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Female hypo-active sexual desire disorder

Hypoactive sexual desire disorder is defined as a persistent or recurrent deficiency or absence of sexual desire or receptivity to sexual activity that causes marked distress or interpersonal difficulty.

Most common FSD with an estimated prevalence rate ranging between 5.4 - 13.6%. Reaches a peak between 30 - 60 years and in individuals having undergone surgical menopause.


Female sexual aversion disorder

Sexual aversion disorder is defined as a persistent or recurrent aversive response to genital contact with a sexual partner that causes distress or interpersonal difficulty.


Risk factors for hypo-active sexual desire disorder

Risk factors include:
- chronic disease,
- depression
- medications, including SSRIs, some oral contraceptives, corticosteroids
- atrophic vaginitis and pelvic floor sx can lead to dyspareunia & sexual aversion leading to hypo active sexual desire disorder
- endocrine and adrenal insufficiency problems
- dysfunctional interpersonal relationships


Female sexual aversion disorder prevalence, risk factors

Prevalence is not well established
Risk factors: painful or traumatic life events.
Treatment: psychotherapy and antidepressants for patients with associated anxiety.


Female sexual dysfunction conditions

Categorized as:
-Sexual desire disorders (hypo-active sexual desire disorder and sexual aversion disorder)
-Sexual arousal disorder
-Orgasmic disorder
-Sexual pain disorder (dyspareunia and vaginismus)


Female Sexual Arousal Disorder

Female sexual arousal disorder refers to an inability to complete sexual activity with adequate lubrication that causes marked distress or interpersonal difficulty.


Female Sexual Arousal Disorder, causes and treatments

Frequently linked to a gynecologic or chronic medical condition or the use of certain medications. Can be r/t atrophic vaginitis after spontaneous menopause or oophorectomy

Treatments: Resolves when inciting disorder is successfully treated or medication is changed or adjusted.

Meds: SSRIs often linked with female sexual arousal disorder.


Female Orgasmic Disorder

Female orgasmic disorder is a persistent or recurrent delay in or absence of orgasm after a normal excitement phase, which causes marked distress or interpersonal difficulty.


Female orgasmic disorder, prevalence

Reported prevalence of 3.4 - 5.8%


Primary orgasmic disorder

Primary orgasmic disorder is defined as never having the ability to achieve orgasm. Women with primary disorder have normal levels of sexual desire but are unable to achieve orgasm. Associated with a history of trauma or abuse or can have genetic origins, but also may have no explanation. Does not resolve on its own.

Treatment, in cases of abuse, psychotherapy and couples counseling.


Secondary orgasmic disorder

Secondary orgasmic disorder is generally the result of another sexual dysfunction. Frequently linked with hypo-active sexual desire disorder and having the same situational and psychosocial causes.

Causes: pelvic surgery, medications (such as antidepressants, especially SSRIs). Social causes include: age, social class, personality, and relationship status, religious and cultural beliefs.


Female Sexual Pain Disorders

Dyspareunia and vaginismus are two subcategories of sexual pain disorders.



Dyspareunia is recurrent or persistent genital pain associated with sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus and causes marked distress or interpersonal difficulty. Common, particularly in postmenopausal women with a prevalence range from 8 - 22%.



Vaginismus is recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse, causing marked distress or interpersonal difficulty. Rare, prevalence rates from 1 - 6%.


Dyspareunia, physical exam

Physical exam will reproduce the pain when the vulva or vagina is touched with a cotton swab or when a finger is inserted into the vagina. Palpation of the walls of the vagina, uterus, and urethral structures can help identify physiologic contributions.


Dyspareunia, linked sexual disorders

Loss of desire and arousal disorders associated with dyspareunia may contribute to the worsening of pain over time because the lack of genital arousal paired with sexual activity often results in physical discomfort.


Vaginismus, linked sexual disorders

Frequently linked to hypo-active sexual desire disorder and sexual aversion.


Vaginismus, variations

In some:
-vaginismus occurs b/c pain is anticipate
-vaginismus is limited to sexual activity
-vaginismus is limited to pelvic examination


Vaginismus, treatment

Most effective treatment is a combination of cognitive and behavioral psychotherapy, typically referred to as systematic desensitization. Women are taught deep muscle relaxation techniques, which they then use during exercises in which they are instructed to very gradually insert objects (usually dilators) of increasing diameter into the vagina. Goal: desensitize a woman to her fear that vaginal penetration will be painful and give her a sense of control.


Medications associated with female sexual dysfunction

-Psychotropic medications
-Histamine blockers
-Hormonal medications
-Most common: SSRIs with most commonly associated dysfunctions being orgasmic dysfunction, decreased sexual desire and decreased arousal.

Solutions: decrease doses, change medications



Unwanted hair growth, a side effect of some conditions and the use of testosterone.


Androgen (testosterone) replacement therapy SE

hirsutism, acne, virilizaiton, cardiovascular complications, possible association with breast cancer.


Hypo-active sexual desire disorder, treatment

Short-term treatment with transdermal testosterone.


Vaginal estrogen, use

Vaginal estrogen for the treatment of postmenopausal atrophy results in improved dyspareunia, less vaginal dryness, improved vaginal mucosal maturation indices, and reduced vaginal pH