, Female Sexual Interest/Arousal Disorder (FSIAD) acknowledges both.
FSIAD is the lack of or significantly reduced sexual desire or arousal that is the cause for significant distress. It includes three of more of the following:
- Absent or reduced desire for sexual activity
- Absent or reduced sexual or erotic thoughts or fantasies
- Reduced or absent initiation of sexual activity and being unreceptive to initiation attempts from a partner
- Absent or reduced sexual arousal or pleasure during sexual activity
- Absent or reduced sexual interest or arousal in response to sexual cues (e.g. written or visual erotica)
- Absent or reduced physical sensation during sexual activity, genital or non-genital
These symptoms must have been present for a minimum of six months and also be a cause of distress. If these symptoms are present but it is not a cause of personal distress, it is not considered a disorder.
What Causes Female Sexual Interest/Arousal Disorder?
Our experiences of sexuality are deeply tied to our biology, psychology, relationships, and broader society. All these factors can be at play in the experience of sexual interest and arousal.
Psychological: desire and arousal is significantly influenced by our mental state such as depression, anxiety, chronic stress, trauma, negative body image, and worrying during sex. In these states it can be difficult to access pleasure, not only in the body, but in the mind, and in life generally. This can have massive implications on sexual pleasure.
Relational: A female’s sexual desire is significantly influenced by feelings towards a partner. If there are relational tensions such as disconnection, unresolved conflict, anger, resentment, over-familiarity, or a partner’s own sexual dysfunction, this can inhibit desire. Desire is the pursuit of pleasure, either in anticipation for pleasure or in response to pleasure. If a female is not experiencing pleasure generally in the relationship, it can be difficult to extend this towards sexual activity.
Biological and Medical: Overall physical health can impact the body’s capacity for arousal. Arousal includes physical symptoms such as blood flow to the clitoris and vagina, lubrication, the swelling of genital tissue: all which can be a pleasurable sensation. Conditions such as diabetes, thyroid dysfunction, nerve damage and even hormonal shifts in menopause and postpartum can impact the body’s capacity for arousal and therefore pleasure. Medications such as SSRIs for depression, can also have a direct impact on arousal.
Common Myths About Female Desire and Arousal:
These myths touch on the societal element in the experience of sexuality. This is the cultural messaging we often internalise about sex that can be unrealistic and unhelpful.
If I don’t just experience desire randomly and frequently, there must be something wrong with me: This is the myth that spontaneous desire is the only and most valid way of experiencing desire. Many individuals experience responsive desire, desire that emerges not randomly, but in response to pleasurable emotional, relational, and physical interactions. Read more on this here. The question is not do I have low desire, rather: is my life and relational context nurturing responsive desire?
I should be able to orgasm through vaginal intercourse: especially in sexual interactions where intercourse is the goal, this can create a pressured environment which strips away pleasure. This also is not realistic given that it is primarily the clitoris that is a source of pleasure and orgasm for most females. Even when orgasm is experienced during intercourse, it is likely due to the internal clitoral structures which surround the entrance of the vagina. Less than 20% of women reliably orgasm during sexual intercourse, and 38% never or rarely orgasm during penetration. Clitoral stimulation enhances arousal, and without it there may not be sufficient arousal for enjoyable vaginal penetration.
My body is broken: often bodies are over-emphasised and over-medicalised. While there are real biological factors at play, which are important to take into consideration, far more often the significant barrier to sexual interest and arousal are relational and psychological. It may also be that the sexual cues provided by a partner are ineffective or not pleasurable.
Treatment Options for Female Sexual Interest/Arousal Disorder
Sex therapy: this includes utilising interventions that address unhelpful thoughts, and beliefs, and support mindfully reconnecting with bodily sensations. Sex therapy is most beneficial when the couple is supported as a sexual team.
Pros:
- Highly effective with lasting results
- Improves sexual satisfaction
- Reduces anxiety and distraction
Cons:
- Significant commitment with time and finances
- Requires active effort
- A supportive partner is beneficial to the process, and this may not be the case for everyone
Medication Adjustment or prescription:
Please speak to your doctor if you have concerns that FSIAD is triggered by medication (such as antidepressants). If medications are the cause of FSIAD, adjusting these can be effective in reversing the side effects.
Pros:
- Can successfully reverse sexual side effects
Cons:
- Does not address psychological or relational factors
- Risk of relapse regarding the condition the medication was prescribed for
- Requires close monitoring by a doctor
Filbanserin (Addyi) is an approved medication to treat low desire in perimenopause. It alters neurotransmitter activity in the brain. It requires a daily dose to be effective.
Pros:
- Improvements in sexual satisfaction and sexual function
- Reduces sex-related distress
Cons:
- It is not rapid acting and is not a cure all
- It does not address psychological or relational factors that may in fact have a bigger impact
- Side effects may include fatigue, nausea, and dizziness
- Alcohol must not be consumed while on this medication
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Hormone Replacement Therapy
HRT primarily addresses the decline of hormones in menopause/postmenopause. Depending on the HRT the pros and cons can include the following.
Pros:
- Boosts overall sexual function including desire and arousal
- Enhances pleasure and improves orgasmic function
- Relieves physical discomfort
- Additional health benefits such as bone health (estrogen)
Cons:
- Can also have severe health risks when used systemically (throughout the whole body) including blood clots, and cancer risks
- If androgens are used this can have unwanted side effects of acne and excess hair
- There may not always be a direct effect on desire
- Many hormone treatments are still controversial and prescribed off-label (not specifically approved for the treatment of arousal or desire)
Can Sex Therapy Help Low Desire and Arousal?
Sex therapy supports the psychological and relational factors that often underlie Female Sexual Interest/Arousal Disorder. While biological factors can play a role, many barriers to desire and arousal are linked to anxiety, pressure, disconnection, or unhelpful sexual expectations.
In therapy, we focus on reducing performance pressure, reconnecting with sensation, and understanding what supports desire in your unique context. This may include exploring responsive desire, improving communication, and strengthening the couple as a sexual team.
Rather than “fixing” the body, the aim is to create the conditions where desire and arousal can emerge more naturally.
I offer online sex therapy across Australia, supporting individuals and couples to understand their sexual response, reduce pressure, and rebuild a sense of connection, pleasure, and confidence in intimacy.
Final Reflection
Changes in sexual desire and arousal are common and do not mean that something is inherently wrong with you. Sexuality is not static; it responds to your body, your mind, your relationships, and your life context.
When approached with curiosity rather than judgement, these experiences can become an opportunity to better understand yourself and what supports your sense of pleasure and connection.
Support is available, and with the right approach, sexual wellbeing can be nurtured in a way that feels authentic and sustainable.
Written by Justine
References
1. McCarthy B, Koman CA, Cohn D. A psychobiosocial model for assessment, treatment, and relapse prevention for female sexual interest/arousal disorder. Sexual and Relationship Therapy. 2018;33(3):353-363.
2. Brotto LA, Laan ETM. Problems of Sexual Desire and Arousal in Women. In: Wylie K, editor. ABC of Sexual Health. 3rd ed. Chichester: John Wiley & Sons, Ltd; 2015. p. 59-67.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
4. Jaspers L, Feys F, Bamer W, Franco O, Leusink P, Laan E. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: A systematic review and meta-analysis. JAMA Internal Medicine. 2016;176(4):453-462.
