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Key Features

  • Encompasses several disorders, including

    • Sexual desire disorder

    • Sexual arousal disorders

    • Orgasmic disorders

    • Sexual pain disorders (see Dyspareunia [Painful Intercourse])

  • Obtain reproductive history (including pregnancies and mode of delivery)

  • In addition, obtain a history of

    • Infertility

    • Sexually transmitted diseases

    • Rape or sexual abuse

    • Gynecologic or urologic disorders

    • Endocrine abnormalities (such as diabetes mellitus or thyroid disease)

    • Neurologic problems

    • Cardiovascular disease

    • Psychiatric disease

    • Current prescription and over-the-counter medication use

Clinical Findings

  • Disorders of sexual desire

    • Emotion is a key factor in sexual desire

    • Lack of desire may be attributed to such physical factors as

      • Chronic illness

      • Fatigue

      • Depression

      • Specific medical disorders (such as diabetes mellitus, thyroid disease, or adrenal insufficiency)

    • Attitudes toward menopause and aging may play a role

    • In addition, sexual desire may be influenced by other sexual dysfunctions

  • Sexual arousal disorders

    • May be both subjective and objective

    • Sexual stimulation normally leads to genital vasocongestion and lubrication

    • Some women may have a physiologic response to sexual stimuli but may not subjectively feel aroused because of factors such as

      • Distractions

      • Negative expectations

      • Anxiety, fatigue, depression

      • Medications, such as selective serotonin reuptake inhibitors (SSRIs) or oral contraceptives

    • Other women may lack both a subjective and physiologic response to sexual stimuli related to vaginal atrophy

  • Orgasmic disorders

    • In spite of subjective and physiologic arousal, women may experience a marked delay in orgasm, diminished sensation of an orgasm, or anorgasmia

  • Sexual pain disorders

    • See Dyspareunia (Painful Intercourse)

Diagnosis

  • Gynecologic examination should focus on findings that may contribute to sexual complaints

Treatment

  • Disorders of sexual desire

    • In the absence of specific medical disorders, the focus of therapy is psychological (eg, cognitive behavioral therapy, sexual therapy, and couples therapy)

    • Pharmacologic therapy, particularly with dopamine agonists or testosterone with estrogen, may be successful but data are lacking

  • Sexual arousal disorders

    • May respond to psychological therapy

    • Some evidence suggests a role for sildenafil in women with sexual dysfunction due to multiple sclerosis, type 1 diabetes mellitus, spinal cord injury, and antidepressant medications, if other, better established, approaches fail

    • Flibanserin (Addyi)

      • Effective for treatment of hypoactive sexual desire disorder in premenopausal women

      • Must be used long-term to be effective

      • Has significant risks that require specific certifications of providers and pharmacies before dispensation to patients in the United States

  • Orgasmic disorders

    • Counseling or sex therapy may be adequate therapy

    • There is an FDA-approved vacuum device that increases clitoral blood flow and may improve the likelihood of orgasm

  • Sexual pain disorders

    • See Dyspareunia (Painful Intercourse)

References

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American College of Obstetricians and Gynecologists. Committee Opinion No 706: Sexual health. Obstet Gynecol. 2017 Jul;130(1):e42–7.
[PubMed: 28644338]  
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Dawson  ML,  et al. The evaluation and management of female sexual dysfunction. J Fam Pract. 2017 Dec;66(12):722–8.
[PubMed: 29202143]  
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Goldstein  I,  et al. Hypoactive sexual desire disorder: International Society for the ...

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