Last updated January 20, 2022

Female Sexual Dysfunction

Recommendations

Low-dose vaginal estrogen therapy is the preferred hormonal treatment for female sexual dysfunction that is due to genitourinary syndrome of menopause.
574

Low-dose systemic hormone therapy, with estrogen alone or in combination with progestin, can be recommended as an alternative to low-dose vaginal estrogen in women experiencing dyspareunia related to genitourinary syndrome of menopause as well as vasomotor symptoms.
574

Ospemifene can be recommended as an alternative to vaginal estrogen for the management of dyspareunia caused by genitourinary syndrome of menopause.
574

Systemic DHEA is not effective and, therefore, is not recommended for use in the treatment of women with sexual interest/arousal disorders.
574

Psychologic interventions, including sexual skills training, cognitive–behavioral therapy (with or without pharmacotherapy), mindfulness-based therapy, and couples therapy, are recommended as part of female sexual dysfunction treatment.
574

A physical examination should be performed to diagnose female sexual dysfunction related to genitourinary syndrome of menopause before starting vaginal or systemic hormone therapy.
574

Short-term use of transdermal testosterone can be considered as a treatment option for postmenopausal women with sexual interest and arousal disorders who have been appropriately counseled about the potential risks and unknown long-term effects.
574

Evidence is insufficient to recommend for or against testosterone for the treatment of sexual interest and arousal disorders in premenopausal women.
574

Sildenafil should not be used for the treatment of female interest/arousal disorders outside of clinical trials.

574

Intravaginal prasterone, low-dose vaginal estrogen, and ospemifene can be used in postmenopausal women for the treatment of moderate-to-severe dyspareunia that is due to genitourinary syndrome of menopause.
574

Estrogen or SERM therapy is not recommended for the treatment of female sexual dysfunction that is not due to a hypoestrogenic state.
574

Vaginal carbon dioxide (CO2) fractional laser for treatment of dyspareunia that is due to genitourinary syndrome of menopause should not be used outside of a research setting.
574

Flibanserin can be considered as a treatment option for hypoactive sexual desire disorder in premenopausal women without depression who are appropriately counseled about the risks of alcohol use during treatment.
574

Obstetrician–gynecologists should initiate a clinical discussion of sexual function during routine care visits to identify issues that may require further exploration and to help destigmatize discussion of sexual function for patients.
574

The initial evaluation of a patient with female sexual dysfunction symptoms may require an extended visit and should include a comprehensive history and physical examination to evaluate possible gynecologic etiologies.
574

Laboratory testing typically is not necessary in the initial evaluation of female sexual dysfunction unless an undiagnosed medical etiology is suspected.
574

If transdermal testosterone therapy is used in postmenopausal women with sexual interest and arousal disorders, a 3–6-month trial is recommended with assessment of testosterone levels at baseline and after 3–6 weeks of initial use to ensure levels remain within the normal range for reproductive-aged women. Transdermal testosterone therapy should be discontinued at 6 months in patients who do not show a response. If ongoing therapy is used, followup clinical evaluation and testosterone measurement every 6 months are recommended to assess for androgen excess. The long-term safety and efficacy of transdermal testosterone have not been studied.
574

Pelvic floor physical therapy is recommended for the treatment of genito–pelvic pain and penetration disorders to restore muscle function and decrease pain.
574

Lubricants, topical anesthesia, and moisturizers may help reduce or alleviate dyspareunia.
574

Recommendation Grading

Overview

Title

Female Sexual Dysfunction

Authoring Organization

Publication Month/Year

July 1, 2019

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife

Scope

Counseling, Diagnosis, Management

Diseases/Conditions (MeSH)

D000074384 - Sexual Health, D012735 - Sexual Dysfunction, Physiological, D020018 - Sexual Dysfunctions, Psychological

Keywords

sexual dysfunction