Female sexual arousal disorder (FSAD) refers to the continual or recurrent inability of a woman to accomplish or maintain an ample lubrication-swelling reaction during sexual intercourse. This lack of physical response may be either lifelong or acquired, and either generalized or situation-specific. According to most recent data, FSAD is the second most common sexual health concern, affecting 26 percent of adult women. FSAD can be broken down into three subsets: genital arousal disorder, subjective arousal disorder, and combined arousal disorder.

There are both psychological and biological causes of female sexual arousal disorder, with these two often overlapping. Prolonged illnesses such as diabetes, multiple sclerosis, and vascular disease can lead to genital arousal disorder by causing peripheral neuropathy and decrease/loss of genital sensation. Decreased blood flow to the genital area is believed to contribute to FSAD similar to the role of vascular disease in male erectile dysfunction. Other causes may include nerve and/or tissue damage. Hormonal imbalance following menopause or childbirth, certain medications such as birth control pills can lead to genital arousal disorder.

Physiological causes of FSAD include:

• damage to the blood vessels of the pelvic region resulting in reduced blood flow

• damage to the nerves in the pelvic area resulting in diminished arousal

• general medical conditions that damage blood vessels (coronary artery disease, high blood pressure, diabetes mellitus)

• nursing a baby (lactation)

• general medical conditions that cause changes in hormone levels (thyroid disorders, adrenal gland disorders, removal of the ovaries)

• lower levels of sex hormones due to aging (menopause)

• side effects of medications (antidepressants, antipsychotic drugs, drugs to lower blood pressure, sedatives, birth control pills, or other hormone-containing pills)

Psychological causes of FSAD include:

• chronic mild depression

• emotional stress

• past sexual abuse

• emotional abuse

• bereavement

• self-image problems

• relationship problems with partner

• other mental health disorders (major depression, posttraumatic stress disorder, or obsessive-compulsive disorder)

The symptoms of FSAD include lack of or insufficient transudation. A woman diagnosed with FSAD does not produce enough fluid to lubricate the vagina. As a result, intercourse is often painful and unsatisfactory. The woman may then avoid sexual activity and intimacy, creating relationship difficulties.

Physical, pelvic and examinations, blood studies, ultrasound, x-ray, electrocardiogram (EKG), bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI), or hormone receptor assay may be indicated.

The treatment for female genital arousal disorder tied to a medical condition may include: adjustment or change medication that has sexual side effects; treatment of a thyroid problem or other hormonal condition; optimization of a treatment for depression or anxiety. Treating female genital arousal disorder linked to a hormonal cause might include estrogen therapy where a localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication. Pain management and nutrition therapy may be initiated.

Counseling, psychotherapy, and support groups may be indicated to assist the patient in dealing with the diagnosis.

• Prior the change in the rating schedule on May 13, 2018, female sexual arousal disorder (FSAD) was evaluated analogously to this diagnostic code (7699-7611).

• A diagnosis of FSAD cannot be rendered or confirmed by a mental health examiner. When a mental health examination or mental health treatment records suggest a diagnosis of FSAD, including FSAD secondary to medication for a psychiatric disorder, the diagnosis must be confirmed in other medical evidence by a qualified medical professional.
• Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
• When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation.
• Review for entitlement to special monthly compensation under 38 CFR 3.350 .