Female Sexual Interest/Arousal Disorder and Female Orgasmic Disorder
Sexual function is a complex interaction among biological, medical, psychosocial, interpersonal, and sociocultural factors. Almost half of women (43%) experience sexual dysfunction and 12% of women report related personal distress with a peak in middle age (14.8% in women aged 45-64 years) compared with reports in younger women (10.8%) and older women (8.9%).
Female sexual dysfunction is categorized into sexual interest/arousal disorders, orgasmic disorder, and genitopelvic pain/penetration disorders that cause personal distress and persist for at least 6 months.
Treatment of interest/arousal disorders focuses on identifying and treating contributing factors, as well as medical interventions. Contributing factors include stress; fatigue; depression; relationship discord; history of abuse; substance abuse; chronic medical conditions; surgeries; medications (antidepressants, psychotropic agents, antiestrogens, anticholinergic agents, cytotoxic agents); and hormonal factors such as hypothyroidism, hyperprolactinemia, and natural or surgical menopause.
Medical conditions should be optimized. Psychologic disorders and interpersonal concerns should be managed with a combination of individual, couples, and sex therapy, including sensate focus. Medications should be adjusted as needed (eg, supplementation with bupropion for women with antidepressant-induced sexual dysfunction may improve symptoms).
Estrogen has shown a small to moderate benefit in sexual function for perimenopausal and menopausal women. Flibanserin is an FDA-approved serotonin receptor agonist/antagonist for interest/arousal disorders in premenopausal women. Risks include somnolence and hypotension, and it is contraindicated in patients with a history of depression or alcohol use. Sildenafil is not recommended for treatment of interest/arousal disorders.
Androgen therapy is not FDA approved for female sexual dysfunction. Testosterone levels are difficult to measure in women, and there is no correlation between androgen levels and sexual desire. Although absolute testosterone levels decline with age, there is a relative increase in circulating free testosterone as sex hormone–binding globulin decreases in postmenopausal women. With the use of systemic estrogen therapy, sex hormone–binding globulin increases, causing a drop in free testosterone. Evidence supports the short-term efficacy and safety of transdermal testosterone in postmenopausal women with sexual dysfunction related to interest/arousal. Testosterone levels should be followed if treatment extends beyond 6 months. Potential risks include hirsutism, acne, and clitoral enlargement that may persist after medication discontinuation. Long-term effects regarding cardiovascular disease, breast cancer, and other cancer risks are unknown. Safety data on long-term use are lacking. There is insufficient evidence to support testosterone use in premenopausal women.
Mechanical treatments for arousal disorders are costly with limited data on benefit; however, given the low risk, they can be considered.
Female orgasmic disorder is the delay in, infrequency of, or absence of orgasm causing personal distress. This can be a primary disorder (rarely due to a physical cause and can be associated with abuse) or secondary disorder (often linked to interest/arousal disorder or medical or psychosocial issues). Treatment includes education about arousal techniques, counseling, treatment of other associated sexual dysfunction, and medication changes.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Female Sexual Dysfunction: ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 213. Obstet Gynecol. 2019 Jul;134(1):e1-e18. doi: 10.1097/AOG.0000000000003324. PMID: 31241598.
Basson R. Testosterone therapy for reduced libido in women. Ther Adv Endocrinol Metab. 2010 Aug;1(4):155-64. doi: 10.1177/2042018810379588. PMID: 23148160; PMCID: PMC3474615.
Initial publication August 2023
Final editing of initial publication performed by The Medical Pen, LLC.
********** 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 2023 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