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Sexual dysfunction in women

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 15 Jun 2025
Last updated: 29 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • 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)
Full details

Other diagnostic factors

  • current stressors
  • negative emotions during sex
  • vulvovaginal atrophy
  • galactorrhea
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • CBC
  • serum glucose level
  • renal function
  • thyroid function tests
  • serum prolactin level
Full details

Treatment algorithm

ONGOING

sexual interest/arousal disorder

female orgasmic disorder (FOD)

substance/medication-induced sexual dysfunction

Contributors

Authors

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

Disclosures

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

PA

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

UK

Disclosures

PK has undertaken research studies for Boehringer Ingelheim.

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)
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  • 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
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