Female Sexual Dysfunction

Diagnosis

To diagnose female sexual dysfunction, your healthcare professional begins with a thorough evaluation to understand possible physical, emotional, or relational causes.

They may take the following steps:

• Discuss your sexual and medical history, as well as your gender identity. It’s natural to feel uneasy discussing intimate topics, but being open helps your healthcare professional identify underlying issues and find suitable treatments.

• Perform a pelvic exam to check for physical changes that might affect sexual comfort or pleasure, such as thinning of genital tissues, scarring, or tenderness.

• Order blood tests to identify medical conditions or hormonal imbalances that may contribute to sexual dysfunction.

Your healthcare professional might also recommend seeing a counselor or therapist who specializes in sexual and relationship concerns.

Treatment

Female sexual dysfunction is treated only when it causes distress or affects your relationship. If it doesn’t bother you, no medical intervention is necessary. However, if sexual difficulties are creating emotional or relationship strain, a mix of medical and nonmedical treatments may help.

Effective treatment usually addresses medical, emotional, and relational factors together.

Nonmedical treatment for female sexual dysfunction

Your healthcare professional might suggest the following lifestyle and behavioral approaches:

• Communicate openly with your partner about your needs and desires. Honest, nonjudgmental communication strengthens intimacy and improves sexual satisfaction.

• Maintain a healthy lifestyle. Limit alcohol intake, stay physically active, and focus on overall wellness. Good physical health supports a healthy sex life.

• Learn stress management techniques to improve focus and relaxation during intimacy.

• Seek counseling or sex therapy to address emotional or relational barriers. Therapy may include education about sexual response and ways to enhance closeness with your partner.

• Use vaginal lubricants during intercourse if dryness causes discomfort or pain.

• Apply vaginal moisturizers regularly to relieve dryness.

• Stay sexually active, alone or with a partner, to increase blood flow to vaginal tissues and reduce discomfort.

• Consider sexual devices, such as vibrators, which may help stimulate arousal and improve orgasm.

Medical treatment for female sexual dysfunction

When medical conditions or hormonal changes are involved, treatment may focus on managing those underlying factors. Your healthcare professional may adjust medications or recommend hormone therapy.

Common medical treatments include:

• Vaginal estrogen: Applied as a cream, tablet, or ring to relieve dryness and pain with intercourse. It also helps improve urinary symptoms related to low estrogen levels.

• Ospemifene (Osphena): An oral selective estrogen receptor modulator (SERM) used to treat painful intercourse due to thinning vaginal tissue. It’s not suitable for those with a history or high risk of breast cancer.

• Testosterone therapy: Though testosterone influences sexual function in women, no FDA-approved formulations exist specifically for female use. Discuss potential benefits and risks with your healthcare team.

• Flibanserin (Addyi): A daily oral medication approved for premenopausal women with low sexual desire. It may increase libido but can cause low blood pressure, fatigue, dizziness, nausea, and fainting. Alcohol use worsens these effects. Treatment should be stopped if there’s no improvement after eight weeks.

• Bremelanotide (Vyleesi): An injectable medication approved for premenopausal women with low sexual desire. It’s administered before sexual activity and may cause nausea, headache, or skin reactions at the injection site.

• Prasterone (Intrarosa): A vaginal insert containing dehydroepiandrosterone (DHEA) to help ease dryness and pain during intercourse.

Potential treatments under research

Several emerging therapies are being studied for effectiveness and safety:

• Tibolone: A synthetic hormone with both estrogen and androgen effects, used in some countries but not approved in the U.S. due to safety concerns such as increased risk of breast cancer and stroke.

• Phosphodiesterase inhibitors: Drugs like sildenafil (Viagra) are effective for erectile dysfunction but have shown mixed results in women. Sildenafil may help those with sexual dysfunction caused by antidepressant use but shouldn’t be used with nitroglycerin for chest pain.

Because female sexual dysfunction often involves both physical and emotional components, even effective medications may not work without addressing relationship, stress, or psychological factors. Combining medical treatment with counseling and lifestyle changes offers the best outcomes for long-term sexual health and satisfaction.