Sexual dysfunction in women
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)
Other diagnostic factors
- current stressors
- negative emotions during sex
- vulvovaginal atrophy
- galactorrhea
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 (nonnerve-sparing)
- cystectomy or proctectomy
- personality factors and attitudes
- relationship factors
- partner sexual dysfunction
- reduced androgen activity
- estrogen deficiency
- premature ovarian failure
- postpartum
- aging
- diabetes mellitus
- renal failure
- cardiovascular disease
- polycystic ovarian syndrome
- drug or substance use
- hypothalamic-pituitary disease
- infertility
- lower urinary tract symptoms
- socioeconomic status
- sexual abuse and developmental trauma
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- CBC
- serum glucose level
- renal function
- thyroid function tests
- serum prolactin level
Treatment algorithm
sexual interest/arousal disorder
female orgasmic disorder (FOD)
substance/drug-induced sexual dysfunction
Contributors
Authors
Miriam Driscoll, MD, FRCP(C)
Clinical Associate Professor
Department of Psychiatry
Associate Member Department of Obstetrics and Gynaecology
University of British Columbia
Sexual Medicine Physician
Academic Co-Head, UBC Sexual Medicine Program
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)
Clinical Instructor
Department of Psychiatry
University of British Columbia
Sexual Medicine Physician
Academic Co-Head, UBC Sexual Medicine Program
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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.
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 213: female sexual dysfunction. Jul 2019 [internet publication].Full text
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
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)
More DifferentialsGuidelines
- Evaluation and management of hypoactive sexual desire disorder in women. Recommendations from the 5th International Consultation on Sexual Medicine
- Female sexual dysfunction
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