Think of sexual arousal as the second phase of lovemaking. First, you want to have sex and then, through foreplay and intimacy, you become aroused. But if your mind is saying "yes" and your body isn't listening, you could be suffering from sexual arousal disorder (SAD).

Medically speaking, SAD is defined as the persistent or recurring inability to maintain adequate genital lubrication, swelling or other responses, such as nipple sensitivity, during the excitement stage of sexual activity.

Vaginal lubrication is dependent on the swelling of blood vessels in the genital region, so any impediment to blood flow could potentially cause SAD, including:

• Pelvic surgery like hysterectomy of which 600,000 are performed each year. Drs. Jennifer and Laura Berman report that the research on hysterectomy is contradictory: Some studies indicate sex improves after surgery, and some show negative results, such as decreased vaginal lubrication and a loss of genital sensation. Even if the surgery spares your ovaries, you can still experience these symptoms. The Bermans say removal of the cervix and injury to the nerves during surgery can severely compromise blood flow, thereby setting the stage for SAD.
• Childbirth trauma (vaginal tearing) from suction or forceps sometimes causes nerve and vascular damage to the vagina, resulting in problems with vaginal and clitoral sensation. Decreased lubrication can also occur during breast-feeding; it is not uncommon in postpartum women due to an elevation of the hormone prolactin.
• Blood flow diseases: Coronory heart disease, high blood pressure, diabetes, and high cholesterol all can impede blood flow to the pelvic region and reduce a woman's ability to become aroused. Ironically, some drugs used to treat high blood pressure, known as beta-blockers, actually cause sexual dysfunction; calcium channel blockers, also used in the treatment of heart disease, have become more popular, say the Bermans, because of their reduced impact on sexual function.
• Hormonal changes: Fluctuations can be instigated by the onset of menopause, childbirth or medications. For instance, some women who take progestin-dominant birth control pills complain of a loss of libido and vaginal dryness. Medications to prevent recurrence of breast cancer, such as Tamoxifen, also can cause vaginal dryness. But by far, the most dramatic change is the drop in estrogen, which occurs with menopause and causes decreased vaginal lubrication as well as many other unpleasant symptoms.

Overcoming Sexual Arousal Disorder
Until the Bermans and other advocates of women's sexual health arrived on the scene, all women had to combat SAD were vaginal lubricants like KY-jelly, which eases symptoms but does not address the underlying problem.