This is defined as the persistent or recurrent inability to initiate or maintain sufficient sexual excitement, leading to personal distress (anxiety, frustration, angst). It can be expressed as a lack of subjective excitement or a lack of vaginal lubrication or other physical responses. It presents in approximately 20% of women, and can reach up to 45% after the menopause.
Lack of excitability may have its origin in the brain, or in the genital area or in non-genital areas (nipples, salivary secretion, vasodilation of the skin).
Excitability at a mental level can be biologically activated by androgens and psychologically by motivational factors such as the need for intimacy and affection (love, tenderness, attention, etc.).
With sexual excitability the majority of women produce a vaginal secretion. Certain neurotransmitters such as vasointestinal peptides (VIP) and nitric oxide (NO) favour the entry of the blood into the clitoris and the vulval vestibule.
In relation to the post-menopausal reduction in oestrogens, there is a corresponding reduction in vaginal lubrication.
The diagnosis must be based on detailed medical history and physical examination. On the basis of the data obtained, a hormonal study may be indicated, fundamentally in those cases of secondary amenorrhoea, puerperium and menopause. Problems of the pelvic floor should also be detected, such as hypertonia and hypotonia of the muscles. The vaginal pH is a good indicator of oestrogen levels. Certain vascular disorders and their risk factors (smoking, hypercholesterolemia, arteriosclerosis, hypertension, diabetes) may affect the provision of blood to the genitals. Equally essential is a psychological evaluation.
The treatment should be based on hormone replacement with oestrogens and androgens applied orally or topically as indicated. Certain oily or aqueous lubricants may be indicated to improve lubrication. In those cases where there is a reduction or increase in muscle tone on the pelvic floor, certain exercises to strengthen the musculature are recommended.
On occasion, treatments may be indicated which are used to improve the man’s erection (sildenafil, vardenafil, tadalafil) due to their vasodilatory effect, favouring the entry of blood into the genitals, as well as the use of a vacuum device which, applied to the clitoris, achieves a similar effect.