Question Part 1: I'm 16 years old and I can't get aroused. I don't know whats wrong with me.

Answer Part 1: I am not a doctor but perhaps if you provide more information I might be able to help you figure things out.

Do you menstruate on a regular basis? Would you say you have little, average, or a lot of body fat? Do you have spontaneous sexual thoughts during the day, or have sexual dreams at night? Do you ever notice clear fluid coming from your vagina? Do you find yourself attracted to boys or girls; your heart rates increases when you see them and get butterflies in your stomach?

Question Part 2: My periods are normal, it's just for some reason I can't get aroused. I've been like this for at least 3 years, and have been to numerous doctors. Every doctor tells me the same thing: that I'm either a late bloomer, or that I should just wait to have sex when I am ready. This is not the case at all. It's not that I don't want to have sex, it's that if I did nothing would happen to me. I would not get aroused. I have anxiety and depression, so I think this might have something to do with it. I take the medication Zololft, but I know it's not why I can't get aroused. I just started taking the medication a few months ago, and like I said, I haven't been able to get aroused for almost 3 years now. Please don't write back and tell me that I shouldn't be concerned about this because I am too young, because I am very concerned. Even though I am only 16, that doesn't mean that I shouldn't want to be normal. I just want to be able to get aroused and be like all the other girls my age. I want to be able to feel healthy, because I know this isn't right. Do you know what might help me???

Answer Part 2: The likely reason why doctors have told you to wait is they simply do not have an answer to your concerns; a nineteen year old reported the same reaction from her doctor. This is because doctors receive little in the way of training in human sexuality, and little is known about adolescent sexuality. The doctors may not have wanted you to know they did not have an answer, as we expect doctors to know everything. Our society also does not usually permit people to explore childhood or adolescent sexuality so we do not know what is "normal" for persons in these age groups. Another factor is your age. Doctors may not feel it is appropriate to discuss sexual issues with a sixteen-year-old. They may fear legal proceedings if you or your parents deem their questions or suggested treatment to be inappropriate. Even I have to be careful in what I say and ask, because of your age. While unfortunate, the doctors response to your situation is not surprising.

Please note that I am not a doctor so I cannot diagnose or recommend treatment for any medical conditions, physical or psychological. The following is just general information and may or may not apply in any way to you. You will need to review this information with your doctors to find a cause and solution, if they are willing to do so. You may need to get your parents involved in this problem so they can help you find a cause and solution. Hopefully your parents are supportive of your sexual development.

Female sexual arousal occurs prior to puberty and is not dependent on puberty. Newborn infant girls have been observed showing indications of vaginal lubrication. Female children may experience sexual arousal spontaneously, or as a result of physical stimulation and sexual fantasies. Arousal is not dependent on sexual desire, and is a hard-wired response. Physical or mental stimulation results in the release of chemicals that cause increased blood to collect in the sexual organs, internal and external. This is evident by clear fluid seeping from the vagina and blood engorgement of the external genitals indicated by increased size, warmth, and redness of the tissues. These changes affect the clitoris and inner and outer labia. Doctors refer to lack of arousal as Sexual Arousal Disorder.

During puberty hormones called androgens start to be produced prior to visible indications of puberty, i.e. breasts and pubic hair. One type of androgen is testosterone. Androgens are responsible for pubic hair, changes in the skin and body odor, and sexual desire. I had trouble finding out when sexual desire first develops in girls. One reference states this occurs between the ages of 9 and 12. I am led to believe it occurs during early puberty, about the time physical indications of puberty are first visible. This means you should at the age of sixteen experience both sexual arousal and desire to some degree. At sixteen, you are likely "physically mature," though perhaps not sexually or emotionally. Doctors refer to lack of desire as Hypoactive Sexual Desire Disorder (HSDD).

Sexual arousal and desire can occur independent of one another, but both are required for normal sexual function. We need to know if you experience a lack of arousal and/or desire. They are two different conditions that may occur at the same time. Sexual desire is indicated by sexual thoughts, fantasies, and possibly by frequency of masturbation. These events in turn should result in sexual arousal. There should also be wet dreams, sexual dreams and arousal while you sleep. A doctor will need to know how often you experience sexual thoughts and arousal and under what conditions. While personal, your masturbation habits are also of interest, past and present. A doctor may feel uncomfortable asking these questions of a sixteen-year-old girl, understandably.

Another factor to consider is when these changes took place, or if they have always been present. They will need to know if you experienced arousal, and possibly orgasm, during childhood and if you experienced the onset of sexual desire during early puberty. You indicate things changed three years ago. They will need to understand what things were like prior to the change(s). They also will need to know what things changed at that time. What physical changes occurred in your body (physical and hormonal), life, family, and school at that time? What emotional changes occurred as a result? Knowing when your breasts and pubic hair started to develop and when menstruation started in relation to these events would be helpful.

Your menstrual cycle and menstruation are controlled by the hormones progesterone and estrogen. These hormones also influence your breasts. This means you could have a healthy menstrual cycle and flow but still experience sexual impairment. Menstruation does give a general indication of your overall health. If you are stressed, underweight, or unhappy your body naturally shuts down your sexual and reproductive systems, as becoming pregnant would be harmful to you and the baby. Missed and irregular periods or menstrual cycle lengths would be possible indictors of physical or emotional problems within your life.

There is the possibility that there is a common cause of your sexual problems and anxiety. The hormone testosterone is responsible for normal sexual function and testosterone is converted into the hormone estradiol, which in turn becomes serotonin and endorphins. Zololft is a serotonin booster. Low serotonin and endorphins can cause anxiety. Some degree of anxiety is normal during puberty, more so for girls, because of conflicts between what your body, family, peers, society, and teachers all want from you. Your sexual impairment would also cause anxiety and emotional distress. Since a doctor has prescribed Zololft, I have to presume your anxiety goes beyond the normal amount, causing major disruptions in your life. If they prescribed Zololft because they did not know what else to do, a second opinion may be needed.

There are many things that can influence your testosterone level. Testosterone production and use by your body is an extremely complex process that I do not fully understand myself. Several organs and processes in your body produce testosterone. Your ovaries and adrenal glands are two of the major participants in this process. Your body many not produce enough testosterone or it is not sensitive to testosterone, or one of the hormones that are required for it to be produced are not present in appropriate levels. Hormonal problems caused by the thyroid gland and too much estrogen are two possible causes. A doctor needs to have a "complete" blood analysis done for you to determine if there are any hormonal problems.

My recommendation at this point is for you to have these blood tests done, if it has not already been done. Evaluating blood tests is complex and open to interpretation so do not expect clear easy answers. Since your parents pay for or paid for these tests you have the right to see them, and probably should. You may have to demand they have a look at your testosterone levels, which is done in a round about way, given your age and sex. Understanding blood test results is difficult and you will need help in doing so.

I also recommend starting a personal journal. Keep a daily record of your health, happiness, and thoughts. Record your menstrual cycle and changes in your body caused by it, physical and emotional. Answer the questions I have presented above. Be open, honest, and thorough. Then when you go to see your doctor, take this journal with you and show it to them. Doctors who are interested in your treatment will be interested in what your journal has to say. The key is finding a doctor who has the time and willingness to read through it. Doctors are very busy so you may have to do some searching. If you are seeing a therapist, they too should be shown the journal and they may be able to help locate a doctor who can help with the medical aspects. These journals are helpful to everyone who is experiencing long term medical problems keep tract of everything that takes places over long periods of time, years in some cases. Record medications and treatments too.

I hope this information is of help. Please feel free to write back if you still have questions. We are addressing some complex issues, which in some cases do not have answers.

The Q&A that addresses Perception of Female Sexual Arousal and Desire may also be of help.