When you focus on the destination, it’s easy to ignore the journey. Hardly anyone looks forward to a long flight. It’s the vacation that matters. Except–one is impossible without the other. When it comes to female arousal, the journey is not just important. It can actually be as enjoyable as the destination.
Arriving is exciting––whether it’s stepping from your ride share onto a Parisian street or climaxing. Unfortunately, while innumerable products, articles, and sexperts promote the orgasm, far less attention is paid to arousal. Yet this component is vital, especially for women. Author Naomi Wolf wrote about the brain-vagina connection ––research that focused on the connection between your mind and how your body responds. She asserted that the “dopamine–oxytocin–opiate loop” which occurs during sexual activity can be short-circuited by trauma or stress. Although her writings were controversial, she believed that for a woman to achieve arousal her mind must be free from stress. To Wolfe, a couple sharing housework was a form of foreplay. She believed that women who can consistently achieve arousal were more productive and creative.
Unfortunately, many women have difficulty achieving arousal. Once known as “hypoactive sexual desire disorder” or “inhibited sexual desire disorder,” female sexual interest/arousal disorder (FSIAD) is a common problem. Studies suggest one out of four premenopausal women and over half of all menopausal women suffer from FSIAD. To meet the criteria for a diagnosis of FSIAD, women must have three of these symptoms for six months or longer:
- Absence or reduction of interest in sexual activity
- Absence or reduction of sexual or erotic thoughts and fantasies
- No or reduced initiation of sexual activity and being unreceptive to a partner’s attempts to initiate;
- Absence or reduction of sexual excitement or pleasure during sexual activity;
- Absence or reduction of sexual interest/arousal in response to sexual or erotic cues; and
- Absence or reduction of genital or nongenital sensations during sexual activity.
These symptoms must not be attributable to another cause, for example, medication use or relationship distress.
Recognizing FSIAD is an important step toward its treatment. So what is female arousal? It is the first of our body’s four-stage sexual response. Because arousal can go on for literally hours, it is usually the longest-lasting stage. Arousal, also called desire or the “excitement stage,” can occur when you aren’t doing anything especially sexual, like grocery shopping or working on a term paper. The other stages are more physical. Usually they require genital-stimulating activity, whether alone or with a partner. The plateau is the second stage, as you approach the point of no return. This is when you enter the third stage, orgasm. “Le petit mort” or the “little death” is that transcendent orgasmic moment that has become the focus for so many. The final stage is resolution which is the time when the body recovers during which climax is not possible.
Although arousal is as much mental as physical, during arousal you are probably aware of your body’s response. This includes the lubrication of your vagina and a quickening heartbeat. Blood flow shifts toward the genitals –– especially the vulva and clitoris. Sexual stimuli actually signals certain changes in your brain, especially in the amygdala and thalamus, parts of your brain involved in emotion and consciousness. It’s important to understand that desire (libido) is different from arousal. A woman can have interest in sex, but physically not attain arousal due to hormonal changes with age, certain medication, and a variety of medical conditions.
Skipping the arousal stage when you are with a partner almost guarantees dissatisfying sex–and not just because it’s less likely you’ll orgasm. In fact, although the promise of orgasm can motivate sexual activity, studies suggest that not only is sexual arousal alone rewarding but it is probably a sexual component for all mammals. No, the reason the sex will be less satisfying is that because your body is not responding, it can actually be painful. So accessing the arousal stage is important with a partner. Prolonging foreplay, exploring different parts of your body, and incorporating toys can all help. You may choose to access this component on your own. The key is patience and taking your time, being mindful and not obsessing about the conclusion. Or as Miley Cyrus once sang, “Ain’t about how fast I get there; ain’t about what’s waiting on the other side; it’s the climb.”
Medical Options for FSIAD
Until recently, the medical options available for women were limited. In the United States, for example, prior to 2015 there were no FDA (U.S. Food and Drug Administration) approved treatments specifically for female sexual desire disorders. Currently there are two medications for female sexual desire disorder. One is Vyleesi (bremelanotide) for FSIAD in premenopausal women. Injected under the skin of the abdomen or thigh at least 45 minutes before anticipated sexual activity, the drug has shown promise. So has Addyi (flibanserin), which, when taken orally, was unsuccessful in treating depression, but had the side effect of increased libido in female patients.
Still, if you have issues with arousal, the first step is determining the cause. Speaking with your health care provider can help determine if there is a physical component, like diabetes, heart conditions, or neurological disorders. Arousal issues are common side effects with many medications along with overuse of alcohol. Once you have ruled those out, you may want to visit with a licensed therapist who specializes in sexual disorders. Determining the root of the problem is just part of the challenge. Becoming comfortable while being patient and forgiving with yourself is important. Once you access arousal, you may find that many things are easier and more enjoyable –– not just sexual activity.
- Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women
- Flibanserin (Addyi): The first FDA-approved treatment for female sexual interest/arousal disorder in premenopausal women
- Female sexual arousal: genital anatomy and orgasm in intercourse
- FDA approves new treatment for hypoactive sexual desire disorder in premenopausal women
- Female Sexual Problems
- Naomi Wolf: Liberate female sexuality research
- Put Your Attention on Sexual Arousal, Not Orgasm
- Current Regulatory Framework: Female Sexual Interest/Arousal Disorder (FSIAD)
- Miley Cyrus – The Climb
- Sexual Dysfunction