Sexual dysfunction in women

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Última revisão: 12 Dec 2025

Última atualização: 29 Jan 2025

Sexual dysfunction in women of all sexual orientations correlates most strongly with poor mental health and with negative feelings for the partner(s), 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 or 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 psychoeducation, cognitive behavioral therapy, sex therapy, mindfulness and psychotherapy, mitigation of biologic and pharmacologic risk factors, and occasionally medications.

Definição

Women's sexual dysfunctions include a spectrum of disorders that are typically multifactorial in etiology 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.[1]

There are three criteria for diagnosing a sexual disorder: symptoms need to have persisted for a minimum of 6 months, they need to have been experienced in all or almost all (75% to 100%) sexual encounters, and to have caused clinically significant distress.[1] 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.[2][3][4][5][6][7][8][9][10][11]

Vaginismus and dyspareunia, now grouped as GPPPD, are specific conditions that will not be covered in this topic. See Evaluation of dyspareunia.

There is only limited research on persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) and its pathophysiology and treatment are not well understood.[12][13]

História e exame físico

Principais fatores diagnósticos

sexual symptoms leading to distress
absent/reduced interest in sexual activity (SIAD)
absent/reduced sexual/erotic thoughts or fantasies (SIAD)
absent/reduced sexual excitement/pleasure during sexual activity (SIAD)
no subjective arousal from erotic or sexual cues (SIAD)
absent/reduced awareness of genital or nongenital sensations during sexual activity (SIAD)
no/reduced initiation of sexual activity (SIAD)
orgasm absent or of minimal intensity (FOD)
marked delay in orgasm (FOD)
marked infrequency of orgasm (FOD)
spontaneous, intrusive, unpleasant genital congestion and feeling of impending orgasm (PGAD/GPD)

Detalhes completos

Outros fatores diagnósticos

current stressors
negative emotions during sex
vulvovaginal atrophy
galactorrhea

Detalhes completos

Fatores de risco

depression
antidepressant use
comorbid anxiety disorder
psychological aspects of cancer
breast cancer
gynecologic and other pelvic cancer
neurologic disease
endometriosis
hyperprolactinemia
radical hysterectomy (non-nerve-sparing)
cystectomy or proctectomy
personality factors and attitudes
relationship difficulties
partner sexual dysfunction
reduced androgen activity
estrogen deficiency
premature ovarian failure
postpartum
aging
diabetes
renal failure
cardiovascular disease
polycystic ovarian syndrome (PCOS)
medication or substance use
hypothalamic-pituitary disease
infertility
lower urinary tract symptoms (LUTS)
socioeconomic status
sexual abuse and developmental trauma

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

CBC
serum glucose level
renal function
thyroid function tests
serum prolactin level

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

sexual interest/arousal disorder

female orgasmic disorder (FOD)

substance/medication-induced sexual dysfunction

Colaboradores

Autores

Miriam Driscoll, MD, FRCP(C)

Clinical Assistant Professor

Department of Psychiatry

Associate Member Department of Obstetrics and Gynaecology

University of British Columbia

Physician

BC Center for Sexual Medicine

Vancouver Coastal Health Authority

Vancouver

Canada

Declarações

MD declares that she has no competing interests.

Leah Rosetti, MD, FRCP(C)

Fellow

Department of Psychiatry

University of British Columbia

Physician

BC Centre for Sexual Medicine

Vancouver Coastal Health Authority

Vancouver

Canada

Disclosures

LR declares that she has no competing interests.

Acknowledgements

Dr Miriam Driscoll and Dr Leah Rosetti would like to gratefully acknowledge Dr Lori Brotto and Dr Rosemary Basson, previous contributors to this topic.

Disclosures

LB is an author or co-author of several references cited in this topic. RB is an author or co-author of several references cited in this topic. RB's department has received research funding from the Canadian Institutes of Health Research (CIHR).

Peer reviewers

Holly N. Thomas, MD, MS

Assistant Professor of Medicine

University of Pittsburgh

Pittsburgh

Disclosures

HNT received a research award from the North American Menopause Society that was funded by AMAG Pharmaceuticals, who originally developed bremelanotide alongside Palatain Technologies.

Philip Kell, MBBS, FRCOG, FRCP

Consultant Physician

Archway Sexual Health Clinic

Whittington Hospital

London

Disclosures

PK has undertaken research studies for Boehringer Ingelheim.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.

Basson, R. The Circles of Sex: Basson’s Sex Response Cycle. In: Lykins, A. (ed) Encyclopedia of Sexuality and Gender. Cham: Springer; 2020:1-11.

Chivers ML, Brotto LA. Controversies of women’s sexual arousal and desire. Eur Psychol 2017;22(1):5-26.

Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016 Feb;78:178-93.Full text Abstract

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 213: female sexual dysfunction. Jul 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Sexual aversion
- Interpersonal factors (e.g., relationship discord, intimate partner violence, other significant stressors)
- Nonsexual mental disorders (e.g., depression)
More Differentials
Guidelines
- Female sexual dysfunction
- The International Society for the Study of Women's Sexual Health process of care for the identification of sexual concerns and problems in women
More Guidelines
Patient information
Anxiety: what is it?
Anxiety: what are the treatment options?
More Patient information
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Sexual dysfunction in women

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Algoritmo de tratamento

sexual interest/arousal disorder

female orgasmic disorder (FOD)

substance/medication-induced sexual dysfunction

Colaboradores

Autores

Miriam Driscoll, MD, FRCP(C)

Declarações

Leah Rosetti, MD, FRCP(C)

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Holly N. Thomas, MD, MS

Disclosures

Philip Kell, MBBS, FRCOG, FRCP

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice