There is a revised classification in the DSM-V that now includes three female dysfunctions, as opposed to five and six respectively in the DSM – 4. Female hypoactive desire dysfunction and female arousal dysfunction were merged into a singular condition called sexual interest/sexual arousal. Sexual arousal has been defined differently for time. In the DSM-IV, the American psychiatric Association in 2000 noted that arousal referred specifically to the body’s response to sexual excitement. In women, it refers specifically to vasocongestion, vaginal lubrication, and swelling of external genitalia. Other researchers such as Bancroft in 2005 and 2009, stated a broader view of arousal, arguing that in addition to general arousal it is a state that includes motivation toward sexual pleasure, attention focus and sexually relevant information. In the simplest terms, for males, interest or desire is what happens in the mind and arousal or directions are what happens in the body, including the penis. Female sexual interest/arousal disorder is diagnosed in a persistent absence or notable reduction of mental interest in sex and/or physical responsiveness to sexual cues. These symptoms must persist for at least six months as transient changes in sexual interest and desire, in response to stressors and life circumstances, are normative. Additionally, the criteria has attempted to operationalize reduced arousal, specifically that it must occur in 75 – 100% of all sexual encounters (criteria A4 and 86), there is still a need for considerable clinical judgment. The most frequently researched and discussed biological factor has been the potential role of endocrine levels in female sexual desire. Endocrine levels have a somewhat more clear relationship with female sexual arousal than they do with desire. This is accounted for primarily by the relationship between estrogen and physiological arousal. Reductions in estradiol during menopause and lactation have been repeatedly shown to be associated with reduced blood flow and vaso congestion (Leiblum, 2005; Simon, 2011). Vascular and neurological problems may also lead directly to arousal problems it is important to consider the indirect effects of biological factors on sexual desire and arousal. Also, a chronic medical illness could be accompanied by various psychosocial stressors, changes in bodily function and appearances where these factors impact interest in sexual activity.

Psychosocial factors may contribute to or maintain low female sexual interest and or arousal. Guilt about sex and sexually conservative views have been associated with lower levels of sexual desire and female arousal problems (Gorzalka, 2012). There are interpersonal factors that have found to be related to low sexual interest that include current life stressors, psychological problems such as anxiety or depression, or history of sexual trauma (Oberg et al., 2002). Interpersonal factors affecting desire and arousal may include general relational conflicts with one’s partner. It has long been known, and repeatedly established in literature, that women’s sexual desire is greatly influenced by the general quality of relationship with one’s partner (eg.,Guthie et al., 2004) . For example, there was a large community study that found women’s self – report of a poor relationship with her partner was associated with desire and arousal problems, even after controlling for other demographics, as well as biological and psychosocial risk factors (Jiann, Su, Yu, & Huang, 2009). It is important to recognize that some women are content without experiencing orgasm or are unconcerned about how they reach orgasm. For those women, the experience of being anorgasmic creates interpersonal stress or feelings of depression, inadequacy, or low self-esteem.