Summary
Definition
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
sexual interest/arousal disorder
female orgasmic disorder (FOD): lifelong
FOD: acquired (antidepressant-induced)
FOD: acquired (not antidepressant-induced)
Contributors
Authors
Rosemary Basson, MD, FRCP (UK)

Clinical Professor
University of British Columbia
Departments of Psychiatry and Obstetrics/Gynecology
Vancouver
Canada
Disclosures
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).
Acknowledgements
Dr Rosemary Basson would like to gratefully acknowledge Dr Lori Brotto, a previous contributor to this topic.
Disclosures
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
Baltimore
MD
Disclosures
MBB declares that she has no competing interests.
Philip Kell, MBBS, FRCOG, FRCP
Consultant Physician
Archway Sexual Health Clinic
Whittington Hospital
London
UK
Disclosures
PK has undertaken research studies for Boehringer Ingelheim.
Differentials
- Sexual aversion
- Marital discord
More DifferentialsGuidelines
- 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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