ABSTRACT
Review of Current Status of Knowledge 127
Epidemiology 127
Anatomy and Physiology 127
Clitoris and Surrounding Erectile Tissue 127
The Anterior Vaginal Wall 128
Central Nervous System and Spinal Chord Pathways 129
Diagnosing FSAD 129
Is Absent or Impaired Genital Responsiveness a Valid Diagnostic
Criterion? 132
Diagnostic Procedures 134
Activation and Regulation of Sexual Response 136
Processing of Sexual Information 136
Sexual Feelings 138
Gender Differences in Sexual Feelings 140
What is a Sexual Dysfunction? 141
Treatment 143
Psychological Treatments 143
Pharmacotherapy 144
Phosphodiesterase Inhibitors 144
Prostaglandines 145
Phentolamine 146
Dopamine Agonists 146
Androgens 146
Recommendations for Clinical Practice 147
References 147
“THE MAIDEN MUST BE KISSED INTO A WOMAN”
Most pharmacological treatments that are currently being developed for women
with sexual arousal disorder are aimed at remedying a vasculogenic deficit. In a
study we did in the late 1990s we compared pre-and postmenopausal women
with and without sexual arousal disorder, diagnosed according to strict
DSM-IV criteria (1). Women with any somatic or mental comorbidity were
excluded. This study investigated whether pre-and postmenopausal women
with sexual arousal disorder were less genitally responsive to visual sexual
stimuli than pre-and postmenopausal women without sexual problems. From
the findings of this study we concluded that in such women, sexual arousal dis-
order is unrelated to organic etiology. In other words, we are convinced, from this
and other studies to be reviewed, that in women without any somatic or mental
comorbidity, impaired genital responsiveness is not a valid diagnostic criterion.
The sexual problems of women with sexual arousal disorder are not related to
their potential to become genitally aroused. We propose that in healthy women
with sexual arousal disorder, lack of adequate sexual stimulation, with or
without concurrent negative effect, underlies sexual arousal problems. This
view is at odds with the dominant view on male sexual arousal problems.
