Back to Search Results


Evaluation of Sexual Dysfunction

Author: Amy Markese. MD

Mentor: Meggan M. Zsemlye, MD
Editor: Julie Zemaitis DeCesare, MD

Registered users can also download a PDF or listen to a podcast of this Pearl.
Log in now, or create a free account to access bonus Pearls features.

Female sexual dysfunction is defined as any sexual complaint or problem that results from disorders of desire, arousal, orgasm, or sexual pain and causes marked distress or interpersonal difficulty lasting at least 6 months.  The term “female sexual dysfunction” encompasses female sexual interest and arousal disorder, female orgasmic disorder, and genito-pelvic pain/penetration disorder. Hypoactive sexual desire disorder is the most common type of female sexual dysfunction, with estimated prevalence between 5.4-13.6%.

The etiology of female sexual dysfunction is multifactorial.  Non-gynecologic medical conditions that may lead to sexual dysfunction include diabetes mellitus, psychiatric disorders, hypertension, coronary artery disease, malignancies, and neurological disorders such as multiple sclerosis. Gynecologic conditions that may contribute to sexual dysfunction include vulvar dermatoses, vulvodynia, urinary incontinence, STIs, endometriosis, chronic pelvic pain, pelvic organ prolapse, and vulvovaginal atrophy.

Medications may also contribute to sexual dysfunction. The most common medications associated with sexual dysfunction are the selective serotonin reuptake inhibitors, with an incidence of associated sexual dysfunction of 30 to 70%. Most commonly, this manifests as hypoactive sexual desire. Other medications that are associated with sexual dysfunction include antihistamines, anticholinergics, antihypertensives, antipsychotics, and tricyclic antidepressants. Some hormonal medications, including aromatase inhibitors, selective estrogen receptor modulators, and GnRH agonists, may also be associated with sexual dysfunction. Data regarding the effect of combined hormonal contraceptives on sexual function is inconclusive.

Psychological factors impacting sexual function include depression, anxiety, psychotic disorders, and history of abuse. Relationship distress, partner sexual dysfunction, and certain cultural or religious views toward sexuality may all also contribute to sexual dysfunction.

Evaluation for sexual dysfunction should be a routine part of well woman care. Studies suggest that women do not frequently raise sexual dysfunction concerns but do want their health care provider to address these issues. A brief set of questions or a validated screening questionnaire, such as the Brief Sexual Symptom Checklist, Brief Profile of Female Sexual Dysfunction, or the PISQ+IR questionnaire can serve as useful screening tools.

When sexual dysfunction is identified, an open discussion should ensue to obtain further information. Questioning should focus around determining the specific type of dysfunction (desire, arousal, orgasm, pain), as well as, any previous treatments and the result of those treatments. The patient’s complete past medical and social history should be elicited, with particular attention to chronic medical conditions, medications, and psychosocial factors such as relationship discord, life stage stressors, or history of physical, emotional, or sexual abuse. A physical examination should be performed with the patient’s permission and should include attention to any dermatologic abnormalities of the vulva and vagina, pelvic organ prolapse, vaginismus or pelvic floor muscle hypertonicity, and vulvovaginal atrophy. There are no specific laboratory or imaging tests that are routinely warranted in the evaluation of sexual dysfunction.

Further reading:

Female sexual dysfunction. ACOG Practice Bulletin No. 213. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;134:e1–18.

Kingsberg S, Rezaee R., Hypoactive sexual desire in women. Menopause. 2013 Dec;20(12):1284-300. doi: 10.1097/GME.0000000000000131.

Faubion S, Ruillo J. Sexual Dysfunction in Women: A Practical Approach. Am Fam Physician. 2015 Aug 15;92(4):281-8.

Initial Approval May 2019. Reaffirmed January 2021. Revised July 2022; Reaffirmed May 2024


********** Notice Regarding Use ************

The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. (“SASGOG”) is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice.

This document is designed to aid practitioners in providing appropriate obstetric and gynecologic care. Recommendations are derived from major society guidelines and high-quality evidence when available, supplemented by the opinion of the author and editorial board when necessary. It should not be construed as dictating an exclusive course of treatment or procedure to be followed.

Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. SASGOG reviews the articles regularly; however, its publications may not reflect the most recent evidence. While we make every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. SASGOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither SASGOG nor its respective officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

Copyright 2024 The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. All rights reserved. No re-print, duplication or posting allowed without prior written consent.



Back to Search Results