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 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 (CBT), sex therapy, mindfulness and psychotherapy, and occasionally medications.
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.
American Psychiatric Association: DSM-5 development
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.
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Basson R, Leiblum S, Brotto L, et al. Definitions of women's sexual dysfunctions reconsidered: advocating expansion and revision. J Psychosom Obstet Gynaecol. 2003;24:221-229.
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Poor mental health, stress,
[2]
Maserejian NN, Shifren JL, Parish J, et al. The presentation of hypoactive sexual desire disorder in premenopausal women. J Sex Med. 2010;7:3439-3448.
http://www.ncbi.nlm.nih.gov/pubmed/20646184?tool=bestpractice.com
and low levels of emotional intimacy between the partners correlate closely with dysfunction,
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Bancroft J, Loftus J, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav. 2003;32:193-208.
http://www.ncbi.nlm.nih.gov/pubmed/12807292?tool=bestpractice.com
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Hartmann U, Philippsohn S, Heiser K, et al. Low desire in midlife and older women: personality factors, psychosocial development, present sexuality. Menopause. 2004;11:726-740.
http://www.ncbi.nlm.nih.gov/pubmed/15543025?tool=bestpractice.com
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Avis NE, Stellato R, Crawford S, et al. Is there an association between menopause status and sexual functioning? Menopause. 2000;7:297-309.
http://www.ncbi.nlm.nih.gov/pubmed/10993029?tool=bestpractice.com
whereas serum levels of sex hormones do not.
[6]
Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during mid-life due to aging or menopause? Fertil Steril. 2001;76:456-460.
http://www.ncbi.nlm.nih.gov/pubmed/11532464?tool=bestpractice.com
[7]
Santoro N, Torrens J, Crawford S, et al. Correlates of circulating androgens in midlife women: the study of women's health across the nation. J Clin Endocrinol Metab. 2005;90:4836-4845.
http://jcem.endojournals.org/cgi/content/full/90/8/4836
http://www.ncbi.nlm.nih.gov/pubmed/15840738?tool=bestpractice.com
[8]
Davis SR, Davison SL, Donath S, et al. Circulating androgen levels and self-reported sexual function in women. JAMA. 2005;294:91-96.
http://jama.ama-assn.org/cgi/content/full/294/1/91
http://www.ncbi.nlm.nih.gov/pubmed/15998895?tool=bestpractice.com
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Erekson EA, Martin DK, Zhu K, et al. Sexual function in older women after oophorectomy. Obstet Gynecol. 2012;120:833-842.
http://www.ncbi.nlm.nih.gov/pubmed/22996101?tool=bestpractice.com
[10]
van Anders SM. Testosterone and sexual desire in healthy women and men. Arch Sex Behav. 2012;41:1471-1484.
http://www.ncbi.nlm.nih.gov/pubmed/22552705?tool=bestpractice.com
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Basson R, Brotto LA, Petkau AJ, et al. Role of androgens in women’s sexual dysfunction. Menopause. 2010;17:962-971.
http://www.ncbi.nlm.nih.gov/pubmed/20539247?tool=bestpractice.com
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.
[12]
Facelle TM, Sadeghi-Nejad H, Goldmeier D. Persistent genital arousal disorder: characterization, etiology, and management. J Sex Med. 2013;10:439-450.
http://www.ncbi.nlm.nih.gov/pubmed/23157369?tool=bestpractice.com
Given that there is only limited research on persistent genital arousal disorder (PGAD), its pathophysiology and treatment are not discussed in this monograph.
