Last reviewed: 25 Dec 2021
Last updated: 15 Sep 2020



History and exam

Key diagnostic factors

  • sexual symptoms leading to distress
  • absent/reduced sexual/erotic thoughts or fantasies
  • absent/reduced sexual excitement/pleasure during sexual activity
  • no subjective arousal from erotica
  • no awareness of genital response
  • no initiation of sexual activity
  • orgasm absent or of minimal intensity, or marked delay
  • spontaneous, intrusive, unpleasant genital congestion and feeling of impending orgasm

Other diagnostic factors

  • current stressors
  • absent/reduced interest in sexual activity
  • negative emotions during sex
  • minimal changes in temperature, muscle tension, heart rate during sex
  • vulvovaginal atrophy
  • loss of pubic hair
  • galactorrhea

Risk factors

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

Diagnostic investigations

1st investigations to order

  • CBC
  • serum glucose level
  • renal function
  • TFTs
  • serum prolactin level

Treatment algorithm



Rosemary Basson, MD, FRCP (UK)
Rosemary Basson

Clinical Professor

University of British Columbia

Departments of Psychiatry and Obstetrics/Gynecology




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).


Dr Rosemary Basson would like to gratefully acknowledge Dr Lori Brotto, a previous contributor to this topic.


LB is an author or co-author of several references cited in this topic.

Peer reviewers

Milena Braga-Basaria, MD

Endocrinology Consultant

Johns Hopkins University

Division of Obstetrics and Gynecology




MBB declares that she has no competing interests.

Philip Kell, MBBS, FRCOG, FRCP

Consultant Physician

Archway Sexual Health Clinic

Whittington Hospital




PK has undertaken research studies for Boehringer Ingelheim.

Use of this content is subject to our disclaimer