When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Sexual dysfunction in women

Last reviewed: 10 Nov 2023
Last updated: 06 Dec 2022



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)
More key diagnostic factors

Other diagnostic factors

  • current stressors
  • negative emotions during sex
  • vulvovaginal atrophy
  • galactorrhea
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum glucose level
  • renal function
  • thyroid function tests
  • serum prolactin level
More 1st investigations to order

Treatment algorithm


sexual interest/arousal disorder

female orgasmic disorder (FOD)

substance/medication-induced sexual dysfunction



Miriam Driscoll, MD, FRCP(C)

Clinical Assistant Professor

Department of Psychiatry

Associate Member Department of Obstetrics and Gynaecology

University of British Columbia


BC Center for Sexual Medicine

Vancouver Coastal Health Authority




MD declares that she has no competing interests.

Leah Rosetti, MD, FRCP(C)


Department of Psychiatry

University of British Columbia


BC Centre for Sexual Medicine

Vancouver Coastal Health Authority




LR declares that she has no competing interests.


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


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




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




PK has undertaken research studies for Boehringer Ingelheim.

  • Differentials

    • Sexual aversion
    • Interpersonal factors (e.g., relationship discord, intimate partner violence, other significant stressors)
    • Nonsexual mental disorders (e.g., depression)
    More Differentials
  • 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
    More Guidelines
  • Patient leaflets

    Anxiety: what is it?

    Anxiety: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer