Epidemiology

Prevalence of women's sexual disorders - even when personal distress is considered - is unclear, as epidemiological studies have used questionnaires based on outdated definitions of sexual disorders that are more reflective of male sexuality (e.g., absence of sexual fantasies and desire ahead of sexual engagement as signifying disorder). In one meta-analysis, the overall prevalence of sexual dysfunction among premenopausal women was 41%.[14] There was substantial heterogeneity between studies, with significantly higher rates in studies that used non-validated questionnaires.[14]

Frequently, women report dysfunction without distress, such that prevalence figures for desire disorder typically reduce from some 35% to around 9% when the distress criterion is included.[15][16] However, one large British study using the criterion of 6 months or longer duration identified 11% of women, of whom 28% sought help (proxy measure for distress).[17] Prevalence figures from nationally representative surveys of US women suggest a prevalence of desire disorder of 8.3% and 9.5% with minimal variation across most ages, with a drop in women over 60 years.[15][18] Prevalence reaches 12.5% for surgically menopausal women generally and 19.9% for women under 45 years.[18] Most surveys have focused on the lubrication component of arousal dysfunction, as opposed to problems with subjective excitement/arousal; a large recent survey of women over 40 years of age showed that some 17% reported moderately or highly problematic arousal.[19]

The Natsal-3 survey (which studied 6,777 women in Britain in terms of problematic sexual response, sexual function within the relationship, and appraisal of sexual life using a new validated questionnaire where biomedical aspects of dysfunction are not the major focus) focused on problems occurring for at least 3 months in the previous year.[20] Approximately 34% of women lacked sexual interest, 16% of women found orgasm elusive, 12% lacked enjoyment, 8% experienced pain, and 8% felt no excitement.[20] All of these problems showed little variation with age. Being anxious during sex was more common in younger women (8%) and vaginal dryness was most common in the decade post-menopause, affecting 27%.[20] The distress criterion was not used. Another large British survey, using proxy measures of DSM-5 sexual disorders, found that while 23% of women reported one or more sexual difficulties (including problematic orgasm, low sexual interest and arousal, or painful sex), only 4% of women met all three DSM-5 criteria for the disorder.[21]

Of women living in the US, the prevalence of dysfunction was higher in those of Japanese and Chinese backgrounds and lower in African-American women.[22] An international study showed highest prevalence of dysfunction in women living in East Asia, South-east Asia, and the Middle East, compared with European and North American samples.[23]

The prevalence of female orgasmic disorder has been reported to be 24% in American and 9% in British women. However, stricter use of the distress criterion yields a prevalence close to 5%.[3]

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