Sexual dysfunction in women

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Última revisão das evidências: 15 Aug 2026

Última atualização do tópico: 08 May 2026

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 pharmacotherapy.

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]

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]

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

Sexual dysfunction in transgender women is outside the scope of this review; however, it may present added complexity related to variability in anatomic and hormonal profiles as well as sociocultural factors.[14]

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 (nonnerve-sparing)
cystectomy or proctectomy
personality factors and attitudes
relationship factors
partner sexual dysfunction
reduced androgen activity
estrogen deficiency
premature ovarian failure
postpartum
aging
diabetes mellitus
renal failure
cardiovascular disease
polycystic ovarian syndrome
drug or substance use
hypothalamic-pituitary disease
infertility
lower urinary tract symptoms
socioeconomic status
sexual abuse and developmental trauma

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

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/drug-induced sexual dysfunction

Colaboradores

Autores

Miriam Driscoll, MD, FRCP(C)

Clinical Associate Professor

Department of Psychiatry

Associate Member Department of Obstetrics and Gynaecology

University of British Columbia

Sexual Medicine Physician

Academic Co-Head, UBC Sexual Medicine Program

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)

Clinical Instructor

Department of Psychiatry

University of British Columbia

Sexual Medicine Physician

Academic Co-Head, UBC Sexual Medicine Program

BC Centre for Sexual Medicine

Vancouver Coastal Health Authority

Vancouver

Canada

Declarações

LR declares that she has no competing interests.

Agradecimentos

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

Declarações

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).

Revisores

Holly N. Thomas, MD, MS

Assistant Professor of Medicine

University of Pittsburgh

Pittsburgh, PA

Declarações

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

Declarações

PK has undertaken research studies for Boehringer Ingelheim.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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

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

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Sexual aversion
- Interpersonal factors (e.g., relationship discord, intimate partner violence, other significant stressors)
- Nonsexual mental disorders (e.g., depression)
Mais Diagnósticos diferenciais
Diretrizes
- Evaluation and management of hypoactive sexual desire disorder in women. Recommendations from the 5th International Consultation on Sexual Medicine
- Female sexual dysfunction
Mais Diretrizes
Folhetos informativos para os pacientes
Sexual dysfunction in women
Mais Folhetos informativos para os pacientes
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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

Investigações a serem consideradas

Algoritmo de tratamento

sexual interest/arousal disorder

female orgasmic disorder (FOD)

substance/drug-induced sexual dysfunction

Colaboradores

Autores

Miriam Driscoll, MD, FRCP(C)

Declarações

Leah Rosetti, MD, FRCP(C)

Declarações

Agradecimentos

Declarações

Revisores

Holly N. Thomas, MD, MS

Declarações

Philip Kell, MBBS, FRCOG, FRCP

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice