Materiały źródłowe

• #1 Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation – UpToDate

  https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-epidemiology-risk-factors-and-evaluation

  Sexual problems are reported by approximately 40 percent of females worldwide, and approximately 12 percent (one in every eight females) have a sexual problem associated with personal or interpersonal distress. […] Female sexual dysfunction refers to a sexual problem associated with personal distress. It takes different forms, including lack of sexual desire, impaired arousal, inability to achieve orgasm, or pain with sexual activity. […] The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and treatment of female orgasmic disorder are also discussed separately.

• #2 Overview of Female Sexual Function and Dysfunction – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/overview-of-female-sexual-function-and-dysfunction

  Women commonly have concerns about sexual function. Concerns that cause personal or interpersonal distress are considered a sexual dysfunction disorder. Approximately 12% of women in the United States have a sexual function issue associated with distress. […] The traditional separation of psychological and physical etiologies is artificial; psychological distress causes changes in hormonal and neurologic physiology, and physical changes may generate psychological reactions that compound the dysfunction. There are often several causes of symptoms within and between categories of dysfunction, and the cause is often unclear. […] Mood disorders (eg, depression, anxiety) are closely correlated with low interest and arousal. For women with major depression and sexual dysfunction, sexual distress becomes less severe when depression is effectively treated with antidepressants. However, some types of antidepressants also cause sexual dysfunction (selective serotonin reuptake inhibitors). Women with an anxiety disorder are also more likely to have sexual dysfunction involving sexual interest, arousal, orgasm and genito-pelvic pain/penetration disorders.

• #3 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Sexual dysfunction in women is a common and often distressing problem that has a negative impact on quality of life and medication compliance. […] The etiology of female sexual dysfunction is multifactorial, encompassing biological, psychological, relational, and sociocultural factors. […] Biological factors may impact sexual function in a variety of ways. Some chronic illnesses, such as vascular disease, diabetes mellitus, neurologic disease, and malignancy, can directly or indirectly impact sexual function. […] Aging itself is associated with decreased sexual responsiveness, sexual activity, and libido. […] Hormonal changes occurring in midlife may impact a woman’s sexual function. Menopause is marked by a decline in ovarian hormone levels, which occurs gradually in natural menopause but may be sudden if menopause occurs because of surgery, radiation, or chemotherapy.

• #4 Female Sexual Dysfunction: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2500107-overview

  Possible causes of FSD are diverse and overlapping, and the initial etiology is sometimes an enormous challenge to discern. Etiologies include organic elements such as hormonal, neurologic, and vascular problems, as well as psychosocial factors such as relationship issues, social stressors, mood, history of physical or sexual abuse, and psychiatric history. […] In terms of physiology, neurotransmitters play an important role. Appropriate female sexual function requires a delicate balance of dopamine for desire, and epinephrine, norepinephrine, and serotonin for arousal and orgasm. Disorders and medications that disrupt these elements may lead to FSD. […] Hormonal deficits may be another factor in pathophysiology. The decrease in estrogen associated with menopause may induce decreased sexual desire and atrophy of genital tissue that leads to painful intercourse.

• #5 FEMALE SEXUAL DYSFUNCTION: THE IMPORTANT POINTS TO REMEMBER | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-female-sexual-dysfunction-the-important-S1807593222032161

  Although somewhat controversial, a number of reports associate menopause with decreased female sexual function, suggesting a possible hormonal mechanism for female sexual function; however, the exact hormonal milieu of normal female sexual function continues to be incompletely understood. […] A variety of medical conditions have been associated with a disposition to FSD. Spinal cord injury may affect sexual function and, although controversial, women with spinal cord lesions at T1 and below are probably anorgasmic. […] It is important to know whether the patient has any history of abdominal/pelvic trauma, sexually transmitted disease, or pelvic inflammatory disease. […] Current knowledge regarding the sexual side effects of certain medications is not as well defined for women as it is for men.

• #6 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/kju.2010.51.7.443

  Central regulation of female sexual response has been explored to some extent. Central lesions are likely to interfere with female sexual physiology and lead to dysfunction. The precise mechanism by which central lesions affect female sexual function is yet to be determined. In general, it is believed that any central lesion would alter the efferent and afferent pathways of female sexual response leading to dysfunction. […] The relationship between spinal cord lesions and female sexual dysfunction has been frequently reported. In women, spinal cord injury may be associated with orgasmic and/or lubrication failure. Arousal may be secondary to audio-visual stimuli, fantasy, or genital stimulation. […] Diabetes affects sexual function in both women and men. Diabetes mellitus, which is known to cause erectile dysfunction in men, may interfere with sexual function in women. This issue, however, has been poorly investigated and it is unclear how diabetes leads to sexual disorders in women. Female sexual dysfunction can be regarded as a silent complication of diabetes mellitus.

• #7 Sexual dysfunction in women: Can we talk about it? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/367

  Sexual dysfunction in women is complex and often multi-factorial and has a significant impact on quality of life. […] Sexual dysfunction negatively affects quality of life and emotional health, regardless of age. […] Biological, psychological, and sociocultural factors may adversely affect female sexual response. […] Evaluation and treatment of female sexual dysfunction is guided by the biopsychosocial model, with potential influences from the biological, psychological, sociocultural, and interpersonal realms. […] Biological factors include pelvic surgery, cancer and its treatment, neurologic diseases, and vascular diseases. Medications, including antidepressants, narcotics, anticholinergics, antihistamines, antihypertensives, oral contraceptives, and antiestrogens may also adversely affect sexual response.

• #8 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/kju.2010.51.7.443

  Peripheral neurological disorders are known to be associated with sexual dysfunction in both women and men. Peripheral neuropathy is a common cause of erectile dysfunction but there is little relevant literature in females. Clitoral neuropathy has been observed to cause sexual dysfunction. […] In women, psychological factors (history of sexual abuse, depression, anxiety, obsessive compulsive disorders), sociocultural issues (beliefs regarding sexual activity), and interpersonal issues (partner availability, partner function, relationship with partner, communication with partner) affect sexual function in all age groups.

• #9 Biology of Female Sexual Function » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/physicianinformation/biology-of-female-sexual-function/

  Female sexual dysfunction is defined as disorders of sexual desire, arousal, orgasm and/or sexual pain, which results in significant personal distress and may have an impact on the quality of life and interpersonal relationships. […] The limited available data on female anatomy, physiology, biochemistry and molecular biology of the female sexual response makes this field particularly challenging to clinicians, psychologists and basic science researchers alike. […] There is a paucity of data concerning the anatomy, physiology, pathophysiology of sexual function in women. […] Large gaps exist in our knowledge of how the central nervous system controls female sexual function. […] The sexual arousal responses of the multiple genital and non-genital peripheral anatomic structures are largely the product of spinal cord reflex mechanisms.

• #10 Biology of Female Sexual Function » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/physicianinformation/biology-of-female-sexual-function/

  In the basal state, clitoral corporal and vaginal smooth muscles are under contractile tone. […] Following sexual stimulation, neurogenic and endothelial release of nitric oxide (NO) plays an important role in clitoral cavernosal artery and helicine arteriolar smooth muscle relaxation. […] In summary, data derived from in vivo animal models indicates that estrogen but not androgens modulate genital blood flow, vaginal lubrication and vaginal tissue structural integrity. […] In summary, the data reported from several laboratories suggest that NO is a key pathway in mediating clitoral smooth muscle relaxation. However, in the vagina, NO appears to play only a partial role in mediating smooth muscle relaxation. […] Further studies with hormonal manipulations at physiological doses are necessary to establish the role of hormones on vaginal smooth muscle relaxation. […] The paucity of biological data may be attributed to lack of reliable experimental models and tools for the investigation of female sexual function, and to limited funding, which is critical for the development of experimental approaches.

• #11 Sexual Dysfunction in Diabetic Women: An Update on Current Knowledge

  https://www.mdpi.com/2673-4540/1/1/2

  Hyperglycemia decreases the hydration of vaginal mucous membranes, causing a lubrication decrease and, in turn, dyspareunia. […] As previously reported, the sexual response is a neurovascular event also in women. It is well known that the chronic insult of hyperglycemia on the endothelium results in endothelial dysfunction. […] In diabetic women, vascular damage results in decreased vaginal blood, leading to a significantly impaired arousal response. […] Diabetic neuropathy may alter the normal transduction of sexual stimuli, contributing to the pathogenesis of sexual dysfunctions. […] Steroid hormonal changes can also play a role in the pathogenesis of FSD in diabetic women.

• #12 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Sexual function worsens with advancing menopause status. […] Endocrine conditions which may affect sexual function include thyroid disease, type 1 and type 2 diabetes mellitus, and polycystic ovary syndrome. […] Cardiovascular disease (CVD) is associated with an increased prevalence of FSD. […] Sexual desire/arousal and orgasm are mediated by central and spinal nerve pathways and involve sympathetic, parasympathetic and somatic nerve activity. […] Psychological factors (history of sexual abuse, depression, anxiety, obsessive-compulsive disorders), sociocultural issues (beliefs regarding sexual activity) and interpersonal issues (partner availability, partner function, relationship with partner, communication with partner) affect sexual function in all age groups. […] Sexual difficulties in chronic pain are frequent and wide-ranging.

• #13 Female Sexual Dysfunction: From Causality to Cure

  https://www.uspharmacist.com/article/female-sexual-dysfunction-from-causality-to-cure

  While pregnancy itself is generally associated with a diminished interest in sex, 23% to 57% of women report decreased libido at three months postpartum and nearly 40% report this at six months. Women who breast-feed often report increased vaginal dryness secondary to diminished estrogen production during this time, and dyspareunia may be associated with the natural childbirth process itself. As a woman’s body transitions through menopause, cessation of ovarian estrogen production is associated with urogenital atrophy and diminished sexual response. These physical changes are often accompanied by vasomotor symptoms, mood alterations, emotional lability, and diminished sense of well-being, which negatively impact sexual function and quality of life. […] Vascular diseases like diabetes, hypertension, hyperlipidemia, kidney disease, atherosclerosis, and traumatic injury are associated with diminished vaginal and clitoral blood flow and impaired sexual functioning. Sexual dysfunction is a common manifestation in women suffering from urologic infections and conditions such as interstitial cystitis, urinary incontinence, disorders of bladder-emptying, sexually transmitted diseases, and pelvic inflammatory disease. Physiologic disorders of the vagina and uterus such as vaginal fissures and endometriosis are associated with sexual-pain disorders. Pelvic surgery, diseases of the central nervous system, and spinal-cord injury cause autonomic nerve dysfunction and have been associated with disorders of arousal and orgasm.

• #14 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Female sexual dysfunction (FSD) is a subjective dissatisfaction, leading to significant distress, with the level or nature of sexual activity. […] The problem is often multifactorial. Biological, psychological, sociocultural, and relationship factors may all play a role, and ageing is a significant contributing factor. […] Female sexual function involves hormonal, neurological, vascular, psychological and emotional aspects. Dysfunction may be triggered or maintained by any of these, or by the interplay between them. […] Sexual dysfunction is highly prevalent in older women. Many women experience a change in their sexual function during the years immediately before and after menopause. […] Hormones, particularly androgens and oestrogens, are involved in the sexual response, particularly in terms of the integrity and sensitivity of genital tissues.

• #15 Overview of Female Sexual Function and Dysfunction – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/overview-of-female-sexual-function-and-dysfunction

  Various genital lesions, systemic and hormonal factors, medications, and illicit drugs may lead or contribute to dysfunction. […] Genitourinary syndrome of menopause describes symptoms and signs due to estrogen and androgen deficiency, such as vulvovaginal atrophy, vaginal dryness and decreased lubrication during intercourse, which cause pain. […] Selective serotonin reuptake inhibitors (SSRIs) are a particularly common iatrogenic cause of sexual dysfunction. SSRIs may contribute to several types of sexual dysfunction. […] Treatment of sexual dysfunction in women varies by disorder and cause; often more than one treatment is required because disorders overlap. Even if criteria for a particular DSM-5-TR disorder are not completely met, treatment may help. […] Psychological therapies (eg, cognitive-behavioral therapy, mindfulness, a combination of the two [MBCT]) should be incorporated into treatment for most types of female sexual dysfunction. […] When indicated, use medications (eg, an estrogen) to treat some types of female sexual dysfunction.

• #16 Female sexual dysfunction – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549

  Female sexual dysfunction is a medical term for ongoing sexual problems that upset you or your partner. […] Sexual response is complex. It involves how your body works, your feelings, things that happen in your life, your beliefs, your lifestyle and how you relate to your partner. A problem in any one of these areas can affect sexual desire, arousal or satisfaction. Treatment often involves more than one approach. […] Sexual dysfunction problems often start when hormones change. This might be after having a baby or during menopause. Major illness, such as cancer, diabetes or heart disease, also can add to sexual dysfunction. […] Lower estrogen levels after menopause may lead to changes in your genital tissues and how you respond to sex. Lower estrogen leads to less blood flow to the pelvis. This can cause you to have less feeling in your genitals and to need more time to become aroused and reach orgasm.

• #17 Urology Cure: Female Sexual Dysfunction Treatment Miami

  https://urologycure.com/female-sexual-dysfunction/

  Any number of medical conditions, including cancer, kidney failure, multiple sclerosis, heart disease and bladder problems, can lead to sexual dysfunction. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sexual desire and your bodys ability to experience orgasm. […] Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. A decrease in estrogen leads to decreased blood flow to the pelvic region, which can result in less genital sensation, as well as needing more time to build arousal and reach orgasm. […] The vaginal lining also becomes thinner and less elastic, particularly if youre not sexually active. These factors can lead to painful intercourse (dyspareunia). Sexual desire also decreases when hormonal levels decrease.

• #18 Female Sexual Dysfunction (FSD) » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/defintions/female-sexual-dysfunction-fsd/

  Sexual Pain Disorders Dyspareunia Recurrent or consistent genital pain associated with genital intercourse. Vaginismus Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration which causes personal distress. Non-Coital Sexual Pain Disorder Recurrent of persistent genital pain induced by non-coital sexual stimulation. […] Female Androgen Insufficiency Syndrome A pattern of clinical symptoms in the presence of decreased bioavailable testosterone and normal estrogen status. Clinical symptoms include: diminished sense of well-being or dysphoric mood persistent, unexplained fatigue sexual function changes including decreased libido, sexual receptivity and pleasure bone loss decreased muscle strength changes in cognition or memory Free testosterone values should be at or below the lowest quartile of the normal range.

• #19 Sexual Dysfunction in Diabetic Women: An Update on Current Knowledge

  https://www.mdpi.com/2673-4540/1/1/2

  Diabetes mellitus (DM) is one of the most common chronic diseases worldwide and its prevalence is expected to increase in the coming years. Therefore, updated knowledge of all diabetic complications and their management is essential for the proper treatment of these patients. Sexual dysfunctions are one of the long-term complications of DM in both genders. However, female sexuality is still a taboo and sexual concerns are often overlooked, underdiagnosed, and untreated. The aim of this review is to summarize the current knowledge on the relationship between sexual function and DM in women. In particular, we evaluated the prevalence, etiology, diagnostic approaches, and current treatment options of female sexual dysfunction (FSD) in diabetic patients. […] The pathogenesis of FSD in diabetic women is complex and multifactorial including both psychological and organic causes.

• #20 Sexual Dysfunction in Diabetic Women: An Update on Current Knowledge

  https://www.mdpi.com/2673-4540/1/1/2

  In contrast to diabetic men, several epidemiological studies have shown that psychosocial factors are more important than organic factors in the pathogenesis of FSD in both DM1 and DM2. Diabetic patients have an increased risk to develop depressive symptoms compared to the healthy population. Depression may significantly impair the quality of life of these patients, including sexual function. Therefore, depression is recognized as the most significant risk factor for FSD in diabetic women and it may impair sexual health at different levels. […] Although psychosocial factors seem to have a key role in the pathogenesis of sexual dysfunction in diabetic women, organic factors, including hyperglycemia, neurovascular alterations, hormonal changes, and recurrent genital infections can also contribute to the onset of FSD.

• #21 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Female sexual dysfunction can be subdivided into desire, arousal, orgasmic and sexual pain disorders. Sexual pain disorders include dyspareunia and vaginismus. […] Medical conditions are a frequent source of direct or indirect sexual difficulties. Vascular disease associated with diabetes might preclude adequate arousal; cardiovascular disease may inhibit intercourse secondary to dyspnea. […] Hysterectomy, gynecologic malignancies and breast cancer present medical and mortality concerns, and alter or remove physical and psychologic symbols of femininity that may result in feelings of decreased sexuality. […] The hypoestrogenic state of menopause may cause significant physical changes and alterations in mood or a diminished sense of well-being, which have been found to have a significant, negative impact on sexuality.

• #22 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Female-Sexual-Dysfunction.aspx

  Female sexual dysfunction (FSD) is defined as any distress that is the result of sexual pain, orgasm difficulties, and/or altered sexual interest or arousal. […] Several different factors must be taken into consideration to determine the cause(s) for FSD. Under the umbrella of medical and surgical conditions that can lead to FSD include endocrine disorders, malignancies, particularly those due to breast and ovarian cancers, inflammatory diseases such as fibromyalgia and rheumatoid arthritis, as well as various neurological conditions, such as multiple sclerosis (MS). […] Outside of these causes, FSDs related to sexual pain may arise from a wide range of anatomic and functional causes, which can be further classified into irritative, anatomic, or infectious. For example, irritative causes of female sexual pain can include poor lubrication, atrophic vaginitis, vulvar dermatoses, and vulvodynia. […] In addition to being a possible cause of FSD themselves, the medications used to treat certain psychological disorders, such as antidepressants, antipsychotics, and hormonal birth control medications can also cause FSDs.

• #23 Self-Assessment Questions – Course #93032: Female Sexual Dysfunction – NetCE

  https://www.netce.com/studypoints.php?courseid=2510&printable=yes&page=printquestions

  Vaginismus may be precipitated by painful intercourse, painful pelvic examination, sexual assault, pelvic inflammatory disease, gynecologic surgery, urogenital atrophy, vulvar dermatologic conditions, or childbirth. […] As noted, in 2015 flibanserin became the first medication approved for the treatment of female sexual dysfunction (specifically HSDD) and the first medication approved to treat sexual desire disorders in either sex. Its mechanism of action is presumed to be primarily the result of postsynaptic action on 5-HT1A receptors, but the actual action is not clear.

• #24 Female Sexual Dysfunction: From Causality to Cure

  https://www.uspharmacist.com/article/female-sexual-dysfunction-from-causality-to-cure

  Female sexual dysfunction (FSD) is a highly prevalent disorder affecting women’s quality of life across the lifespan and around the world. Disorders of sexual function are known to increase with age, subsequent to the onset of menopause. Approximately 52.4% of naturally menopausal women–an estimated 16 million women aged 50 and older–are likely to be affected by low sexual desire and symptoms of FSD. Other medical comorbidities that may be involved include diabetes, hypertension, cardiovascular disease, cancer, surgical procedures (particularly pelvic-floor surgery), and the use of certain medications. Importantly, these manifestations of FSD are attributable to various psychological, physical, and medical causes that must be identified before effective treatment can occur. […] The etiology of FSD is multifactorial. General physical and mental status; prior sexual experiences; levels of stress, education, and employment; socioeconomic status; cultural and ethnic identity; relationship dynamics; and the presence and health status of a partner all contribute to a woman’s sexual identity and define usual sexual behavior. Psychological factors related to emotional or relationship issues; depression and the use of antidepressants; and poor self-esteem and self-perception are the most prevalent, and often the most difficult to treat, causes of FSD. These psychogenic triggers can be associated with any of the manifestations of FSD. Additionally, psychiatric illness and adverse effects of antipsychotic medications may sometimes manifest as symptoms of FSD. A woman’s body is subject to hormonal influences and imbalances throughout her lifespan that affect her sexual physiology, most notably pregnancy and menopause.

• #25 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Decreased vaginal lubrication and dyspareunia are associated with low estradiol levels; however, the association between low sexual desire and lower estradiol levels has been inconsistent. […] The most common psychological factors impacting female sexual function are depression, anxiety, distraction, negative body image, sexual abuse, and emotional neglect. […] Common contextual or sociocultural factors that cause or maintain sexual dysfunction include relationship discord, partner sexual dysfunction (e.g., erectile dysfunction), life stage stressors (e.g., transition into retirement, children leaving home), and cultural or religious messages that inhibit sexuality. […] Sexual dysfunction induced by selective serotonin reuptake inhibitor use is common, with an incidence between 30% and 70%, and may include difficulty with sexual desire, arousal, and orgasm.

• #26 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Medications that are associated with female sexual dysfunction include antidepressants, cancer therapies, antihypertensives, antiepileptics, and benzodiazepines. […] The management of FSD will depend on the predominant underlying causes and there will often be several. […] Behavioural interventions, particularly mindfulness-based therapies, have shown positive effects on sexual desire, sexual distress and overall sexual function. […] Oestrogens are the most commonly used medications for the treatment of FSD, especially in perimenopausal and postmenopausal women. […] Testosterone is one of the most frequently prescribed (off-label) medications for women with sexual interest/arousal disorder. […] Flibanserin is a centrally acting drug which activates 5-HT1A receptors in the prefrontal cortex, increasing dopamine and adrenaline levels and decreasing serotonin levels. […] The mechanism of clitoral engorgement differs from that in the penis in that there is no obstructive process enhancing tumescence – the clitoris is engorged by increased blood flow only.

• #27 FEMALE SEXUAL DYSFUNCTION: THE IMPORTANT POINTS TO REMEMBER | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-female-sexual-dysfunction-the-important-S1807593222032161

  Major tranquilizers such as diazepam are believed to limit sexual function secondary to a dopaminergic action. […] The cornerstone of treatment is centered on the use a series of graduated dilators coupled with relaxation techniques. […] In general, the longer-standing the sexual dysfunction, the more difficult it becomes to treat. In addition, the earlier the sexual response cycle is interrupted, the more resilient to treatment it potentially becomes. Therefore, disorders of the desire phase are generally harder to treat than disorders of the arousal phase, which in turn are more difficult to treat than orgasmic dysfunction.

• #28 Sexual dysfunction in women – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/352

  Sexual dysfunction in women of all sexual orientations correlates most strongly with poor mental health and with negative feelings for the partner(s), rather than with any serum hormone (or hormone metabolite) levels. […] Poor mental health, stress, and low levels of emotional intimacy between the partners correlate closely with dysfunction, whereas serum levels of sex hormones do not. […] There is only limited research on persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) and its pathophysiology and treatment are not well understood.

• #29 Overview of Female Sexual Function and Dysfunction – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/overview-of-female-sexual-function-and-dysfunction

  Women commonly have concerns about sexual function. Concerns that cause personal or interpersonal distress are considered a sexual dysfunction disorder. Approximately 12% of women in the United States have a sexual function issue associated with distress. […] The traditional separation of psychological and physical etiologies is artificial; psychological distress causes changes in hormonal and neurologic physiology, and physical changes may generate psychological reactions that compound the dysfunction. There are often several causes of symptoms within and between categories of dysfunction, and the cause is often unclear. […] Mood disorders (eg, depression, anxiety) are closely correlated with low interest and arousal. For women with major depression and sexual dysfunction, sexual distress becomes less severe when depression is effectively treated with antidepressants. However, some types of antidepressants also cause sexual dysfunction (selective serotonin reuptake inhibitors). Women with an anxiety disorder are also more likely to have sexual dysfunction involving sexual interest, arousal, orgasm and genito-pelvic pain/penetration disorders.

• #30 Female Sexual Dysfunction in Association with Sexual History, Sexual Abuse and Satisfaction: A Cross-Sectional Study in Hungary

  https://www.mdpi.com/2077-0383/12/3/1112

  Female sexual dysfunction (FSD) has a negative impact on women’s quality of life, self-esteem, and physical health. […] The etiology of FSD is complex and has a multifactorial background, where psychological, social, and biological factors play an important role. […] One of the most cited psychosocial factors is abuse. Childhood sexual abuse has been shown to be positively associated with vaginismus, lubrication failure, orgasmic disorder, and female sexual interest/arousal disorders. […] Our results suggest that female sexual dysfunction is associated with women’s sexual history (of the first sexual experience, presence or absence of sexual education, an early encounter with pornographic content, and sexual abuse), their self-satisfaction (with their own body, genitalia, and sexual attraction) and their sexual orientation.

• #31 Sexual Dysfunction: Types, Causes, Diagnosis, Treatment

  https://www.verywellhealth.com/sexual-dysfunction-7111756

  In females, the lack of sexual arousal is typically regarded as a facet of FSIAD. […] Psychological factors associated with sexual dysfunction include those predisposing you to sexual dysfunction (such as past sexual trauma or a restrictive upbringing) and those that precipitate (give rise to) symptoms of sexual dysfunction. […] Chief among the precipitating factors are depression and anxiety, both of which have a cause-and-effect relationship with sexual dysfunction. […] People who experienced past sexual violence or abuse, such as rape or incest, are vulnerable to vaginismus, vestibulodynia, and postcoital dysphoria. Post-traumatic stress disorder (PTSD) is commonly diagnosed in people with FSIAD. […] A wide range of medical conditions can directly or indirectly affect the physical function of the sexual organs and/or the moods that direct the sexual response.

• #32 Sexual dysfunction in women: Can we talk about it? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/367

  Psychological factors include a history of sexual abuse or trauma, body image concerns, distraction, stress, anxiety, depression, and personality disorders. […] Sociocultural factors include lack of sex education, unrealistic expectations, cultural norms, and religious influences. […] Relationship factors include conflict with one’s partner, lack of emotional intimacy, absence of a partner, and partner sexual dysfunction. […] As sexual dysfunction in women is often multifactorial, management of the problem is well suited to a multidisciplinary approach. […] Even in the initial visit, the primary care provider can educate, reassure regarding normal sexual function, and treat conditions such as genitourinary syndrome of menopause and antidepressant-associated sexual dysfunction. […] Hypoactive sexual desire disorder is defined as persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity associated with marked distress and not due exclusively to a medication, substance abuse, or a medical condition.

• #33 Female Sexual Dysfunction in Association with Sexual History, Sexual Abuse and Satisfaction: A Cross-Sectional Study in Hungary

  https://www.mdpi.com/2077-0383/12/3/1112

  All three conditions (FOD, FSIAD, GPPPD) showed a strong association with abuse, STDs, and self-esteem (self-image). […] Previous studies have found that women with FOD have more negative and fewer positive cognitive associations. […] Our results show that satisfaction issues related to self-esteem also correlated with FOD. […] In accordance with other studies showing a strong association between the occurrence of sexual abuse and sexual interest disorder, in our research, previous sexual abuse was more common in those who had FSIAD (19%). […] The occurrence of sexually transmitted diseases was more common among women with GPPPD than among women free of this problem.

• #34 Sexual Dysfunction Disorders | Abnormal Psychology

  https://courses.lumenlearning.com/wm-abnormalpsych/chapter/sexual-dysfunction-disorders/

  Research has not yet examined factors associated with FSIAD and there has been little investigation of the impact of individual factors, notably stress, levels of fatigue, gender identity, health, and other individual attributes and experiences, such as dysfunctional sexual beliefs that may affect sexual desire or response. However, researchers have investigated a number of causes and consequences of low sexual interest in women and low sexual arousal. These elements are broken down into biological factors including medical health, hormones, and medications, and psychological factors including stress, relationships, comorbid mental illness, and history of sexual abuse.

• #35 Female sexual arousal disorder – Wikipedia

  https://en.wikipedia.org/wiki/Female_sexual_arousal_disorder

  Kaplan proposed that sexual dysfunction was based on intrapsychic, interpersonal, and behavioural levels. Four factors were identified that could have a role in the development of sexual dysfunction: 1) lack of correct information regarding sexual and social interaction, 2) unconscious guilt or anxiety regarding sex, 3) performance anxiety, and 4) failure to communicate between the partners.

• #36 Female sexual dysfunction in an outpatient andrology clinic—A therapeutic opportunity? | Revista Internacional de Andrología

  https://www.elsevier.es/es-revista-revista-internacional-andrologia-262-articulo-female-sexual-dysfunction-in-an-S1698031X23000298

  Female sexual dysfunction (FSD) can influence the treatment of the man who seeks clinical help. […] Identify sexual dysfunction in female partners of patients attending an andrology clinic may provide a therapeutic opportunity. […] Our study demonstrated that the proportion of FSD in female partners of patients attending an andrology clinic is significantly higher than control group. FSD treatment should be considered as a therapeutic opportunity for the couple in this setting. […] Some studies have shown that FSD is associated with the sexual function of their partners. […] The disruption of these phases leads to female sexual dysfunction and further interferes with her partner’s sexual performance and reinforces the male sexual dysfunction (MSD). […] Thus, the dysfunction of one of the elements of the couple may have the effect of originating and/or aggravating eventual sexual dysfunction in the partner.

• #37 Female sexual dysfunction in an outpatient andrology clinic—A therapeutic opportunity? | Revista Internacional de Andrología

  https://www.elsevier.es/es-revista-revista-internacional-andrologia-262-articulo-female-sexual-dysfunction-in-an-S1698031X23000298

  This dysfunction involving the couple and their sexual dynamics leads to a cycle of negative, vicious events which damage the relationship as a whole and the sexual relationship in particular. […] In our study, almost half of the women (46.6%) in the SG classified the current relationship as worse than previous relationships and this may be perceived by the partner. […] Our study shows that an important proportion of women (73%), partners of patients attending the andrology clinic present sexual dysfunction (FSFI < 25.66). [...] Although the mutual interaction and influence in the sexual sphere of a couple is often overlooked during an andrology clinical context, some studies have advocated a more comprehensive approach to sexual dysfunctions, always as a problem of the couple, suggesting an assessment of both the man and the woman. [...] In conclusion, FSD is frequent in the context of an andrology clinic and should be seen as a therapeutic opportunity.

• #38 Female sexual dysfunction – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549

  Anxiety or depression that isn’t treated can cause sexual dysfunction or add to it. So can long-term stress, a history of sexual abuse, worries of pregnancy and the demands of having an infant. […] Problems with your partner can affect your sex life. So can cultural and religious issues and problems with body image.

• #39 Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0602-4

  Factors which consistently had a significant, protective effect across all domains were: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, sex education and finding sex to be important. […] Risk factors such as older age, poor health, and relationship dissatisfaction were found in all human development groups, regardless of the level of gender inequality. […] The results of these two large-scale studies cannot show causality between sexual dysfunction and gender inequality, but they do underline the importance of examining sexual health outcomes in terms of the level of gender inequality in a society. […] Further stratification of these predictors was essential to this analysis. Because there were lower meta-analytical prevalence rates in gender equal sexual regimes and because of the correlation between high female sexual dysfunction rates and high gender inequality, the risk factors and protective factors were examined through paradigms of gender inequality in order to better understand trends in predictors of female sexual dysfunction.

• #40 Sexual Dysfunction Disorders | Abnormal Psychology

  https://courses.lumenlearning.com/wm-abnormalpsych/chapter/sexual-dysfunction-disorders/

  Female sexual interest/arousal disorder (FSIAD) is defined as a lack of, or significantly reduced, sexual interest/arousal, manifesting through at least three of the following symptoms: no or little interest in sexual activity, no or few sexual thoughts, no or few attempts to initiate sexual activity or respond to partners initiation, no or little sexual pleasure/excitement in 75-100% of sexual experiences, no or little sexual interest in internal or external erotic stimuli, and no or few genital/nongenital sensations in 75-100% of sexual experiences. […] The cause of lifelong/generalized HSDD is unknown. In the case of acquired/generalized low sexual desire, possible causes include various medical/health problems, psychiatric problems, low levels of testosterone or high levels of prolactin. One theory suggests that sexual desire is controlled by a balance between inhibitory and excitatory factors. This is thought to be expressed via neurotransmitters in selective brain areas. A decrease in sexual desire may therefore be due to an imbalance between neurotransmitters with excitatory activity like dopamine and norepinephrine and neurotransmitters with inhibitory activity, like serotonin. Low sexual desire can also be a side effect of various medications.

• #41 Female Sexual Dysfunction: From Causality to Cure

  https://www.uspharmacist.com/article/female-sexual-dysfunction-from-causality-to-cure

  As androgen levels also diminish with age, women reporting decreased sexual desire and satisfaction–symptoms related to testosterone deficiency or low serum testosterone levels–may benefit from testosterone replacement therapy, although recent findings suggest that there is no evidence that low serum testosterone levels are, in fact, associated with sexual dysfunction. Long-term efficacy and safety data for testosterone replacement therapy are unknown. Estrogen-testosterone combination products, including esterified estrogens and methyltestosterone (Estratest; Estratest HS), have also been utilized and are approved for menopausal symptoms unrelieved by estrogen supplementation alone; they also may be used off-label for certain disorders of sexual dysfunction. […] Vasoactive medications, particularly phosphodiesterase inhibitors, have garnered much attention in the realm of male sexual dysfunction. In women, sildenafil works by decreasing cyclic guanosine monophosphate metabolism, resulting in nitric oxide-mediated vasodilation and relaxation of the vaginal smooth muscles and clitoris. Data from clinical trials in premenopausal and postmenopausal women are conflicting, with younger women experiencing improvements in arousal, orgasm, sexual fantasy, and activity and older women experiencing minimal, nonsignificant improvements in satisfaction and overall sexual function.

• #42 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Urogenital atrophy is the most common cause of arousal disorders in postmenopausal women, and estrogen replacement, when appropriate, is usually effective therapy. […] Anorgasmia is quite responsive to therapy. This condition is caused by sexual inexperience or the lack of sufficient stimulation and is common in women who have never experienced orgasm. […] Dyspareunia can be divided into three types of pain: superficial, vaginal and deep. Superficial dyspareunia occurs with attempted penetration, usually secondary to anatomic or irritative conditions, or vaginismus. Vaginal dyspareunia is pain related to friction (i.e., lubrication problems), including arousal disorders. Deep dyspareunia is pain related to thrusting, often associated with pelvic disease or relaxation.

• #43 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/kju.2010.51.7.443

  In contrast to the male, the pathophysiology of female sexual dysfunction is not easily categorized as vasculogenic, neurologic, or hormonal. Rather, it appears to involve multidimensional biologic, psychologic, and interpersonal aspects. […] Neurologic disorders are known to be associated with sexual dysfunction both in women and men. The role of neurologic factors in female sexual dysfunction, however, remains somewhat unexplored and may be undiagnosed. Many neurologic disorders, including autonomic and peripheral neuropathy, spinal cord injury, diabetic neuropathy, multiple sclerosis, and lumbar radiculopathy are likely to interfere with the neurophysiology of the female genital organs and lead to their dysfunction. It is believed that any neural lesion, central or peripheral, can interfere with the sensory and somatic component of the female genitals and lead to dysfunction. Dysfunction of the sensory fibers may interfere with the afferent signaling and sensory modalities that are quite important in female sexual response.

• #44 Sexual dysfunction in women: Can we talk about it? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/367

  Multiple biological, psychological, and social factors may contribute to the problem. Identifying the ones that are present can help in planning treatment. […] Female sexual arousal disorder is the persistent or recurrent inability to attain or maintain an adequate lubrication-swelling response of sexual excitement. […] Sexual arousal results from a complex interaction between genital response, central nervous system activity, and information processing of the sexual stimulus. […] Female orgasmic disorder is the marked delay, marked infrequency, or absence of orgasm, or markedly reduced intensity of orgasm. […] The DSM-5 describes genitopelvic pain/penetration disorder as fear or anxiety, marked tightening or tensing of abdominal and pelvic muscles, or actual pain with vaginal penetration that is recurrent or persistent for a minimum of 6 months.

• #45 SciELO Brazil – A Model for the Management of Female Sexual Dysfunctions A Model for the Management of Female Sexual Dysfunctions

  https://www.scielo.br/j/rbgo/a/8jYfk8hMmsCK5P3ZmyGbGTN/?lang=en

  The TOP model could help physicians better manage patients who have sexual complaints. In regions where doctors are not trained in sexology, the TOP model can help physicians provide patients with basic information on sex, so that women can become familiar with their sexuality. […] The learning session allows the gynecologist to deal with sexual myths and mistaken beliefs about sex, and to reformulate concepts on affectivity and the sharing of sexual experiences. […] The management of women with sexual desire/arousal dysfunction must take into account that this disorder may arise from organic and/or psychical factors. […] The clitoris seems to be the most important anatomic structure to female orgasm, which can occur in women when the clitoris is effectively stimulated during masturbation, oral sex, anal intercourse, partner masturbation, or during vaginal intercourse.

• #46 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  Depression and anxiety commonly contribute to sexual dysfunction. […] Various fears of letting go, of being rejected, or of losing control and low self-esteem can contribute to sexual dysfunction. […] Various sexual worries can impair sexual function. […] After menopause, changes in the vagina and urinary tract (called genitourinary syndrome of menopause) can affect sexual function. […] Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, commonly cause problems with sexual function. […] Vaginal lubricants and moisturizers can reduce vaginal dryness, which causes pain during intercourse. […] Depending on the type of dysfunction, sexual skills training (for example, instruction in masturbation) and exercises to facilitate communication with a partner about sexual needs and preferences can be implemented. […] Vaginal dryness or painful sex due to menopause can be treated with vaginal hormone therapy, including low-dose estrogen (as a cream, tablet, or ring) or dehydroepiandrosterone (DHEA, as a suppository).

• #47 Disgust as a mechanism underlying female sexual dysfunction | Whitman College

  https://arminda.whitman.edu/theses/2021047

  The sexual pain disorders vaginismus and dyspareunia share the core diagnostic feature of pain or fear of pain during genital contact or penetration of the vagina. […] Although the exact etiology of sexual dysfunctions are unknown, individual traits such as disgust propensity, sexual arousal, and socio-moral conservatism might predispose individuals to these conditions. […] People with vaginismus tend to be higher in disgust propensity, defined as how easily and intensely one experiences disgust. […] When an individuals disgust propensity is high, it may interfere with sexual arousal and impact ones ability to have fulfilling sexual experiences. […] However, measures of sexual arousal and desire were associated with approach behavior towards the disgusting sexual stimuli. […] These results suggest that sexual arousal may facilitate approach behavior towards potentially disgusting sexual stimuli and that trait sexual desire may serve as a protective factor against vaginismus.

• #48

  https://link.springer.com/article/10.1007/s40750-015-0029-1

  Overall, a model that accounts for the high prevalence of sexual dysfunction in women is proposed, which combines the three evolutionary models. In this model most of the variation in sexual functioning is accounted for by balancing selection with polygenic mutation, and ancestral neutrality also playing a role.

• #49 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  In substance/medication-induced sexual dysfunction, sexual dysfunction is related to initiation, change in dose, or stopping of a substance (including illicit drugs) or medication. […] Persistent genital arousal disorder is a rare disorder that can occur in both men and women but does not have specific criteria for diagnosis. Women with persistent genital arousal disorder experience excess physical arousal (indicated by increased blood flow to the genital organs and increased vaginal secretion), but sexual desire is absent. […] A woman’s sexual response is strongly influenced by her mental health and by the quality of her relationship with her partner. […] Many factors cause or contribute to the various types of sexual dysfunction. Traditionally, causes are considered physical or psychological. However, the two types of causes cannot be separated.

• #50 SciELO Brazil – A Model for the Management of Female Sexual Dysfunctions A Model for the Management of Female Sexual Dysfunctions

  https://www.scielo.br/j/rbgo/a/8jYfk8hMmsCK5P3ZmyGbGTN/?lang=en

  Sexual dysfunction leads to negative effects on interpersonal and social relationships, and on the well-being and the quality of life of women. Numerous clinical, psychological and social conditions may affect this important aspect of life, and patients may report full recovery only if normal sexual activities are restored. […] Even though female sexual dysfunction is prevalent, after it is identified, few protocols are available for the management of organic and non-organic sexual complaints. […] The present work shows step-by-step the protocol used to manage female sexual dysfunction in a gynecologic setting, an interdisciplinary service formed by a team of gynecologists, psychologists, a psychiatrist, and physiotherapists, all experts in sexology. An interdisciplinary approach is required for the appropriate assessment of the sexual dysfunction of a person, due to a complex interaction of psychological, social, cultural and physiological processes and one or more factors that may impact on any stage of the sexual response cycle.

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