Summary
Definition
History and exam
Key diagnostic factors
- sexual symptoms leading to distress
- absent/reduced interest in sexual activity (SIAD)
- absent/reduced sexual/erotic thoughts or fantasies (SIAD)
- absent/reduced sexual excitement/pleasure during sexual activity (SIAD)
- no subjective arousal from erotic or sexual cues (SIAD)
- absent/reduced awareness of genital or non-genital sensations during sexual activity (SIAD)
- no/reduced initiation of sexual activity (SIAD)
- orgasm absent or of minimal intensity (FOD)
- marked delay in orgasm (FOD)
- marked infrequency of orgasm (FOD)
- spontaneous, intrusive, unpleasant genital congestion and feeling of impending orgasm (PGAD/GPD)
Other diagnostic factors
- current stressors
- negative emotions during sex
- vulvovaginal atrophy
- galactorrhoea
Risk factors
- depression
- antidepressant use
- comorbid anxiety disorder
- psychological aspects of cancer
- breast cancer
- gynaecological and other pelvic cancer
- neurological disease
- endometriosis
- hyperprolactinaemia
- radical hysterectomy (non-nerve-sparing)
- cystectomy or proctectomy
- personality factors and attitudes
- relationship difficulties
- partner sexual dysfunction
- reduced androgen activity
- oestrogen deficiency
- premature ovarian failure
- post-partum
- ageing
- diabetes
- renal failure
- cardiovascular disease
- polycystic ovarian syndrome (PCOS)
- medication or substance use
- hypothalamic-pituitary disease
- infertility
- lower urinary tract symptoms (LUTS)
- socio-economic status
- sexual abuse and developmental trauma
Diagnostic investigations
1st investigations to order
- FBC
- serum glucose level
- renal function
- thyroid function tests
- serum prolactin level
Treatment algorithm
Contributors
Authors
Miriam Driscoll, MD, FRCP(C)
Clinical Assistant Professor
Department of Psychiatry
Associate Member Department of Obstetrics and Gynaecology
University of British Columbia
Physician
BC Center for Sexual Medicine
Vancouver Coastal Health Authority
Vancouver
Canada
Disclosures
MD declares that she has no competing interests.
Leah Rosetti, MD, FRCP(C)
Fellow
Department of Psychiatry
University of British Columbia
Physician
BC Centre for Sexual Medicine
Vancouver Coastal Health Authority
Vancouver
Canada
Disclosures
LR declares that she has no competing interests.
Acknowledgements
Dr Miriam Driscoll and Dr Leah Rosetti would like to gratefully acknowledge Dr Lori Brotto and Dr Rosemary Basson, previous contributors to this topic.
Disclosures
LB is an author or co-author of several references cited in this topic. RB is an author or co-author of several references cited in this topic. RB's department has received research funding from the Canadian Institutes of Health Research (CIHR).
Peer reviewers
Holly N. Thomas, MD, MS
Assistant Professor of Medicine
University of Pittsburgh
Pittsburgh
PA
Disclosures
HNT received a research award from the North American Menopause Society that was funded by AMAG Pharmaceuticals, who originally developed bremelanotide alongside Palatain Technologies.
Philip Kell, MBBS, FRCOG, FRCP
Consultant Physician
Archway Sexual Health Clinic
Whittington Hospital
London
UK
Disclosures
PK has undertaken research studies for Boehringer Ingelheim.
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