Sexual Dysfunction in Women

This article provides a comprehensive clinical framework for assessing and managing sexual dysfunction in women, emphasizing that such dysfunction is defined by subjective dissatisfaction with sexual well-being rather than a universal norm. Drawing on ICD-11 criteria, the author outlines four major categories: hypoactive sexual desire, arousal, orgasmic, and unspecified dysfunction each influenced by complex biopsychosocial factors. Epidemiologic data suggest that hypoactive sexual desire and associated distress peak in midlife, with risk factors including hormonal shifts, chronic illness, psychological distress, medications, and sociocultural influences. The article presents a structured assessment protocol covering biologic, intrapersonal, interpersonal, and contextual domains. Management options span nonpharmacologic interventions (e.g., counseling, pelvic floor therapy, lifestyle changes) and targeted pharmacologic strategies. Approved therapies include topical estrogens for dyspareunia, flibanserin and bremelanotide for premenopausal hypoactive sexual desire disorder, and transdermal testosterone for postmenopausal women. The author calls for individualized, evidence-based treatment, normalization of clinical conversations around sexuality, and expanded access to validated care pathways.

This article provides a comprehensive clinical framework for assessing and managing sexual dysfunction in women, emphasizing that such dysfunction is defined by subjective dissatisfaction with sexual well-being rather than a universal norm. Drawing on ICD-11 criteria, the author outlines four major categories: hypoactive sexual desire, arousal, orgasmic, and unspecified dysfunction each influenced by complex biopsychosocial factors. Epidemiologic data suggest that hypoactive sexual desire and associated distress peak in midlife, with risk factors including hormonal shifts, chronic illness, psychological distress, medications, and sociocultural influences. The article presents a structured assessment protocol covering biologic, intrapersonal, interpersonal, and contextual domains. Management options span nonpharmacologic interventions (e.g., counseling, pelvic floor therapy, lifestyle changes) and targeted pharmacologic strategies. Approved therapies include topical estrogens for dyspareunia, flibanserin and bremelanotide for premenopausal hypoactive sexual desire disorder, and transdermal testosterone for postmenopausal women. The author calls for individualized, evidence-based treatment, normalization of clinical conversations around sexuality, and expanded access to validated care pathways.