Psych · Specialty psychiatry — sexual medicine interface
Female sexual interest, arousal and pain disorders
Also known as Female sexual interest/arousal disorder · FSIAD · Hypoactive sexual desire disorder · HSDD · Female sexual arousal disorder · Genito-pelvic pain/penetration disorder · GPPPD · Vaginismus · Dyspareunia · Vulvodynia · Genitourinary syndrome of menopause · GSM · Flibanserin · Bremelanotide
Exam-exhaustive fellowship atlas on female sexual interest/arousal disorder and genito-pelvic pain/penetration disorder — DSM-5-TR vs ICD-11 nosology, Basson responsive desire and dual-control models, epidemiology with distress thresholds, SSRI and medical differentials, FSFI-informed assessment, stepped psychosexual care, flibanserin/bremelanotide/testosterone pathways, GSM local therapies, and exposure/physio for pain. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Acute sexual assault or ongoing intimate partner/sexual violence — forensic-medical pathway, safety plan, jurisdiction-specific reporting duties
- Flibanserin with alcohol or strong CYP3A4 inhibitors — severe hypotension/syncope risk; stop and medically assess
- Postmenopausal bleeding, pelvic mass, fever with severe pelvic pain, or sudden neurological genital sensory loss — urgent gynaecology/medical work-up
- Severe depression or active suicidal ideation precipitated by relationship/sexual crisis — same-day risk assessment
- Coercive partner demanding sexual access framed as 'treatment' — do not collude; prioritise consent and safety
- Adolescent safeguarding concerns or exploitation — child-protection pathways, not adult drug algorithms
Meet the patient
A 38-year-old teacher, two years into a stable relationship, has lost all interest in sex. She is not distressed about the lack of desire itself — she is distressed because her partner is hurt and the gap between them is widening. Six months ago her GP started her on sertraline for anxiety, and her periods have become lighter. She wonders, quietly, whether she is "broken".[7][14]
The examiner is testing four things: nosology precision (FSIAD versus the ICD-11 split), medication literacy (the SSRI is doing work here), non-stigmatising history skills, and stepped care rather than moral commentary. The single most important sentence on this page is that frequency is never a diagnosis — distress is the gate.[3][4][14]
References14ShowHide
- [1]Basson R The female sexual response: a different model J Sex Marital Ther, 2000.PMID 10693116
- [2]Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function J Sex Marital Ther, 2000.PMID 10782451
- [3]Laumann EO, Paik A, Rosen RC Sexual dysfunction in the United States: prevalence and predictors JAMA, 1999.PMID 10022110
- [4]Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates Obstet Gynecol, 2008.PMID 18978095
- [5]McCabe MP, Sharlip ID, Lewis R, et al. Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015 J Sex Med, 2016.PMID 26953829
- [6]Bancroft J, Graham CA, Janssen E, Sanders SA The dual control model: current status and future directions J Sex Res, 2009.PMID 19308839
- [7]Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients J Clin Psychiatry, 2001.PMID 11229449
- [8]Serretti A, Chiesa A Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis J Clin Psychopharmacol, 2009.PMID 19440080
- [9]Segraves RT, Clayton A, Croft H, et al. Bupropion sustained release for the treatment of hypoactive sexual desire disorder in premenopausal women J Clin Psychopharmacol, 2004.PMID 15118489
- [10]Katz M, DeRogatis LR, Ackerman R, et al. Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial J Sex Med, 2013.PMID 23672269
- [11]Kingsberg SA, Clayton AH, Portman D, et al. Bremelanotide for the Treatment of Hypoactive Sexual Desire Disorder: Two Randomized Phase 3 Trials Obstet Gynecol, 2019.PMID 31599840
- [12]Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women J Clin Endocrinol Metab, 2019.PMID 31498871
- [13]ter Kuile MM, Melles R, de Groot HE, et al. Therapist-aided exposure for women with lifelong vaginismus: a randomized waiting-list control trial of efficacy J Consult Clin Psychol, 2013.PMID 24060195
- [14]Clayton AH, Goldstein I, Kim NN, et al. The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women Mayo Clin Proc, 2018.PMID 29545008