If the first step of lovemaking is desire, then step two is sexual arousal. But, if sex is what your mind wants and your body doesn't respond, you could be suffering from sexual arousal disorder (SAD). During successful arousal, the body achieves adequate genital lubrication and swelling, and nipple sensitivity. Vaginal lubrication is dependent on the swelling of blood vessels in the genital region. Any condition that impedes blood flow to this area could potentially cause problems with sexual arousal.

Pelvic Surgery

Pelvic surgery, including hysterectomy, can cause problems with arousal. Although some studies indicate sex improves after pelvic surgery, other studies show difficulty with vaginal lubrication and a loss of genital sensation. Some experts believe that the removal of the cervix and injury to the nerves during surgery can compromise blood flow to the genital region.

Childbirth Trauma

Vaginal tearing from vacuum- or forceps-assisted delivery during childbirth sometimes causes nerve and vascular damage and problems with vaginal and clitoral sensation. In addition, delivery of a large baby relative to birth canal size can cause trauma.


Decreased vaginal lubrication can occur while breastfeeding. This is not uncommon, and it is caused by an increase in the production of the hormone called prolactin, and an associated decrease in estrogen levels. This condition reverses once menses resume, which restores estrogen levels back to normal. For some women, menses return even while breastfeeding. For others, menses and the resulting return of normal estrogen levels does not occur until full weaning.

Blood Flow Diseases

Blood flow diseases, including heart disease, high blood pressure, diabetes and high cholesterol can all impede blood flow to the pelvic region. A reduction in blood flow can impede a woman's ability to become sexually aroused.


Drugs used to treat high blood pressure and migraines, known as beta-blockers, can cause sexual dysfunction. If you are having difficulty with arousal, ask your doctor if there are other options for these conditions that might cause fewer sexual side effects. Some women who take birth control pills notice a diminished sex drive and vaginal dryness. Finally, medications to prevent recurrence of breast cancer can also cause vaginal dryness.

Menopause and Aging

Menopause can alter hormone levels, resulting in problems with arousal. During menopause, there is a sharp decrease in estrogen production. In addition, testosterone levels gradually decline with aging. As a result, many women at midlife have decreased vaginal lubrication and associated difficulties with arousal. These hormonal changes may also be responsible for a decrease in sex drive.