WHAT IS IT?

Female sexual dysfunction is a condition in which a woman experiences persistent and recurrent problems with any aspect of her sexual activity. The problem must cause her personal distress and/or be affecting her relationship. Female sexual dysfunction typically falls into one of the following categories:

• Problems with libido – an absence of desire and fantasies
• Problems with arousal – an absence of response to sexual stimulus, either objectively or subjectively
• Problems with orgasm –  an inability to achieve an orgasm when desired
• Problems with pain –  an experience of pain either before, during or after coitus

KEY POINTS:

• While elements of sexual dysfunction may be present, the issues need to cause the patient distress, either personally or in her relationship, in order to define the problem as a clinical concern
• Sexual dysfunction issues often involve comorbidity
  • It is often difficult for a woman to distinguish for herself which problem may be primary and which may be secondary
• Problems of desire and arousal are often confused by the patient or intertwined, therefore the most recent DSM –5 merged the two concerns into “Sexual Interest/Arousal Disorder”
• Diagnosis and management of some sexual dysfunction cases are highly complex and time consuming, necessitating appropriate referrals to sexual health specialists
• Avoid assumption that pelvic pain is psychological in patients who are unable to identify the cause of the pain
• When the cause of pain cannot be readily diagnosed and treated, consider referrals to:
  • Pelvic pain specialists
  • Pelvic floor physical therapists
• In cases of low desire, decreased arousal or orgasm consider all potential physiological causes, including complaints resulting as a side effect of medications when also considering referral to sex therapists. Consider referrals to:
  • Sexual health specialists
  • Endocrinologists specializing in sexual health
  • Prescribing physicians in those cases where complaints are most likely to be side effects of other medications
• Note: Many of these medications leading tend to be psychotropics, so consider importance of involving psychiatrists
• Referrals to sex therapists and psychologists are best made in tandem with appropriate medical referrals or in cases where the practitioner comes to the conclusion the problem is one of relationship, body dysmorphia or lack of sexual awareness in the patient

Learn More – Primary Sources:

Arriving at the Diagnosis of Female Sexual Dysfunction

Female Sexual Dysfunction: Assessment

The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women

Should Sexual Desire and Arousal Disorders in Women Be Merged?

DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions

Locate a Sexual Health Professional:

AASECT-Referral Directory 

ISSWSH-Find a Provider 

SSTAR-Find a Therapist

The ObG Project is in no way affiliated with any outside entity or professional organization

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Prescribing Flibanserin for Low Desire: How, When and Where?

Asking About Sexual Health

What is Sex Therapy?