It is normal for females to experience fluctuations in sexual desire throughout life. However, a substantial or total loss of interest in sex, or difficulty responding to stimulation, may indicate female sexual interest/arousal disorder (FSIAD).
FSIAD is a type of sexual dysfunction. A person with the condition may experience a lack of sexual desire, a lack of physical arousal, or both.
As with other types of sexual dysfunction, FSIAD can be distressing. It can affect a person’s self-esteem, relationships, and overall well-being.
In this article, we explore FSIAD and its symptoms, causes, and treatments.
FSIAD describes a loss or significant reduction in sexual desire or physical arousal in females. It is a relatively new term that first appeared in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).
Previously, FSIAD was split into two separate disorders:
- hypoactive sexual desire disorder, which describes a lack of interest in sex
- female sexual arousal disorder (FSAD), which refers to reduced excitement, sensation, or pleasure during sexual activity
FSAD used to refer to a lack of lubrication and swelling in the female genitals, which researchers focused on as a cause for sexual dysfunction.
However, some experts argue that this is a flawed concept, as low levels of lubrication does not necessarily indicate female arousal, nor does it always prevent sex.
There is a close link between sexual desire and physical arousal. As a result, the DSM-5 combined the two conditions.
It is unclear how many people experience FSIAD specifically. However, sexual dysfunction is highly common in males and females.
A 2016 meta-analysis suggests that around 40.9% of premenopausal women worldwide experience at least one type of sexual dysfunction. Of those, 28% reported low sexual desire.
However, compared to some types of sexual dysfunction in males, such as erectile dysfunction, FSIAD is far less well-known.
According to the DSM-5, a person must have three of the following symptoms to have FSIAD:
- reduced or no interest in sex
- few or no thoughts about sex
- decreased sexual arousal or pleasure during sexual activity
- reduced or no arousal in response to visual, written, or verbal cues
- infrequent or no initiation of sexual activity within a relationship
- reduced or no sensations in the genitals
They must also have:
- symptoms lasting 6 months or more
- significant distress about their symptoms
- symptoms that are not more accurately explained by a nonsexual mental health disorder, domestic abuse, medication, substance abuse, or another medical condition
In addition to this, people with FSIAD can experience symptoms in different ways. The condition may be:
- Generalized or situational: Generalized FSIAD involves symptoms that occur in any situation, with any partner, and during any type of sexual stimulation. Situational FSIAD is more specific and only occurs in certain scenarios.
- Lifelong or acquired: If a person’s symptoms are lifelong, this means they first noticed them as soon as they became sexually active. Acquired FSIAD means a person previously had sexual function but currently does not.
Partners may notice that a person with FSIAD does not want to engage in sex most of the time and that they talk about it less, or not at all.
FSIAD vs. asexuality
It is important to note that FSIAD is different from asexuality.
Asexuality is an umbrella term for sexual orientations that involve varying degrees of sexual and romantic attraction towards others. It is not a medical condition.
Some asexual people have lifelong preferences for nonsexual relationships. While a lifelong lack of interest in sex can occur due to sexual dysfunction, this is not always the case.
According to the DSM-5, for an FSIAD diagnosis to apply, a person must show signs of “clinically significant distress” about their lack of desire.
A person who identifies as asexual, does not feel distressed by it, and has no problem developing close relationships, does not meet the criteria for FSIAD.
Sexual desire and arousal are complex. Many factors influence the amount and type of sexual desire a person has and how their body responds to intimacy.
While a single cause is often difficult to identify, the DSM-5 notes that people with FSIAD often have other sexual or emotional difficulties, some of which are explored below.
A 2018 review found that relationship dissatisfaction was a risk factor for sexual dysfunction in females. This may be the result of communication problems, a lack of emotional intimacy, or unresolved conflict.
The mental and physical health of partners may also have an impact. If a person desires sex more often than their partner or partners, or they have sexual dysfunction themselves, this may influence the development of FSIAD.
Mental health conditions
A negative self-image, lack of confidence in one’s body or appearance, and mood disorders are also associated with FSIAD.
Negative body image, or body dysmorphic disorder, may make the prospect of removing clothes or sexual activity stressful. Stress, anxiety, and depression can also reduce a person’s desire to have sex.
However, it is important to note that low self-esteem, stress, and mental health conditions can occur as a result of FSIAD, and may not be the direct cause.
Some people with FSIAD have previously experienced emotional or sexual abuse. A 2020 study suggests that sexual trauma, such as childhood sexual abuse, can lead to shame surrounding sex, which may then contribute to sexual dysfunction.
Negative beliefs surrounding sex
Personal, cultural, and religious beliefs can play a role in FSIAD.
People who believe in traditional gender roles may feel they should not play an active role in sex or that they should not enjoy it. This may create feelings of shame surrounding sex.
Need for quality sex education
If a person does not have much experience or knowledge about sex, they may have unrealistic ideas about what is “normal” in terms of sexual desire. They may also struggle to explain what they like or dislike, or be unaware of different sexual techniques.
It is important that people have access to quality sex education that normalizes sexual desire, and teaches that sex has a positive role in a person’s well-being.
The 2018 review notes that sex education and feeling that sex is important in a relationship are both protective factors against sexual dysfunction.
Other sexual dysfunction
Many people with FSIAD may also experience other types of sexual difficulties, such as:
- pain during sex, for example, as a result of vaginismus or vulvodynia
- general pelvic pain, for example, due to endometriosis
- difficulty reaching orgasm, or female orgasmic disorder
- vaginal dryness
Treating these conditions may help with improving a person’s FSIAD symptoms.
Other factors that may cause changes to a person’s sexual desire and arousal include:
There are several ways to approach treatment for FSIAD. These include:
Psychotherapy or sex therapy
Talking with a sex therapist, psychotherapist, or counselor specializing in female sexual health can help someone identify factors contributing to their FSIAD.
A sex therapist or psychotherapist can help someone:
- learn skills for coping with stress and anxiety
- gradually change their self-image, and develop compassion towards themselves
- challenge any beliefs that make them feel ashamed about sex
- learn how to communicate more openly with their partner
- resolve past traumas in a safe environment
If relationship difficulties contribute to FSIAD, a therapist may also recommend relationship counseling sessions, where the person’s partner also attends.
Medication options for FSIAD include Vyleesi (bremelanotide), which activates receptors in the brain that influence sexual behavior and desire.
Hormone therapy may help treat low sexual desire in people going through menopause or who have hormone imbalances.
These medications will not be appropriate for everyone. It is important to discuss the safety, interactions, and side effects of these treatments with a doctor before trying them.
Treating other conditions
If a person’s sexual desire or physical response to sexual stimulation has changed since they developed a mental or physical health condition, or since they began taking a certain medication, this may be a factor.
A person can discuss the following options with a doctor:
- changing medications or dosages
- trying nonhormonal contraception, such as an intrauterine device or condoms
- trying treatments to address hormone imbalances or menopause symptoms
If a person notices they have lower sexual desire than usual, or do not seem to respond to sexual stimulation as they used to, they can seek help from a physician or healthcare professional specializing in sexual function.
It can be difficult to talk about sexual dysfunction, but there is no shame in doing so. It is a medical condition, which can get better with treatment.
Being specific about any concerns or changes in desire or arousal will help a doctor advise on the next steps.
FSIAD is a type of sexual dysfunction that occurs when a person’s sexual desire or arousal is much lower than usual. It can cause significant distress. However, sexual dysfunction is prevalent in females, and it is treatable.
Many factors may contribute to FSIAD, so a person may benefit from trying several treatment approaches. Options include individual therapy, trauma therapy, relationship counseling, or medication.