Despite its prevalence and adverse effect on women’s quality of life, female sexual dysfunction (FSD) is often not addressed for a myriad of reasons. Among these include reluctance on the part of women to initiate conversation about a topic that may make them uncomfortable and anxious. However, clinicians also may not be comfortable broaching the issue with patients because of insufficient training and confidence in talking about the issue, underestimating its prevalence, or for the more practical reason of not having enough time to obtain a sexual history.
In 2011, the American College of Obstetricians and Gynecologists (ACOG) issued clinical management guidelines for gynecologists to help provide information on (FSD).1 Developed by the Committee on Practice Bulletins – Gynecology, the guidelines offer clinicians a basic understanding of normal female sexual response, criteria for diagnosing female sexual dysfunction, and current management strategies.
This article focuses on criteria for diagnosing FSD by listing and describing the types of dysfunction. As outlined in the ACOG guidelines, there are four main categories of FSD: sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorders. Sexual dysfunction is diagnosed when symptoms of these types of sexual dysfunction cause marked distress in women or create interpersonal difficulties.
A description of each category, along with estimated prevalence, is listed in Table 1.
As indicated in Table 1, psychosocial (trauma, sexual abuse) and medical conditions as well as use of specific medications often accompany and are associated with female sexual dysfunction making a thorough assessment critical to understanding what underlies the symptoms of sexual dysfunction. In addition, women may have more than one type of sexual dysfunction.
As such, the authors of the guidelines emphasize the importance of identifying the primary type of dysfunction. They state, “Because more than one female sexual dysfunction may exist in the same patient, it is important that the clinician determine which is the primary female sexual dysfunction and how comorbid female sexual dysfunctions evolved over time.”
1. Female sexual dysfunction. Practice Bulletin No. 119. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:996-1007.
2. Boardman LA, Stockdale CK. Sexual pain. Clin Obstet Gynecol 2009;52:682-90.