Lived experiences of women with sexual arousal disorder; A qualitative study

Introduction
Low sexual desire is the most commonly reported and diagnosed sexual problem among women and the most frequent reason that the couples lokking for sex therapy (Thomas & Gurevich, 2021). Female sexual interest/arousal disorder (FSIAD) is characterized by low sexual desire, few/no sexual thoughts, no initiation of sexual behavior and lack of: receptivity to partner initiation, pleasure during sexual activity, responsive desire to erotic cues, and difficulties with physical sexual arousal (American Psychiatric Association, 2022). At least 3 of these symptoms must persist for a minimum of 6 months
  Studies show that women with HSDD experience significant declines in their physical health (general health, physical functioning, and bodily pain) and psychological well-being (social functioning, emotional role, and mental health). Women's sexual discomfort is associated with low relationship satisfaction and the partner's sexual problems (Lim-Watson, Hays, Kingsberg, Kallich and Murimi-Worstell, 2022). Also, women who have distress in addition to sexual interest/arousal disorders, had lower psychological well-being, lower relationship satisfaction, two person relationship s, more severe libido disorders, and more sex dysfunction (Hendrickx, Janssen and Enzlin, 2016). Compared to partners of women coping with sexual dysfunction, partners of women with FSIAD report lower sexual and intercourse satisfaction and more sexual discomfort and partnered women with FSIAD report greater distress than their unpartnered counterparts (Hogue, Rosen, Bockaj, Impett, and Muise, 2019 ).
  The etiology of FSIAD is multifactorial and includes biological, psychological, and interpersonal and sociocultural factors (McCarthy, Koman and Cohn, 2018).
Although FSIAD is described in the DSM-5 and ICD-10, these descriptions are not based on systematic qualitative description and review of patients' reported problems.
Studies conducted on psychiatric patients have also shown that many of these patients believe that the description of disorders is focused on the external symptoms of the disease and pay little attention to their internal experiences. In many cases, the diagnostic description is far from what the patients understand about their physical, emotional and psychological experiences, and they have a feeling of being incomprehensible or neglected. Although understanding the diagnostic criteria is beneficial, therapists should know that these criteria do not accurately reflect the patient's inner world (Hackmann, Balhara & et al, 2019). According to these cases, it seems necessary to use the lived experiences of patients in every treatment process and especially in the design of treatment for FSIAD.
 
Methods and Materials
The present study was qualitative and using descriptive phenomenological approach. Participants included 30 women with FSIAD referred to psychological service centers in Isfahan who were selected by purpose - based method and according to theoretical saturation . The research instrument was a semi - structured  interview.
Interviews with open - ended questions "Describe your experiences of sexual desire disorder? " and " What changes has this disease caused in your life ? " It started and the next questions were asked based on the interview path and the answers of the interviewees. The duration of the interview lasted between 45 and 90 minutes.
To analyze the data, Collaizi analysis method was used. Thus , after interviewing the participants of the research , the text of the conversations was rewritten word for word and reviewed several times in order to understand the experiences and perceptions of the participants . In the second step, information related to the purpose of the research was specified. In the third stage, in order to formulate meanings and extract concepts, the important phrases of each interview were identified and an attempt was made to extract a concept from each phrase that represented the key concepts of the participants ' thinking. In the fourth step, the collected concepts were classified based on the similarity of the concepts. In the fifth stage , in order to compile an analytical description of the participants ' experiences and views on the subject and a comprehensive description of female Sexual Interest / Arousal Disorder , the results were linked together and more general classifications were formed . In the sixth step, a comprehensive description of the studied phenomenon was presented in a clear and unambiguous language. In the final stage and in order to validate the findings, coding was sent to the participants to announce their suggested changes if necessary ( Morrow , Rodriguez & et al , 2015 ).
Results and discussion
The results showed that the lived experiences of women with FSIAD in 5 main central categories of individual factors with the main themes ( psychological characteristics , dysfunctional  attitudes and lack of skills ) , marital life dysfunction with the main themes ( process marriage , marital conflicts , inhibiting spouse and sexual dyslexia ) , social environmental factors with main themes ( social cultural factors , developmental history and unhealthy lifestyle ) , consequences and treatment considerations ( with main themes of problems and limitations of treatment , facilitating factors and expectations and desires treatment ) was obtained.
Conclusion
The findings of this study showed that the experiences of women with sexual interest/arousal disorder are classified into 5 main categories of individual factors, marital life dysfunction, social environmental factors, consequences and treatment considerations.
In summary, the findings of this research indicate that female sexual interest/arousal disorder is a multidimensional disorder and has significant negative consequences on the performance and quality of married life of these patients. Significant each category of psychological causes can be promising for researchers and therapists to discover effective strategies for psychological treatment in order to help patients recover. According to the findings and symptoms experienced and the consequences of the disease and the expectations of the participants from the treatment, it seems that therapist should have a comprehensive approach to treat this disease and be able to treat each of the symptoms and consequences of this disease. And the effective factors in the etiology of this disease should have a set of therapeutic models and scientific techniques, up-to-date and effective, and use them in the treatment process according to the needs and symptoms of the patients.
So considering culture and social conditions can help in creating a more efficient framework in preventive or intervention programs for these patients