Sexual dysfunction and dyspareunia

Overview & definition

It is 19:00 in clinic. A patient says, “Sex has become difficult, but I do not know how to explain it.” Your first task is not a label. It is to make the consultation safe and specific.

[1]

Female sexual dysfunction (FSD) means persistent or recurrent sexual symptoms that cause personal distress or interpersonal difficulty. A partner's preference, a frequency difference, or a culturally unusual practice is not a disorder without the patient's own distress or impairment. [2]

Use the patient's goal as your organising question: “Is the main problem desire, physical arousal, orgasm, pain, or a mixture?” Pain commonly suppresses desire secondarily, so do not diagnose primary low desire until pain and other contributors are addressed.

[1]

References15Show ledgerHide ledger

1. [1]Basson R Human sexual response Handb Clin Neurol, 2015.PMID 26003236
2. [2]Goldstein I, Kim NN, Clayton AH Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review Mayo Clin Proc, 2017.PMID 27916394
3. [3]Portman DJ, Gass MLS Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society Menopause, 2014.PMID 25179577
4. [4]The NAMS 2020 GSM Position Statement Editorial Panel The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society Menopause, 2020.PMID 32852449
5. [5]Faubion SS, Larkin LC, Stuenkel CA, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health Menopause, 2018.PMID 29762200
6. [6]Danan ER, Sowerby C, Ullman KE Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review Ann Intern Med, 2024.PMID 39250810
7. [7]Di Carlo C, et al. Ospemifene and vulvovaginal atrophy: an update of the clinical profile for post-menopausal women Expert Opin Pharmacother, 2024.PMID 39129457
8. [8]Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia J Sex Med, 2016.PMID 27045260
9. [9]Bornstein J, Preti M, Simon JA Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society) J Low Genit Tract Dis, 2019.PMID 30768446
10. [10]Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women J Sex Med, 2021.PMID 33814355
11. [11]Lee JH, et al. Pharmacotherapy for Sexual Dysfunction in Women J Womens Health, 2022.PMID 35102537
12. [12]Hocké C, et al. Genitourinary menopause syndrome. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines Gynecol Obstet Fertil Senol, 2021.PMID 33757926
13. [13]Simon JA, Goldstein I, Kim NN The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review Menopause, 2018.PMID 29870471
14. [14]Qiangzhao L, Qiong L, Bohong G Psychological therapies for female sexual function: a systematic review and network meta-analysis J Sex Med, 2026.PMID 41718740
15. [15]Ronghe V, et al. Understanding Hypoactive Sexual Desire Disorder (HSDD) in Women: Etiology, Diagnosis, and Treatment Cureus, 2023.PMID 38161863