Interest in womenʼs sexual functioning has increased in recent years although the primary emphasis has been on deficits in both genital and subjective sexual response. Clinically, it is not uncommon for women of all ages to present with complaints of difficulty becoming or remaining sexually aroused. While hormonal deficits or pharmacological agents are often implicated etiologically in the genital arousal and lubrication problems of peri or postmenopausal women, psychological and interpersonal factors usually play a significant role as well. Given the high prevalence of sexual complaints generally in women, and the co-morbidity of desire and arousal disorders, it is, perhaps, not surprising, that there exists a common assumption that womenʼs genital responsivity is less reliable and robust than that of males. Recent sexual psychophysiology research suggests that this is not the case and that, in fact, women are capable of greater sexual responsiveness than previously assumed.

There are also women who complain of excessive genital arousal. This condition, originally named persistent sexual arousal syndrome (PSAS) was renamed persistent genital arousal disorder (PGAD, Leiblum, 2006) because the problem appeared to be primarily one of unwanted and intrusive sensations of genital, rather than sexual, arousal.

PGAD is characterized by five features: (1) involuntary genital and clitoral arousal that persists for an extended period of time; (2) persistent genital arousal that feels intrusive and unwanted; (3) persistent genital arousal that does not completely resolve following one or more orgasms; (4) persistent genital arousal that appears to be unrelated to conscious feelings of sexual desire; and (5) persistent genital arousal that is experienced as moderately distressing. In 2003, it was included as a provisional diagnosis by an international committee of experts convened to recommend revisions in the nomenclature of womenʼs sexual dysfunctions.

While there are women at either extreme of the genital arousal continuum, that is, too little or too much arousal, there is a third group of women- women who report genital arousal that appears unsolicited but which may be experienced as relatively persistent, pleasurable and nondistressing.

Todayʼs talk will review the findings of the most recent research on PGAD and non-PGAD women and will present case illustrations of the four kinds of arousal complaints in women. We will suggest that what appears to be spontaneous genital arousal in some women may be the result of either subconscious processing of sexual stimuli in the environment - stimuli that are either consciously unacceptable or not noticed- and that are negatively evaluated. This negative evaluation of genital sensations may result in heightened vigilance, increased anxiety, pelvic tension and increased sensations which reinforces the condition. Psychological interventions may be helpful in treating this problem for a subset of women without an identifiable organic basis for their complaint.