Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 18-19: Female Sexual Dysfunction + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Gynecologic examination should focus on findings that may contribute to sexual complaints + Treatment Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ + +; American College of Obstetricians and Gynecologists.. Committee Opinion No 706: Sexual health. Obstet Gynecol. 2017 Jul;130(1):e42–7. [PubMed: 28644338] + +Clayton AH et al. Female sexual dysfunction. Psychiatr Clin North Am. 2017 Jun;40(2):267–84. [PubMed: 28477652] + +Dawson ML et al. The evaluation and management of female sexual dysfunction. J Fam Pract. 2017 Dec;66(12):722–8. [PubMed: 29202143] + +Goldstein I et al. Hypoactive sexual desire disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clin Proc. 2017 Jan;92(1):114–28. [PubMed: 27916394] + +Kingsberg SA et al. Female sexual dysfunction—medical and psychological treatments, Committee 14. J Sex Med. 2017 Dec;14(12):1463–91. Erratum in: J Sex Med. 2018 Feb;15(2):270. [PubMed: 29198504] + +Stenson AL. Vulvodynia: diagnosis and management. Obstet Gynecol Clin North Am. 2017 Sep;44(3):493–508. [PubMed: 28778645] + +Zhou ES et al. Hormonal changes and sexual dysfunction. Med Clin North Am. 2017 Nov;101(6):1135–50. [PubMed: 28992859]