Female Sexual Interest/Arousal Disorder

What is FSIAD?

A sexual dysfunction characterized by persistent deficits in desire and/or arousal in individuals with a vulva.

Why does DSM-5-TR combine desire and arousal in women?

Research shows these two often overlap in women.

How long must symptoms persist for a FSIAD diagnosis?

Greater than or equal to 6 months, occurring in Less than or equal to 75–100% of sexual encounters.

How many symptoms are required for a FSIAD diagnosis according to DSM-5-TR?

At least 3 or more of the listed symptoms.

What are the onset types of FSIAD?

Lifelong and Acquired.

What is "Lifelong" onset type of FSIAD?

The woman has never experienced normal sexual interest or arousal since becoming sexually active.

What is "Acquired" onset type of FSIAD?

Develops after a period of normal functioning.

What are some common triggers for acquired FSIAD?

Relationship conflict, childbirth/postpartum changes, depression, stressful life transitions, hormonal changes, medications.

How long must FSIAD persist to meet diagnostic criteria?

Less than or equal to 6 months, present 75–100% of the time.

What are the specifiers for FSIAD?

Generalized vs. Situational; Severity (mild, moderate, severe).

What are the clinical subtypes of FSIAD?

Desire-focused, Arousal-focused, and Mixed.

What characterizes the "Desire-focused" subtype of FSIAD?

Low sexual thoughts, low initiation, low motivation.

What characterizes the "Arousal-focused" subtype of FSIAD?

Difficulty becoming physically aroused, reduced lubrication, minimal genital sensations, low subjective excitement.

What characterizes the "Mixed" subtype of FSIAD?

Both desire & arousal are impaired.

Why does the prevalence of FSIAD increase with age, according to DSM-5-TR?

Due to hormonal and relational factors.

What are some psychiatric comorbidities associated with FSIAD?

Depression, anxiety disorders, PTSD (especially sexual trauma), history of childhood sexual abuse.

What are some medical comorbidities associated with FSIAD?

Hypothyroidism, diabetes, chronic pain conditions, endocrine disorders, cardiovascular disease.

What are some medications associated with FSIAD?

SSRIs (most common), antipsychotics, antihypertensives, hormonal contraception (some women).

What are some relationship factors associated with FSIAD?

Conflict, resentment, emotional disengagement, poor communication.

What is considered a normal variation in the context of sexual desire?

Natural fluctuation of sexual desire; within normal limits; not pathological

When is low desire not considered a disorder in DSM-5-TR?

Low libido exists but no personal distress.

Why is asexuality not considered a disorder?

Stable lack of sexual attraction; considered a sexual orientation, not psychopathology.

How can major depressive episode affect sexual function?

Depression commonly reduces libido and sexual responsiveness.

How can Genito-Pelvic Pain / Penetration Disorder affect desire?

Pain, fear, tension, or difficulty with penetration may secondarily lower desire.

How can primary relationship problems affect sexual interest?

Conflict, resentment, poor communication, attachment issues reduce sexual interest.

How can hormonal/endocrine disorders affect desire?

Low testosterone, thyroid disorders, hyperprolactinemia, menopause, etc. affecting desire.

How can substance use affect sexual desire?

Alcohol, cannabis, stimulants, opioids may suppress or dysregulate sexual desire.

How can sexual avoidance due to dysphoria affect desire?

Desire is inhibited due to distress related to gender incongruence, not intrinsic sexual dysfunction.

How does dopamine affect desire and arousal?

Increases desire & arousal.

How does serotonin affect desire?

Inhibits desire (explains SSRI effects).

How does norepinephrine affect sexual excitement?

Enhances sexual excitement.

What can low NE activity cause?

Blunted arousal, decreased genital responsiveness, and reduced sexual motivation.

What does oxytocin enhance regarding sexual response?

Bonding and erotic response.

What does oxytocin facilitate?

Emotional attachment and sexual pleasure.

What hormone contributes to sexual desire in women?

Testosterone.

What can low testosterone lead to in women?

Low sexual motivation.

What symptoms might postmenopausal women or women on anti-androgen therapy experience?

FSIAD-like symptoms.

What does estrogen maintain in women?

Vaginal lubrication, genital blood flow, and vulvovaginal tissue elasticity.

What can low estrogen lead to?

Pain, decreased genital arousal, and reduced lubrication.

What does the limbic system integrate to generate sexual desire?

Emotional, reward, and sexual cues.

What can dysfunction or inhibitory processes in the limbic system lead to?

Reduced spontaneous sexual motivation, leading to FSIAD.

What does parasympathetic activation promote?

Genital blood flow, lubrication, and clitoral engorgement.

What does sympathetic activation do to arousal?

Inhibits arousal.

What can excessive sympathetic tone lead to?

Failure to achieve genital response.

What does anxiety and performance concerns in FSIAD activate?

Sympathetic dominance.

What does dopaminergic or androgenic dysfunction lead to regarding sexual desire?

Desire deficit.

What does estrogen deficiency, parasympathetic inhibition, or sympathetic overactivation lead to regarding sexual arousal?

Arousal deficit.

What does persistent low arousal increase?

Anticipatory anxiety.

What does anticipatory anxiety activate?

Sympathetic nervous system.

What influences the systems involved in FSIAD, explaining frequent overlap?

Depression, anxiety, SSRIs, and endocrine disorders.

What kind of disorder is FSIAD?

A biopsychosocial disorder.

What interacts in FSIAD?

Neurotransmitters, hormones, and neural circuits with cognitive, emotional, and relational factors.

What causes must be ruled out before diagnosing FSIAD?

Medical, psychiatric, substance-related, relational, or identity-based causes.