[Women's arousal disorders]. / Troubles de l'excitation chez la femme.

ABSTRACT

OBJECTIVE: To evaluate the clinical presentation of women's arousal disorders (AD) and therapeutic options, suggested in the literature. PATIENTS AND METHODS: Review of articles published on this subject in the Medline database, selected according to their scientific relevance, of consensus conferences and published guidelines. RESULTS: Women's AD form three clinical entities. The most well known is a lack of lubrication and genital congestion in response to a sexual stimulus corresponding to an objective AD. More recently, subjective AD has been identified, with decrease of perception of arousal. In practice these two cases are frequently associated. The prevalence of objective AD varies from 9 to 38%, with a peak after the menopause. The prevalence of the subjective AD, much less studied, is among 17%. All clinical studies have reported an absence of correlation between physiological response, genital arousal, and the subjective response, which makes it difficult to clinically assess and manage these disorders. After the menopause, a lack of estrogen is a major factor in decrease in lubrication and poor vaginal trophicity. Clinical examination is essential for the assessment of these symptoms. Subjective AD and sexual desire disorders both have etiological psychological and contextual factors very similar. They mutually sustained and are grouped together in the new classification of DSM-V in one definition. CONCLUSIONS: Anxiety and a lack of harmony with the partner are among the factors, which affect adversely women's sexual desire and also subjective arousal. For this reason a sexo/psychotherapy is often necessary even for menopausal women. For them local hormonal therapy with estrogen is also recommended in case of lubrication or vaginal trophicity problem.