If you've been experiencing arousal difficulties, you'll know by now that the way we commonly talk about feeling aroused - getting 'turned on' - isn't actually quite right. Much to all of our dismay, arousal isn't a switch that you can just turn on and off, but rather a natural process of becoming ready for a sexual encounter. But, even though arousal is a natural process, you can't force it, and it's very easily interrupted, especially by anxiety. In this article, we'll take a look at what arousal actually means, as well as some of the things that can cause arousal difficulties, and what you can do to help.
In simple terms, sexual arousal is what happens when your body and mind get ready for a sexual experience. For our bodies, this means erections, lubrication, increased heart rate and blood pressure, pupil dilation, becoming flushed, etc. And yes, in terms of sexual response, both men and women get lubricated, and experience swelling in their external genitalia when they become aroused - but lack of lubrication is usually more of a problem for women than men, and men are more likely to experience difficulties with getting or maintaining an erection. For our minds, sexual arousal means becoming more responsive to erotic stimuli, i.e. viewing certain sights, sounds, smells, activities, etc., as 'sexy'. Crucially, arousal is not the same as desire, because while arousal is about mental and physical preparation, desire is about an emotional wanting.
Like any sexual dysfunction, arousal problems can be caused by a number of physical factors, but often the cause is psychological. Struggling to be in the moment, feeling anxious about sex, feeling self-conscious about your body or your performance, putting pressure on yourself, or negative self-talk: all of these can interrupt the sexual response cycle, and interfere with your sexual arousal. It may also be that the sex you’re having isn’t quite what you want it to be, and doesn’t provide you with enough stimulation to become aroused - not just physically, in terms of genital stimulation, but also mentally, in terms of other erotic stimuli, i.e. the things that you might need to see or hear, or think about.
Relationship satisfaction can also be a factor when it comes to sexual dysfunction. If there are underlying issues between you and your partner that haven't yet been resolved, and those issues are causing either of you stress, then you might not feel psychologically 'safe' enough to allow arousal to happen, which will interfere with your sexual relationship. The same thing applies to sexual desire and orgasm disorders, including premature ejaculation, retrograde ejaculation, and anorgasmia.
The problem here is that, even for people who feel like their relationship is really strong, arousal difficulties can cause a vicious cycle, in which one person experiences an arousal difficulty like erectile dysfunction or vaginal dryness, and then feels self-conscious, but their partner takes it personally and also feels self-conscious, so the sex isn't very enjoyable - which causes you both anxiety about sex in general. This can make sex even harder to talk about, so you avoid it more, and become more anxious about it, which leads to more sexual difficulty - and so it goes on. If this sounds familiar to you, the first thing to do is to talk to your partner openly, honestly, and kindly about your experience to prevent the cycle from continuing.
Your general mental health can also impact sexual arousal, particularly if you suffer from anxiety or depression. Unfortunately, some pharmacological treatments for depression and anxiety, predominantly selective serotonin reuptake inhibitors (SSRIs) can have a wide range of side effects, including creating temporary sexual dysfunction, or exacerbating existing sexual dysfunction, making it harder to become aroused, creating a vicious cycle where sexual dysfunction and the mental health condition reinforce each other. If you think your medication might be having an impact on your sex life, don't stop taking them without talking to your doctor first.
Your mental health can also include more subtle things that you might not realize, such as low self-esteem, concerns about body image, or unhelpful beliefs about sex that you learned from society, the media, or your family, and then internalized. All of these could contribute to any number of sexual arousal disorders, including low sex drive, vaginal dryness, premature ejaculation, other orgasm difficulties, and erectile difficulties.
Even though arousal difficulties can feel intensely personal and individual, they're also very common. A recent national survey of sexual behavior and sexual dysfunction in the UK found that nearly 3,500,000 men had trouble getting and maintaining an erection, and a similar number of women experienced vaginal dryness. (1) For both of these, the prevalence increased with age. There are a number of different sexual arousal disorders, which we'll talk about in more detail. Before we get to that, though, it's important to note that sexual difficulties are not the same as sexual disorders, because it's completely normal to experience some sexual issues throughout your life, but a disorder is something that meets a certain set of criteria in relation to symptoms, duration, and personal distress.
Female Sexual Interest/Arousal Disorder, as you might be able to guess from the name, is a condition that's characterized by a persistent lack of, or greatly reduced, sexual arousal and/or sexual desire. According to the DSM-5, though, in order to be diagnosed with FSIAD, a woman must have three of the following six symptoms:
In order to be formally diagnosed with FSIAD, these symptoms must cause clinically significant distress and have persisted for a minimum of six months, but you can still experience arousal difficulties even if you don't officially have a sexual arousal disorder.
Erectile dysfunction (ED) refers to any medical condition that prevents an individual from achieving and maintaining an erection during sexual activity. While this is a common problem in older people, it can happen to anyone at any time while they're sexually active. If you're experiencing ED, while it's completely understandable that it might feel embarrassing and frustrating, it's worth speaking to your doctor, because ED can be an indication of medical conditions such as diabetes and heart disease, because of how closely erections are linked to the health of your blood flow. More often, though, it's caused by psychological factors like stress, anxiety, depression, relationship difficulties, low self-esteem, lack of confidence, performance anxiety, and fear of rejection, among other things.
Similarly to ED, vaginal dryness can be caused by any number of physical and psychological factors, and is particularly common after menopause, if you're breastfeeding, on certain medication (including the contraceptive pill), if you've had a hysterectomy, or if you're currently in chemotherapy, because all of these things will affect your estrogen levels. Common symptoms of vaginal dryness include experiencing a burning sensation, vaginal itching or discomfort, or abnormal vaginal discharge. Struggling with a lack of lubrication might also mean that you experience pain during sex or while masturbating, which will only exacerbate any feelings of anxiety around sex or a lack of sexual desire; it's completely normal to want to avoid something that causes you pain. But vaginal dryness doesn't have to be a burden on your sex life; speak to your doctor or gynecologist and they should be able to help.
Sexual arousal is a natural bodily function, but it often doesn’t occur in the presence of anxiety. One of the main sex therapy techniques we use at Blueheart is called Sensate Focus, which is a series of touch exercises that are designed to take the pressure away from sex, by reducing sexual anxiety and providing opportunities for you to explore your own and your partner's body in new ways that don't just focus on intercourse. By helping you stay focused only on the sensations you feel, you learn to get out of your head and into the moment, which gives your body space to respond naturally.
If you already practice or know about mindfulness - a state of relaxed, curious, non-judgmental awareness of our thoughts, emotions, and sensations - you might have noticed that it shares a strong link with Sensate Focus. In fact, thanks mainly to Dr. Lori Brotto and her team, there is increasing evidence of the benefit of mindfulness as a treatment for sexual difficulties, including sexual desire and arousal problems and difficulties with orgasm. Two of the reasons why mindfulness helps with sexual difficulties is because it helps to reduce stress (which interferes with sexual arousal and desire), and it helps us to become more aware of what's going on in our bodies and minds, which means we can be more connected with ourselves and our partner(s).
In Sensate Focus, you go entirely at your own pace, doing only what you feel comfortable with, and touch for your own curiosity, without trying to force any kind of response from yourself or from your partner. And it really works; in a 2015 study of the effectiveness of Sensate Focus as a treatment for a variety of sexual difficulties, therapists found it to be 83% effective, including for arousal difficulties. (2)