Assessment and management of women's sexual dysfunctions: problematic desire and arousal.
BACKGROUND
Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management.


OBJECTIVE
To provide recommendations/guidelines for the assessment and management of women's sexual dysfunctions focusing on low desire, low interest, and lack of arousal.


METHODS
An international consultation, in collaboration with major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One subcommittee of five members focused on women's sexual desire and arousal, developing over a 2-year period various recommendations.


METHODS
Expert opinion was based on grading of evidence-based scientific literature, widespread internal committee discussion, public presentation, and debate.


RESULTS
Women's sexual response in health can be reconceptualized as a circular model of overlapping phases of variable order influenced by psychological, societal, and biological factors. Subsequent revisions to definitions of arousal and desire disorder are given. Recommendations regarding assessment and management focus on factors reducing arousability and satisfaction. These include women's mental health and feelings for their partner, generally and at the time of sexual activity. Recommendations reflect the poor correlation of subjective arousal and increases in genital vasocongestion.


CONCLUSIONS
Further outcome research of management based on new conceptualization of sexual response and revised definitions of dysfunction is needed. The basis of the variable correlation between genital vasocongestion and subjective arousal needs clarification as do the biological underpinnings of sexual response and their changes with age and life cycle.
Basson
Rosemary
R
UBC Department of Psychiatry, B.C. Centre for Sexual Medicine, Vancouver, BC, Canada. sexmed@interchange.ubc.ca
Brotto
Lori A
LA
Laan
Ellen
E
Redmond
Geoffrey
G
Utian
Wulf H
WH
D000328:Adult; D000728:Androgens / Q000172:deficiency; D016642:Bupropion / Q000627:therapeutic use*; D003863:Depression / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use*; D004967:Estrogens / Q000172:deficiency; D005260:Female; D006801:Humans; D007989:Libido; D009652:Norpregnenes / Q000627:therapeutic use*; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000728:Androgens; D018765:Dopamine Uptake Inhibitors; D020847:Estrogen Receptor Modulators; D004967:Estrogens; D009652:Norpregnenes; D016642:Bupropion; C027385:tibolone