Impaired arousal has been defined, in physiological terms, as lack of/or impaired erection in males, and lack of/or impaired lubrication/swelling in females. However, these criteria lack any correlation with the subjective experience of arousal

Treatment of sexual arousal disorders has been the most successful area of treatment of sexual dysfunctions. Nevertheless, the initial enthusiasm about the efficacy of phosphodiesterase-5 inhibitors in male erectile disorder has been tempered by studies demonstrating that pharmacological agents alone do not address all the complexities of the causative factors or treatment-subsequent psychological issues. It is also obvious that the effectiveness of pharmacological treatments is lower than their efficacy, especially in long term treatment. The results of treatment trials of female arousal disorder with pharmacological agents (oral or topical) suggest that no agent alone has been really consistently efficacious in this indication.

The interplay of physiological and psychological factors in the etiology of female and male sexual arousal disorder and the results of treatment trials underscore the need for an integrated approach to the treatment of this disorder.

Several trials suggest that the combination of pharmacological and psychological treatments may be the most suitable approach. For instance, one study demonstrated higher rates of success of the combination of sildenafil and cognitive-behavior sex therapy over sildenafil alone in male erectile disorder.

This presentation discusses the advantages of integration of pharmacological, psychological and other treatment modalities in the management of impaired sexual arousal and proposes a stepwise integrated approach to this disorder in both males and females.