Definition and prevalence
Female sexual dysfunction includes a spectrum of disorders that are often multi-factorial in nature: sexual interest and arousal disorder (SIAD), female orgasmic disorder (FOD) and genito-pelvic penetration pain disorder (GPPPD), which includes dyspareunia and vaginismus. The exact prevalence of female sexual dysfunction is uncertain, as most studies have historically focused on male sexual dysfunction, but it is estimated to be between 11% overall and 41% in premenopausal women. There are 3 criteria for diagnosing a sexual disorder: (1) symptoms present for at least 6 months; (2) symptoms are experienced in ≥75% of sexual encounters; (3) symptoms have caused significant distress.
The aetiology of sexual dysfunction is often multifactorial and involves psychological, contextual, pharmacological and physiological factors. For instance, SIAD is strongly linked to mood disorders, such as depression and anxiety, in addition to PTSD and previous experience of abuse. GPPPD can be predominantly psychological in origin (as in vaginismus) but can also be due to surgical, medical and pharmacological causes (see Table 3).
| Drug-Related | SSRIs | Aromatase inhibitors (letrozole, anastrozole) |
| Anti-hypertensives (β blockers, spironolactone, thiazides) | Lithium | |
| Anti-psychotics | Opioids | |
| Anti-epileptics | ||
| Medical | Diabetes mellitus | Perimenopause/menopause |
| Hyperthyroidism | Pelvic inflammatory disorder (PID) | |
| Hyperprolactinaemia | STI | |
| IBS/IBD | Thyroid disorders | |
| Interstitial cystitis | UTI | |
| Neurological disease (MS, Parkinson’s) | ||
| Surgical | Adenomyosis | Interstitial cystitis |
| Endometriosis | Malignancy (endometrial, cervical) | |
| FGM | Ovarian cyst | |
| Fibroids | Previous pelvic surgery | |
Table 3. Non-psychological causes of female sexual dysfunction.
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