Highlights & Basics
- Sexual dysfunction in women of all sexual orientations correlates most strongly with poor mental health and with negative feelings for the partner(s), rather than with any serum hormone (or hormone metabolite) levels.
- Normal changes with age and relationship duration must not be mistaken for desire/interest disorder. Desire disorder is diagnosed when there is a lack of anticipatory sexual desire, and desire (along with pleasure, arousal, and excitement) cannot be triggered during sexual activity and results in distress.
- The most common syndrome is lack of initial desire, little subjective arousal (mental sexual excitement) such that desire is not triggered during any portion of the sexual engagement, and infrequent or no orgasm.
- Given the sensitive nature of the information collected and reluctance or embarrassment to disclose at initial appointments, the clinician should continue to assess relevant information and integrate into treatment throughout contact with the patient.
- Treatment includes components of psychoeducation, cognitive behavioral therapy, sex therapy, mindfulness and psychotherapy, mitigation of biologic and pharmacologic risk factors, and occasionally medications.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.
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.[Abstract][Full Text]
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 213: female sexual dysfunction. Jul 2019 [internet publication].[Full Text]
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.
2. Maserejian NN, Shifren JL, Parish J, et al. The presentation of hypoactive sexual desire disorder in premenopausal women. J Sex Med. 2010 Oct;7(10):3439-48.[Abstract]
3. Bancroft J, Loftus J, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav. 2003 Jun;32(3):193-208.[Abstract]
4. Hartmann U, Philippsohn S, Heiser K, et al. Low desire in midlife and older women: personality factors, psychosocial development, present sexuality. Menopause. 2004 Nov-Dec;11(6 Pt 2):726-40.[Abstract]
5. Avis NE, Stellato R, Crawford S, et al. Is there an association between menopause status and sexual functioning? Menopause. 2000 Sep-Oct;7(5):297-309.[Abstract]
6. Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during mid-life due to aging or menopause? Fertil Steril. 2001 Sep;76(3):456-60.[Abstract]
7. Santoro N, Torrens J, Crawford S, et al. Correlates of circulating androgens in midlife women: the study of women's health across the nation. J Clin Endocrinol Metab. 2005 Aug;90(8):4836-45.[Abstract]
8. Davis SR, Davison SL, Donath S, et al. Circulating androgen levels and self-reported sexual function in women. JAMA. 2005 Jul 6;294(1):91-6.[Abstract][Full Text]
9. Erekson EA, Martin DK, Zhu K, et al. Sexual function in older women after oophorectomy. Obstet Gynecol. 2012 Oct;120(4):833-42.[Abstract]
10. van Anders SM. Testosterone and sexual desire in healthy women and men. Arch Sex Behav. 2012 Dec;41(6):1471-84.[Abstract]
11. Basson R, Brotto LA, Petkau AJ, et al. Role of androgens in women's sexual dysfunction. Menopause. 2010 Sep-Oct;17(5):962-71.[Abstract]
12. Facelle TM, Sadeghi-Nejad H, Goldmeier D. Persistent genital arousal disorder: characterization, etiology, and management. J Sex Med. 2013 Feb;10(2):439-50.[Abstract]
13. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) review of epidemiology and pathophysiology, and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD). J Sex Med. 2021 Apr;18(4):665-97.[Abstract][Full Text]
14. McCool ME, Zuelke A, Theurich MA, et al. Prevalence of female Sexual dysfunction among premenopausal women: a systematic review and meta-analysis of observational studies. Sex Med Rev. 2016 Jul;4(3):197-212.[Abstract]
15. Leiblum SR, Koochaki PE, Rodenberg CA, et al. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS). Menopause. 2006 Jan-Feb;13(1):46-56.[Abstract]
16. Dennerstein L, Koochaki P, Barton I, et al. Hypoactive sexual desire disorder in menopausal women: a survey of western European women. J Sex Med. 2006 Mar;3(2):212-22.[Abstract]
17. Mitchell KR, Mercer CH, Wellings K, et al. Prevalence of low sexual desire among women in Britain: associated factors. J Sex Med. 2009 Sep;6(9):2434-44.[Abstract]
18. West SL, D'Aloisio AA, Agans RP, et al. The prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med. 2008 Jul 14;168(13):1441-9.[Abstract]
19. Addis IB, Van Den Eeden SK, Wassel-Fyr CL, et al. Sexual activity and function in middle-aged and older women. Obstet Gynecol. 2006 Apr;107(4):755-64.[Abstract]
20. Mitchell KR, Mercer CH, Ploubidis GB, et al. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet. 2013 Nov 30;382(9907):1817-29.[Abstract][Full Text]
21. Mitchell KR, Jones KG, Wellings K, et al. Estimating the prevalence of sexual function problems: the impact of morbidity criteria. J Sex Res. 2016 Oct 12;53(8):955-67.[Abstract][Full Text]
22. Cain VS, Johannes CB, Avis NE, et al. Sexual functioning and practices in a multi-ethnic study of midlife women: baseline results from SWAN. J Sex Res. 2003 Aug;40(3):266-76.[Abstract]
23. Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men, aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviours. Int J Impot Res. 2005 Jan-Feb;17(1):39-57.[Abstract]
24. Basson R. Sexual desire and arousal disorders in women. N Engl J Med. 2006 Apr 6;354(14):1497-506.[Abstract]
25. Brotto L, Atallah S, Johnson-Agbakwu C, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2016 Apr;13(4):538-71.[Abstract]
26. Scharff DE. Life processes that restructure relationships. In: Levine SB, Risen CB, Althof SE, eds. Handbook of clinical sexuality. New York, NY: Brunner-Routledge; 2003:37-55.
27. Staples J, Rellini AH, Roberts SP. Avoiding experiences: sexual dysfunction in women with a history of sexual abuse in childhood and adolescence. Arch Sex Behav. 2012 Apr;41(2):341-50.[Abstract]
28. Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. Womens Health (Lond). 2018 Jan-Dec;14:1745506518762664.[Abstract]
29. Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet. 2007 Feb 3;369(9559):409-24.[Abstract]
30. Basson R, Bronner G. Management and rehabilitation of neurologic patients with sexual dysfunction. In: Vodusek DB, Boller F, eds. Handbook of clinical neurology. Vol. 130. Waltham, MA: Elsevier; 2015:415-34.
31. Battaglia C, Battaglia B, Mancini F, et al. Sexual behavior and oral contraception: a pilot study. J Sex Med. 2012 Feb;9(2):550-7.[Abstract]
32. Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI, et al. Hormonal contraceptives, female sexual dysfunction, and managing strategies: a review. J Clin Med. 2019 Jun 25;8(6):908.[Abstract][Full Text]
33. Zethraeus N, Dreber A, Ranehill E, et al. Combined oral contraceptives and sexual function in women-a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2016 Nov;101(11):4046-53.[Abstract][Full Text]
34. Teplin V, Vittinghoff E, Lin F, et al. Oophorectomy in premenopausal women: health-related quality of life and sexual functioning. Obstet Gynecol. 2007 Feb;109(2 Pt 1):347-54.[Abstract]
35. Heiman JR. Orgasmic disorders in women. In: Leiblum SR, ed. Principles and practice of sex therapy. 4th ed. New York, NY: Guilford Press; 2007:66-8.
36. Leiblum S, Seehuus M, Brown C. Persistent genital arousal: disordered or normative aspect of female sexual response? J Sex Med. 2007 May;4(3):680-9.[Abstract]
37. Pereira VM, Silva AC, Nardi AE. Persistent genital arousal disorder: a literature review. Jornal Brasileiro de Psiquiatria [in Portuguese]. 2010;59(3):223-32.[Full Text]
38. Waldinger MD, Schweitzer DH. Persistent genital arousal disorder in 18 Dutch women: part II. A syndrome clustered with restless legs and overactive bladder. J Sex Med. 2009 Feb;6(2):482-97.[Abstract]
39. Waldinger MD, de Lint GJ, Venema PL, et al. Successful transcutaneous electrical nerve stimulation in two women with restless genital syndrome: the role of adelta- and C-nerve fibers. J Sex Med. 2010 Mar;7(3):1190-9.[Abstract]
40. Meston CM, Buss DM. Why humans have sex. Arch Sex Behav. 2007 Aug;36(4):477-507.[Abstract]
41. Goldhammer DL, McCabe MP. A qualitative exploration of the meaning and experience of sexual desire among partnered women. Can J Hum Sex. 2011;20:19-34.
42. 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.
43. Chivers ML, Brotto LA. Controversies of women's sexual arousal and desire. Eur Psychol 2017;22(1):5-26.
44. Chivers ML, Seto MC, Lalumière ML, et al. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Arch Sex Behav. 2010 Feb;39(1):5-56.[Abstract][Full Text]
45. Heiman JR, Rupp H, Janssen E, et al. Sexual desire, sexual arousal and hormonal differences in premenopausal US and Dutch women with and without low sexual desire. Horm Behav. 2011 May;59(5):772-9.[Abstract]
46. Labrie F, Archer D, Bouchard C, et al. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause. 2009 Sep-Oct;16(5):923-31.[Abstract]
47. Wåhlin-Jacobsen S, Pedersen AT, Kristensen E, et al. Is there a correlation between androgens and sexual desire in women? J Sex Med. 2015 Feb;12(2):358-73.[Abstract]
48. Kokcu A, Kurtoglu E, Bildircin D,et al. Does surgical menopause affect sexual performance differently from natural menopause? J Sex Med. 2015 Jun;12(6):1407-14.[Abstract]
49. Randolph JF Jr, Zheng H, Avis NE, et al. Masturbation frequency and sexual function domains are associated with serum reproductive hormone levels across the menopausal transition. J Clin Endocrinol Metab. 2015 Jan;100(1):258-66.[Abstract][Full Text]
50. Davis SR, Bell RJ, Robinson PJ, et al. Testosterone and estrone increase from the age of 70 years: findings from the sex hormones in older women study. J Clin Endocrinol Metab. 2019 Dec 1;104(12):6291-300.[Abstract][Full Text]
51. Davison SL, Bell R, Donath S, et al. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab. 2005 Jul;90(7):3847-53.[Abstract][Full Text]
52. Basson R, O'Loughlin JI, Weinberg J, et al. Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire. Psychoneuroendocrinology. 2019 Jun;104:259-68.[Abstract][Full Text]
53. Clayton A, Kornstein S, Prakash A, et al. Changes in sexual functioning associated with duloxetine, escitalopram, and placebo in the treatment of patients with major depressive disorder. J Sex Med. 2007 Jul;4(4 Pt 1):917-29.[Abstract]
54. Montejo AL, Perahia DG, Spann ME, et al. Sexual function during long-term duloxetine treatment in patients with recurrent major depressive disorder. J Sex Med. 2011 Mar;8(3):773-82.[Abstract]
55. Cyranowski JM, Bromberge J, Youk A, et al. Lifetime depression history and sexual function in women at midlife. Arch Sex Behav. 2004 Dec;33(6):539-48.[Abstract]
56. Bhasin S, Enzlin P, Coviello A, et al. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007 Feb 17;369(9561):597-611.[Abstract]
57. Bull SA, Hu XH, Hunkeler EM, et al. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. JAMA. 2002 Sep 18;288(11):1403-9.[Abstract][Full Text]
58. Clayton AH, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer anti-depressants. J Clin Psychiatry. 2002 Apr;63(4):357-66.[Abstract]
59. Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological, and physical problems in men and women: a cross-sectional population survey. J Epidemiol Community Health. 1999 Mar;53(3):144-8.[Abstract]
60. Barlow DH. Causes of sexual dysfunction: the role of anxiety and cognitive interference. J Consult Clin Psychol. 1986 Apr;54(2):140-8.[Abstract]
61. Krychman M, Millheiser LS. Sexual health issues in women with cancer. J Sex Med. 2013 Feb;10(suppl 1):5-15.[Abstract]
62. Ganz PA, Desmond KA, Leedham B, et al. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002 Jan 2;94(1):39-49.[Abstract]
63. Coady D, Kennedy V. Sexual health in women affected by cancer: focus on sexual pain. Obstet Gynecol. 2016 Oct;128(4):775-91.[Abstract]
64. Sadovsky R, Basson R, Krychman M, et al. Cancer and sexual problems. J Sex Med. 2010 Jan;7(1 Pt 2):349-73.[Abstract]
65. Melisko ME, Goldman M, Rugo HS. Amelioration of sexual adverse effects in the early breast cancer patient. J Cancer Surviv. 2010 Sep;4(3):247-55.[Abstract][Full Text]
66. Taylor S, Harley C, Ziegler L, et al. Interventions for sexual problems following treatment for breast cancer: a systematic review. Breast Cancer Res Treat. 2011 Dec;130(3):711-24.[Abstract]
67. Carter J, Lacchetti C, Andersen BL, et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline. J Clin Oncol. 2018 Feb 10;36(5):492-511.[Abstract][Full Text]
68. Baumgart J, Nilsson K, Evers AS, et al. Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer. Menopause. 2013 Feb;20(2):162-8.[Abstract]
69. Alder J, Zanetti R, Wight E, et al. Sexual dysfunction after premenopausal stage I and II breast cancer: do androgens play a role? J Sex Med. 2008 Aug;5(8):1898-906.[Abstract]
70. Carter J, Stabile C, Gunn A, et al. The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med. 2013 Feb;10(suppl 1):21-34.[Abstract]
71. Abbott-Anderson K, Kwekkeboom KL. A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecol Oncol. 2012 Mar;124(3):477-89.[Abstract]
72. Incrocci L, Jensen PT. Pelvic radiotherapy and sexual function in men and women. J Sex Med. 2013 Feb;10(suppl 1):53-64.[Abstract]
73. Hentzen C, Musco S, Amarenco G, et al. Approach and management to patients with neurological disorders reporting sexual dysfunction. Lancet Neurol. 2022 Jun;21(6):551-62.[Abstract]
74. Rees P, Fowler CJ, Maas CP. Sexual function in men and women with neurological disorders. Lancet. 2007 Feb 10;369(9560):512-25.[Abstract]
75. Jia SZ, Leng JH, Sun PR, et al. Prevalence and associated factors of female sexual dysfunction in women with endometriosis. Obstet Gynecol. 2013 Mar;121(3):601-6.[Abstract]
76. Pluchino N, Wenger JM, Petignat P, et al. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update. 2016 Nov;22(6):762-74.[Abstract][Full Text]
77. Kadioglu P, Yalin AS, Tiryakiodlu O, et al. Sexual dysfunction in women with hyperprolactinemia: a pilot study reports. J Urol. 2005 Nov;174(5):1921-5.[Abstract]
78. Jongpipan J, Charoenkwan K. Sexual function after radical hysterectomy for early-stage cervical cancer. J Sex Med. 2007 Nov;4(6):1659-65.[Abstract]
79. Plotti F, Nelaj E, Sansone M, et al. Sexual function after modified radical hysterectomy for early stage cervical cancer. A prospective study. J Sex Med. 2012 Mar;9(3):909-17.[Abstract]
80. Thakar R. Is the uterus a sexual organ? Sexual function following hysterectomy. Sex Med Rev. 2015 Oct;3(4):264-78.[Abstract]
81. Zippe C, Nandipati K, Agarwal A, et al. Sexual dysfunction after pelvic surgery. Int J Impot Res. 2006 Jan-Feb;18(1):1-18.[Abstract]
82. Andersen BL, Cyranowski JM. Women's sexual self-schema. J Pers Soc Psychol. 1994;67:1079-100.
83. Grauvogl A, Pelzer B, Radder V, et al. Associations between personality disorder characteristics, psychological symptoms, and sexual functioning in young women. J Sex Med. 2018 Feb;15(2):192-200.[Abstract]
84. Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men, aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviours. Int J Impot Res. 2005 Jan-Feb;17(1):39-57.[Abstract]
85. Burri A, Spector T. Recent and lifelong sexual dysfunction in a female UK population sample: prevalence and risk factors. J Sex Med. 2011 Sep;8(9):2420-30.[Abstract]
86. Shindel AW, Rowen TS, Lin TC, et al. An Internet survey of demographic and health factors associated with risk of sexual dysfunction in women who have sex with women. J Sex Med. 2012 May;9(5):1261-71.[Abstract]
87. Oberg K, Sjogern Fugl Myer K. On Swedish women's distressing sexual dysfunctions: some concomitant conditions and life satisfaction. J Sex Med. 2005 Mar;2(2):169-80.[Abstract]
88. Chevret-Méasson M, Lavallée E, Troy S, et al. Improvement in quality of sexual life in female partners of men with erectile dysfunction treated with sildenafil citrate: findings of the index of sexual life (ISL) in a couple study. J Sex Med. 2009 Mar;6(3):761-9.[Abstract]
89. Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016 Feb;78:178-93.[Abstract][Full Text]
90. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 213: female sexual dysfunction. Jul 2019 [internet publication].[Full Text]
91. Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019 Oct;7(10):754-66.[Abstract][Full Text]
92. Davis SR, Panjari M, Stanczyk FZ. Clinical review: DHEA replacement for postmenopausal women. J Clin Endocrinol Metab. 2011 Jun;96(6):1642-53.[Abstract]
93. Van der Stege JG, Groen H, van Zadelhoff SJ, et al. Decreased androgen concentrations and diminished general and sexual well-being in women with premature ovarian failure. Menopause. 2008 Jan-Feb;15(1):23-31.[Abstract]
94. Wierman ME, Nappi RE, Avis N, et al. Endocrine aspects of women's sexual function. J Sex Med. 2010 Jan;7(1 Pt 2):561-85.[Abstract]
95. Pastore L, Owens A, Raymond C. Postpartum sexuality concerns among first-time parents from one U.S. academic hospital. J Sex Med. 2007 Jan;4(1):115-23.[Abstract]
96. Barrett G, Peacock J, Victor CR, et al. Cesarean section and postnatal sexual health. Birth. 2005 Dec;32(4):306-11.[Abstract]
97. Hayes R, Dennerstein L. The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies. J Sex Med. 2005 May;2(3):317-30.[Abstract]
98. Hayes RD, Dennerstein L, Bennet C, et al. What is the 'true' prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact? J Sex Med. 2008 Apr;5(4):777-87.[Abstract]
99. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281(6):537-44.[Abstract][Full Text]
100. Esposito K, Maiorino MI, Bellastella G, et al. Determinants of female sexual dysfunction in type 2 diabetes. Int J Impot Res. 2010 May-Jun;22(3):179-84.[Abstract]
101. Enzlin P, Rosen R, Wiegel M, et al. Sexual dysfunction in women with type 1 diabetes: long-term findings from the DCCT/EDIC study cohort. Diabetes Care. 2009 May;32(5):780-5.[Abstract][Full Text]
102. Toorians AW, Janssen E, Laan E, et al. Chronic renal failure in sexual functioning: clinical status versus objectively assessed sexual response. Nephrol Dial Transplant. 1997 Dec;12(12):2654-63.[Abstract][Full Text]
103. Hultgren R, Sjogren B, Soderberg M, et al. Sexual function in women suffering from aortoiliac occlusive disease. Eur J Basc Endovas Surg. 1999 Apr;17(4):306-12.[Abstract]
104. Duncan LE, Lewis C, Jenkins P, et al. Does hypertension and its pharmacotherapy affect sexual function in women? Am J Hypertens. 2000 Jun;13(6 Pt 1):640-7.[Abstract]
105. Stovall DW, Scriver JL, Clayton AH, et al. Sexual function in women with polycystic ovary syndrome. J Sex Med. 2012 Jan;9(1):224-30.[Abstract][Full Text]
106. Battaglia C, Battaglia B, Mancini F, et al. Sexual behavior and oral contraception: a pilot study. J Sex Med. 2012 Feb;9(2):550-7.[Abstract]
107. Miller KK, Biller BM, Beauregard C, et al. Effects of testosterone replacement in androgen-deficient women with hypopituitarism: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2006 May;91(5):1683-90.[Abstract]
108. Luca G, Parrettini S, Sansone A, et al. The Inferto-Sex Syndrome (ISS): sexual dysfunction in fertility care setting and assisted reproduction. J Endocrinol Invest. 2021 Oct;44(10):2071-102.[Abstract][Full Text]
109. Verhaak CM, Smeenk JM, van Minnen A, et al. A longitudinal prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod. 2005 Aug;20(8):2253-60.[Abstract][Full Text]
110. Handa VL, Harvey L, Cundiff GW, et al. Sexual function among women with urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol. 2004 Sep;191(3):751-6.[Abstract]
111. Salonia A, Briganti A, Deho F, et al. Women's sexual dysfunction: a review of the "surgical landscape". Eur Urol. 2006 Jul;50(1):44-52.[Abstract]
112. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 498: adult manifestations of childhood sexual abuse. Aug 2011 [internet publication].[Full Text]
113. Neumann DA, Houskamp BM, Pollock VE, et al. The long-term sequelae of childhood sexual abuse in women: a meta-analytic review. Child Maltreat. 1996;1:6-16.
114. Dove NL, Wiederman MW. Cognitive distraction and women's sexual functioning. J Sex Marital Ther. 2000 Jan-Mar;26(1):67-78.[Abstract]
115. Daskalakis NP, Bagot RC, Parker KJ, et al. The three-hit concept of vulnerability and resilience: toward understanding adaptation to early-life adversity outcome. Psychoneuroendocrinology. 2013 Sep;38(9):1858-73.[Abstract][Full Text]
116. Hatzichristou D, Rosen RC, Derogatis LR, et al. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010 Jan;7(1 Pt 2):337-48.[Abstract]
117. Leddy L, Yang C, Stuckey B, et al. Influence of PDE5 inhibitor on genital engorgement in women with female sexual arousal disorder. J Sex Med. 2011;8(suppl 2):63.
118. Dove NL, Wiederman MW. Cognitive distraction and women's sexual functioning. J Sex Marital Ther. 2000 Jan-Mar;26(1):67-78.[Abstract]
119. Basson R, Leiblum S, Brotto L, et al. Definitions of women's sexual dysfunctions reconsidered: advocating expansion and revision. J Psychosom Obstet Gynaecol. 2003 Dec;24(4):221-9.[Abstract]
120. Kuffel SW, Heiman JR. Effects of depressive symptoms and experimentally adopted schemas on sexual arousal and affect in sexually healthy women. Arch Sex Behav. 2006 Apr;35(2):163-77.[Abstract]
121. Middleton LS, Kuffel SW, Heiman JR. Effects of experimentally adopted sexual schemas on vaginal response and subjective sexual arousal: a comparison between women with sexual arousal disorder and sexually healthy women. Arch Sex Behav. 2008 Dec;37(6):950-61.[Abstract]
122. Sadovsky R, Alam W, Enecilla M, et al. Sexual problems among a specific population of minority women aged 40 to 80 years attending a primary care practice. J Sex Med. 2006 Sep;3(5):795-803.[Abstract]
123. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 554: reproductive and sexual coercion. Feb 2013 [internet publication].[Full Text]
124. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 547: health care for women in the military and women veterans. Dec 2012 [internet publication].[Full Text]
125. Parish SJ, Hahn SR, Goldstein SW, et al. The International Society for the Study of Women's Sexual Health process of care for the identification of sexual concerns and problems in women. Mayo Clin Proc. 2019 May;94(5):842-56.[Abstract][Full Text]
126. Basson R, Wierman ME, van Lankveld J, et al. Summary of the recommendations on sexual dysfunctions in women. J Sex Med. 2010 Jan;7(1 Pt 2):314-26.[Abstract]
127. Brotto LA, Bitzer J, Laan E, et al. Women's sexual desire and arousal disorders. J Sex Med. 2010 Jan;7(1 Pt 2):586-614.[Abstract]
128. Brotto LA, Basson R, Luria M. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. J Sex Med. 2008 Jul;5(7):1646-59.[Abstract]
129. Brotto LA, Basson R. Group mindfulness-based therapy significantly improves sexual desire in women. Behav Res Ther. 2014 Jun;57:43-54.[Abstract]
130. Mize SJS. A review of mindfulness-based sex therapy interventions for sexual desire and arousal difficulties: from research to practice. Curr Sex Health Rep. 2015;7:89-97.
131. Heiman JR, LoPiccolo J. Becoming orgasmic: a sexual and personal growth program for women. New York, NY: Fireside; 1988.
132. Jankovich R, Miller PR. Response of women with primary orgasmic dysfunction to audiovisual education. J Sex Marital Ther. 1978 Spring;4(1):16-9.[Abstract]
133. Brotto LA, Heiman JR, Goff B, et al. A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Arch Sex Behav. 2008 Apr;37(2):317-29.[Abstract]
134. Brotto LA, Erskine Y, Carey M, et al. A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol. 2012 May;125(2):320-5.[Abstract]
135. Candy B, Jones L, Vickerstaff V, et al. Interventions for sexual dysfunction following treatments for cancer in women. Cochrane Database Syst Rev. 2016 Feb 2;(2):CD005540.[Abstract][Full Text]
136. Frühauf S, Gerger H, Schmidt HM, et al. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. 2013 Aug;42(6):915-33.[Abstract]
137. Günzler C, Berner MM. Efficacy of psychosocial interventions in men and women with sexual dysfunctions--a systematic review of controlled clinical trials: part 2--the efficacy of psychosocial interventions for female sexual dysfunction. J Sex Med. 2012 Dec;9(12):3108-25.[Abstract]
138. Masters WH, Johnson VE. Human sexual response. Boston, MA: Little, Brown & Co; 1966.
139. Masters WH, Johnson VE. Human sexual inadequacy. Boston, MA: Little, Brown & Co; 1970.
140. Sarwer DB, Durlak JA. A field trial of the effectiveness of behavioral treatment for sexual dysfunctions. J Sex Marital Ther. 1997 Summer;23(2):87-97.[Abstract]
141. Schnarch D. Desire problems: a systemic perspective. In: Leiblum SR, Rosen RC, eds. Principles and practice of sex therapy. New York, NY: Guilford Press; 2000:17-56.
142. Verhulst J, Heiman JR. A systems perspective on sexual desire. In: Leiblum SR, Rosen RC, eds. Sexual desire disorders. New York, NY: Guilford Press; 1988:243-67.
143. Pridal CG, LoPiccolo J. Multielement treatment of desire disorders. In: Leiblum SR, Rosen RC, eds. Principles and practice of sex therapy. New York, NY: Guilford Press; 2000:57-81.
144. Brotto LA, Chivers ML, Millman RD, et al. Mindfulness-based sex therapy improves genital-subjective arousal concordance in women with sexual desire/arousal difficulties. Arch Sex Behav. 2016 Nov;45(8):1907-21.[Abstract]
145. Kocsis A, Newbury-Helps J. Mindfulness in sex therapy and intimate relationships (MSIR): clinical protocol and theory development. Mindfulness. 2016;7(3):690-9.
146. Carson JW, Carson KM, Gil KM, et al. Mindfulness-based relationship enhancement. Behav Ther. 2004;35:471-94.
147. Hucker A, McCabe MP. An online, mindfulness-based, cognitive-behavioral therapy for female sexual difficulties: impact on relationship functioning. J Sex Marital Ther. 2014;40(6):561-76.[Abstract]
148. Stephenson KR, Kerth J. Effects of mindfulness-based therapies for female sexual dysfunction: a meta-analytic review. J Sex Res. 2017 Sep;54(7):832-49.[Abstract]
149. Faubion SS, Sood R, Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. Mayo Clin Proc. 2017 Dec;92(12):1842-9.[Abstract][Full Text]
150. European Medicines Agency. Four-week limit for use of high-strength estradiol creams. 10 April 2019 [internet publication].[Full Text]
151. American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice, Farrell R. ACOG Committee Opinion No. 659: the use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol. 2016 Mar;127(3):e93-6.[Abstract]
152. Nastri CO, Lara LA, Ferriani RA, et al. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2013 Jun 5;(6):CD009672.[Abstract][Full Text]
153. Labrie F, Archer D, Bouchard C, et al. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause. 2009 Sep-Oct;16(5):923-31.[Abstract]
154. Labrie F, Derogatis L, Archer DF, et al. Effect of intravaginal prasterone on sexual dysfunction in postmenopausal women with vulvovaginal atrophy. J Sex Med. 2015 Dec;12(12):2401-12.[Abstract]
155. Jacobsen PL, Mahableshwarkar AR, Palo WA, et al. Treatment-emergent sexual dysfunction in randomized trials of vortioxetine for major depressive disorder or generalized anxiety disorder: a pooled analysis. CNS Spectr. 2016 Oct;21(5):367-78.[Abstract]
156. Clayton AH, Durgam S, Li D, et al. Effects of vilazodone on sexual functioning in healthy adults: results from a randomized, double-blind, placebo-controlled, and active-controlled study. Int Clin Psychopharmacol. 2017 Jan;32(1):27-35.[Abstract][Full Text]
157. Montejo AL, Prieto N, de Alarcón R, et al. Management strategies for antidepressant-related sexual dysfunction: A clinical approach. J Clin Med. 2019 Oct 7;8(10):1640.[Abstract][Full Text]
158. Winter J, Curtis K, Hu B, et al. Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management. Expert Opin Drug Saf. 2022 Jul;21(7):913-30.[Abstract]
159. European Medicines Agency. Intrinsa (testosterone): withdrawal of the marketing authorisation in the European Union. July 2012 [internet publication].[Full Text]
160. Basson R. Testosterone therapy for reduced libido in women. Ther Adv Endocrinol Metab. 2010 Aug;1(4):155-64.[Abstract][Full Text]
161. Labrie F, Belanger A, Belanger P, et al. Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. J Steroid Biochem Mol Biol. 2006 Jun;99(4-5):182-8.[Abstract]
162. Reed BG, Bou Nemer L, Carr BR. Has testosterone passed the test in premenopausal women with low libido? A systematic review. Int J Womens Health. 2016;8:599-607.[Abstract][Full Text]
163. Zhao D, Guallar E, Ouyang P, et al. Endogenous sex hormones and incident cardiovascular disease in post-menopausal women. J Am Coll Cardiol. 2018 Jun 5;71(22):2555-66.[Abstract][Full Text]
164. Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4660-66.[Abstract][Full Text]
165. Wolfman W, Krakowsky Y, Fortier M. Guideline no. 422d: Menopause and sexuality. J Obstet Gynaecol Can. 2021 Nov;43(11):1334-41.e1.[Abstract]
166. Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. J Womens Health (Larchmt). 2021 Apr;30(4):474-91.[Abstract][Full Text]
167. Ruth KS, Day FR, Tyrrell J, et al. Using human genetics to understand the disease impacts of testosterone in men and women. Nat Med. 2020 Feb;26(2):252-8.[Abstract][Full Text]
168. Jaspers L, Feys F, Bramer WM, et al. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med. 2016 Apr;176(4):453-62.[Abstract]
169. Joffe HV, Chang C, Sewell C, et al. FDA approval of flibanserin - treating hypoactive sexual desire disorder. N Engl J Med. 2016 Jan 14;374(2):101-4.[Abstract][Full Text]
170. Anderson R, Moffatt CE. Ignorance is not bliss: if we don't understand hypoactive sexual desire disorder, how can flibanserin treat it? Commentary. J Sex Med. 2018 Mar;15(3):273-83.[Abstract]
171. Mintzes B, Tiefer L, Cosgrove L. Bremelanotide and flibanserin for low sexual desire in women: the fallacy of regulatory precedent. Drug Ther Bull. 2021 Dec;59(12):185-8.[Abstract]
172. Basson R, Driscoll M, Correia S. Flibanserin for low sexual desire in women: a molecule from bench to bed? EBioMedicine. 2015 Aug 6;2(8):772-3.[Abstract][Full Text]
173. Kingsberg SA, Clayton AH, Portman D, et al. Bremelanotide for the treatment of hypoactive sexual desire disorder: two randomized phase 3 trials. Obstet Gynecol. 2019 Nov;134(5):899-908.[Abstract][Full Text]
174. Clayton AH, Kingsberg SA, Portman D, et al. Safety profile of bremelanotide across the clinical development program. J Womens Health (Larchmt). 2022 Feb;31(2):171-82.[Abstract]
175. LoPiccolo J, Stock WE. Treatment of sexual dysfunction. J Consult Clin Psychol. 1986 Apr;54(2):158-67.[Abstract]
176. Fichten CS, Libman E, Brender W. Methodological issues in the study of sex therapy: effective components in the treatment of secondary orgasmic dysfunction. J Sex Marital Ther. 1986 Spring;12(1):22-34.[Abstract]
177. Hurlbert DF, Apt CV. The coital alignment technique and directed masturbation: a comparative study on female orgasm. J Sex Marital Ther. 1995 Spring;21(1):21-9.[Abstract]
178. Montejo AL, Llorca G, Izquierdo JA, et al. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 suppl 3:10-21.[Abstract]
179. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014 Oct;99(10):3489-510.[Abstract]
180. Bradford A, Meston CM. Behavior and symptom change among women treated with placebo for sexual dysfunction. J Sex Med. 2011 Jan;8(1):191-201.[Abstract][Full Text]
181. Bradford A. Listening to placebo in clinical trials for female sexual dysfunction. J Sex Med. 2013 Feb;10(2):451-9.[Abstract]
182. Greenberger D, Padesky C. Mind over mood: change how you feel by changing how you think. New York, NY: Guilford Press; 1995.
183. Kabat-Zinn J. Wherever you go, there you are. New York: Hyperion; 1994.
184. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delta Trade Paperbacks; 1990.
185. Hanh TN. The miracle of mindfulness: a manual on meditation. Boston, MA: Beacon Press; 1976.
186. Siegel RD. The mindfulness solution: everyday practices for everyday problems. The New York: Guilford Press, 2009.
187. Hawton K, Catalan J, Fagg J. Low sexual desire: sex therapy results and prognostic factors. Behav Res Ther. 1991;29(3):217-24.[Abstract]
