Women's sexual dysfunctions correlate most strongly with poor mental health and with negative feelings for the partner, rather than with any serum hormone (or hormone metabolite) levels.
Normal changes with age and relationship duration must not be mistaken for desire/interest disorder. Desire disorder is diagnosed when there is a lack of anticipatory sexual desire, and desire (along with pleasure, arousal, and excitement) cannot be triggered during sexual activity and results in distress.
The most common syndrome is lack of initial desire, little subjective arousal (mental sexual excitement) such that desire is not triggered during any portion of the sexual engagement, and infrequent or no orgasm.
Given the sensitive nature of the information collected and reluctance/embarrassment to disclose at initial appointments, the clinician should continue to assess relevant information and integrate into treatment throughout contact with the patient.
Treatment includes components of psycho-education, cognitive behavioural therapy (CBT), sex therapy, mindfulness and psychotherapy, and occasionally medicines.
Women's sexual dysfunctions include a spectrum of disorders that are typically multi-factorial in aetiology and include sexual interest/arousal disorder (SIAD), female orgasmic disorder (FOD), and genito-pelvic penetration pain disorder (GPPPD), which combines the frequently overlapping diagnoses of vaginismus and dyspareunia.
A diagnosis of dysfunction or disorder is only made when the symptoms are ongoing and associated with distress, the degree of which should be recorded.  Poor mental health, stress,  and low levels of emotional intimacy between the partners correlate closely with dysfunction,    whereas serum levels of sex hormones do not.      
Vaginismus and dyspareunia, now grouped as GPPPD, are specific conditions that will not be covered in this monograph; however, further information is available in the dyspareunia monograph.
Given that there is only limited research on persistent genital arousal disorder (PGAD),  its pathophysiology and treatment are not discussed in this monograph.
University of British Columbia
Departments of Psychiatry and Obstetrics/Gynecology
RB is an author or co-author of several references cited in this monograph. RB's department has received research funding from the Canadian Institutes of Health Research (CIHR).
Dr Rosemary Basson would like to gratefully acknowledge Dr Lori Brotto, a previous contributor to this monograph. LB is an author or co-author of several references cited in this monograph.
Johns Hopkins University
Division of Obstetrics and Gynecology
MBB declares that she has no competing interests.
Archway Sexual Health Clinic
PK has undertaken research studies for Boehringer Ingelheim.
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