Screening and Management of Female Sexual Dysfunction During the Second Half of Life

  • Ana M. Fernández-Alonso
  • Marcos J. Cuerva
  • Peter Chedraui
  • Faustino R. Pérez-López


Female sexual dysfunction (FSD) includes different disorders that are highly prevalent in perimenopausal and older women which require precise diagnosis and management. Screening of FSD should be based on clinical history and the use of screening tools such as the 14-item Changes in Sexual Functioning Questionnaire, the 19-item Female Sexual Function Index (FSFI-19) and its short version (FSFI-6), or the Decreased Sexual Desire Screener. The clinical exam should include the assessment of menopausal symptoms, vulvovaginal atrophy, and comorbidity including pelvic floor disorders, endocrine disorders, depressive symptoms, cancer diseases, and chronic medication use that may interfere with sexuality. The management of genito-pelvic pain/penetration disorders includes the appropriate treatment of the genitourinary syndrome of menopause, urinary incontinence, and pelvic floor disorders with appropriate selection for surgery and/or other treatments. The management of female sexual interest/arousal disorder (also known as hypoactive sexual desire disorder) may include systemic or topical steroid hormone therapy, including dehydroepiandrosterone sulfate, central-acting agents (flibanserin, bupropion, bremelanotide), and/or natural remedies (Tribulus terrestris, Trigonella foenum-graecum). Female orgasmic disorder may be managed by conductual methods and/or drugs.


Arousal disorder Bremelanotide Bupropion Dehydroepiandrosterone sulfate Female orgasmic disorder Female sexual function index Female sexual interest/arousal disorder Flibanserin Genito-pelvic pain/penetration disorder Genitourinary syndrome Hypoactive sexual desire disorder Ospemifene Prasterone Tibolone Tribulus terrestris Trigonella foenum-graecum 


Competing Interest

None to declare.

Funding: None.


  1. 1.
    Chedraui P, Pérez-López FR. Assessing sexual problems in women at midlife using the short version of the female sexual function index. Maturitas. 2015;82:298–302.CrossRefGoogle Scholar
  2. 2.
    Pérez-López FR, Fernández-Alonso AM, Trabalón Pastor M, Vara C, Chedraui P. Assessment of sexual function with the 6-item female sex function index and related factors in mid-aged sexually active Spanish women. Menopause. 2012;19:1224–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Chedraui P, Pérez-López FR, Blümel JE, Hidalgo L, Barriga J. Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints. Gynecol Endocrinol. 2010;26:86–92.PubMedCrossRefGoogle Scholar
  4. 4.
    McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health. 2018;18:108.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Chedraui P, Pérez-López FR, San Miguel G, Avila C. Assessment of sexuality among middle-aged women using the female sexual function index. Climacteric. 2009;12:213–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Ishak IH, Low WY, Othman S. Prevalence, risk factors, and predictors of female sexual dysfunction in a primary care setting: a survey finding. J Sex Med. 2010;7:3080–7.PubMedCrossRefGoogle Scholar
  7. 7.
    McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Lewis R, Segraves RT. Definitions of sexual dysfunctions in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016;13:135–43.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    World Health Organization. International Classification Diseases 11. Accessed 11 Aug 2018.
  9. 9.
    American Psychiatric Association. DSM-5: diagnostic and statistical manual for mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.CrossRefGoogle Scholar
  10. 10.
    Kingsberg SA, Althof S, Simon JA, Bradford A, Bitzer J, Carvalho J, Flynn KE, Nappi RE, Reese JB, Rezaee RL, Schover L, Shifrin JL. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med. 2017;14:1463–91. Erratum in: J Sex Med. 2018;15:270.PubMedCrossRefGoogle Scholar
  11. 11.
    Szwabo PA. Counseling about sexuality in the older person. Clin Geriatr Med. 2003;19:595–604.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Cuerva MJ, González D, Canals M, Otero B, Espinosa JA, Molero F, Senturk LM, Mendoza N, SMS Young Experts Group. The sexual health approach in postmenopause: the five-minutes study. Maturitas. 2018;108:31–6.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33:731–45.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Keller A, McGarvey EL, Clayton AH. Reliability and construct validity of the Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14). J Sex Marital Ther. 2006;32:43–52.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Ornat L, Martínez-Dearth R, Muñoz A, Franco P, Alonso B, Tajada M, Pérez-López FR. Sexual function, satisfaction with life and menopausal symptoms in middle-aged women. Maturitas. 2013;75:261–9.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Llaneza P, Fernández-Iñarrea JM, Arnott B, García-Portilla MP, Chedraui P, Pérez-López FR. Sexual function assessment in postmenopausal women with the 14-item changes in sexual functioning questionnaire. J Sex Med. 2011;8:2144–51.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Wiegel M, Meston C, Rosen R. The Female Sexual Function Index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Burri A, Hilpert P, Spector T. Longitudinal evaluation of sexual function in a cohort of pre- and postmenopausal women. J Sex Med. 2015;12:1427–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Isidori AM, Pozza C, Esposito K, et al. Development and validation of a 6-item version of the Female Sexual Function Index (FSFI) as a diagnostic tool for female sexual dysfunction. J Sex Med. 2010;7:1139–46.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Clayton AH, Goldfischer ER, Goldstein I, Derogatis L, Lewis-D’Agostino DJ, Pyke R. Validation of the decreased sexual desire screener (DSDS): a brief diagnostic instrument for generalized acquired female hypoactive sexual desire disorder (HSDD). J Sex Med. 2009;6:730–8.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, Pfaus J, Simon JA, Kingsberg SA, Meston C, Stahl SM, Wallen K, Worsley R. Hypoactive sexual desire disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel review. Mayo Clin Proc. 2017;92:114–28.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Clayton AH, Goldstein I, Kim NN, Althof SE, Faubion SS, Faught BM, Parish SJ, Simon JA, Vignozzi L, Christiansen K, Davis SR, Freedman MA, Kingsberg SA, Kirana PS, Larkin L, McCabe M, Sadovsky R. The International Society for the Study of Women’s Sexual Health process of Care for Management of hypoactive sexual desire disorder in women. Mayo Clin Proc. 2018;93:467–87.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Shindel AW, Rowen TA, Lin TC, Li CS, Robertson PA, Breyer BN. An internet survey of demographic and health factors associated with risk of sexual dysfunction in women who have sex with women. J Sex Med. 2012;9:1261–71.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Woods NF, Mitchell ES. Consequences of incontinence for women during the menopausal transition and early postmenopause: observations from the Seattle midlife Women’s health study. Menopause. 2013;20:915–21.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Rees M, Pérez-López FR, Ceasu I, Depypere H, Erel T, Lambrinoudaki I, Schenck-Gustafsson K, Simoncini T, van der Schouw Y, Tremollieres F. EMAS. EMAS clinical guide: low-dose vaginal estrogens for postmenopausal vaginal atrophy. Maturitas. 2012;73:171–4.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016;(8):CD001500.Google Scholar
  28. 28.
    Wysocki S, Kingsberg S, Krychman M. Management of vaginal atrophy: implications from the REVIVE survey. Clin Med Insights Reprod Health. 2014;8:23–30.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the vaginal health: insights, views & attitudes survey. Menopause. 2013;20:1043–8.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Fernández-Alonso AM, Alcaide Torres J, Fernández Alonso IM, Chedraui P, Pérez-López FR. Application of the 21-items vulvovaginal symptoms questionnaire in postmenopausal Spanish women. Menopause. 2017;24:1295–301.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Gracia CR, Sammel MD, Freeman EW, Liu L, Hollander L, Nelson DB. Predictors of decreased libido in women during the late reproductive years. Menopause. 2004;11:144–50.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Labrie F, Martel C, Pelletier G. Is vulvovaginal atrophy due to a lack of both estrogens and androgens? Menopause. 2017;24:452–61.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Ke Y, Bélanger A, Simard JN, Gonthier R, Martel C, Vaillancourt M, Labrie F. Concentration range of serum sex steroids in normal postmenopausal women and those with diagnosis of vulvovaginal atrophy. Menopause. 2018;25:293–300.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Davis SR, Worsley R, Miller KK, Parish SJ, Santoro N. Androgens and female sexual function and dysfunction findings from the fourth international consultation of sexual medicine. J Sex Med. 2016;13:168–78.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Shatkin-Margolis A, Pauls RN. Sexual function after prolapse repair. Curr Opin Obstet Gynecol. 2017;29:343–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Sayed Ahmed WA, Kishk EA, Farhan RI, Khamees RE. Female sexual function following different degrees of perineal tears. Int Urogynecol J. 2017;28:917–92.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Karbage SA, Santos ZM, Frota MA, de Moura HJ, Vasconcelos CT, Neto JA, Bezerra LR. Quality of life of Brazilian women with urinary incontinence and the impact on their sexual function. Eur J Obstet Gynecol Reprod Biol. 2016;201:56–60.PubMedCrossRefGoogle Scholar
  38. 38.
    Salama S, Boitrelle F, Gauquelin A, Malagrida L, Thiounn N, Desvaux P. Nature and origin of “squirting” in female sexuality. J Sex Med. 2015;12:661–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Jha S, Ammenbal M, Metwally M. Impact of incontinence surgery on sexual function: a systematic review and metaanalysis. J Sex Med. 2012;9:34–43.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Su CC, Sun BY, Jiann BP. Association of urinary incontinence and sexual function in women. Int J Urol. 2015;22:109–13.PubMedCrossRefGoogle Scholar
  41. 41.
    Hunter MM, Nakagawa S, Van Den Eeden SK, Kuppermann M, Huang AJ. Predictors of impact of vaginal symptoms in postmenopausal women. Menopause. 2016;23:40–6.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Lester RA, Protto RA, Sadownik LA. Provoked vestibulodynia and the health care implications of comorbid pain conditions. J Obstet Gynaecol Can. 2015;37:995–1005.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Krysiak R, Drosdzol-Cop A, Skrzypulec-Plinta V, Okopien B. Sexual function and depressive symptoms in young women with thyroid autoimmunity and subclinical hypothyroidism. Clin Endocrinol. 2016;84:925–31.CrossRefGoogle Scholar
  44. 44.
    Oppo A, Franceschi E, Atzeni F, Taberlet A, Mariotti S. Effects of hyperthyroidism, hypothyroidism, and thyroid autoimmunity on female sexual function. J Endocrinol Investig. 2011;34:449–53.CrossRefGoogle Scholar
  45. 45.
    Pasquali D, Maiorino MI, Renzullo A, Bellastella G, Accardo G, Esposito D, Barbato F, Esposito K. Female sexual dysfunction in women with thyroid disorders. J Endocrinol Investig. 2013;36:729–33.CrossRefGoogle Scholar
  46. 46.
    Janssen OE, Hahn S, Tan S, Benson S, Elsenbruch S. Mood and sexual function in polycystic ovary syndrome. Semin Reprod Med. 2008;26:45–52.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Benetti-Pinto CL, Ferreira SR, Antunes A Jr, Yela DA. The influence of body weight on sexual function and quality of life in women with polycystic ovary syndrome. Arch Gynecol Obstet. 2015;291:451–5.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Nasiri Amiri F, Ramezani Tehrani F, Esmailzadeh S, Tohidi M, Azizi F, Basirat Z. Sexual function in women with polycystic ovary syndrome and their hormonal and clinical correlations. Int J Impot Res. 2018;30:54–61.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Llaneza P, García-Portilla MP, Llaneza-Suárez D, Armott B, Pérez-López FR. Depressive disorders and the menopause transition. Maturitas. 2012;71:120–30.CrossRefGoogle Scholar
  50. 50.
    Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. J Sex Med. 2012;9:1497–507.CrossRefGoogle Scholar
  51. 51.
    Clayton AH, El Haddad S, Iluonakhamhe JP, Ponce Martinez C, Schuck AE. Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf. 2014;13:1361–74.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Clayton AH, Maserejian NN, Connor MK, Huang L, Heiman JR, Rosen RC. Depression in premenopausal women with HSDD: baseline findings from the HSDD registry for women. Psychosom Med. 2012;74:305–11.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Alicikus ZA, Gorken JB, Sen RC, Kentli S, Kinay M, Alanyali H, Harmancioglu O. Psychosexual and body image aspects of quality of life in Turkish breast cancer patients: a comparison of breast conserving treatment and mastectomy. Tumori. 2009;95:212–8.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Stan D, Loprinzi CL, Ruddy KJ. Breast cancer survivorship issues. Hematol Oncol Clin North Am. 2013;27:805–27.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Panjari M, Bell RJ, Davis SR. Sexual function after breast cancer. J Sex Med. 2011;8:294–302.PubMedCrossRefGoogle Scholar
  56. 56.
    Fobair P, Spiegel D. Concerns about sexuality after breast cancer. Cancer J. 2009;15:19–26.PubMedCrossRefGoogle Scholar
  57. 57.
    Montejo AL, Montejo L, Navarro-Cremades F. Sexual side-effects of antidepressant and antipsychotic drugs. Curr Opin Psychiatry. 2015;28:418–23.PubMedCrossRefGoogle Scholar
  58. 58.
    Lorenz T, Rullo J, Faubion S. Antidepressant-induced female sexual dysfunction. Mayo Clin Proc. 2016;91:1280–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Coupland C, Morriss R, Arthur A, Moore M, Hill T, Hippisley-Cox J. Safety of antidepressants in adults aged under 65: protocol for a cohort study using a large primary care database. BMC Psychiatry. 2013;13:135.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Ishak WW, Christensen S, Sayer G, Ha K, Li N, Miller J, Nguyen JM, Cohen RM. Sexual satisfaction and quality of life in major depressive disorder before and after treatment with citalopram in the STAR∗D study. J Clin Psychiatry. 2013;74:256–61.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Doumas M, Tsiodras S, Tsakiris A, Douma S, Chounta A, Papadopoulos A, Kanellakopoulou K, Giamarellou H. Female sexual dysfunction in essential hypertension: a common problem being uncovered. J Hypertens. 2006;24:2387–92.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Spatz ES, Canavan ME, Desai MM, Krumholz HM, Lindau ST. Sexual activity and function among middle-aged and older men and women with hypertension. J Hypertens. 2013;31:1096–105.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Thomas HN, Evans GW, Berlowitz DR, Chertow GM, Conroy MB, Foy CG, Glasser SP, Lewis CE, Riley WT, Russell L, Williams O, Hess R, SPRINT Study Group. Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT). J Hypertens. 2016;34:1224–31.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Bitzer J, Platano G, Tschudin S, Alder J. Sexual counseling in elderly couples. J Sex Med. 2008;5:2027–43.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Educ Ther. 1976;2:1–15.CrossRefGoogle Scholar
  66. 66.
    Herbenick D, Fu T-C, Arter J, Sanders SA, Dodge B. Women’s experiences with genital touching, sexual pleasure, and orgasm: results from a U.S. probability sample of women ages 18 to 94. J Sex Marital Ther. 2018;44:201–12.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Steinke EE. Sexuality and chronic illness. J Gerontol Nurs. 2013;39:18–27.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Steinke E, Jaarsma T. Sexual counseling and cardiovascular disease: practical approaches. Asian J Androl. 2015;17:32.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Sarwer DB, Durlak JA. A field trial of the effectiveness of behavioral treatment for sexual dysfunctions. J Sex Marital Ther. 1997;23:87–97.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. 2013;42:915–33.PubMedCrossRefGoogle Scholar
  71. 71.
    Bouman WP. Principles and practice of sex therapy. Sex Relation Ther. 2008;23:95–101.CrossRefGoogle Scholar
  72. 72.
    Kim H-K, Kang S-Y, Chung Y-J, Kim J-H, Kim M-R. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015;21:65.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014;21:1063–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Farrell AE. Genitourinary syndrome of menopause. Aust Fam Physician. 2017;46:481–4.Google Scholar
  75. 75.
    Vieira-Baptista P, Marchitelli C, Haefner HK, Donders G, Pérez-López F. Deconstructing the genitourinary syndrome of menopause. Int Urogynecol J. 2017;28:675–9.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Labrie F, Archer DF, Martel C, Vaillancourt M, Montesino M. Combined data of intravaginal prasterone against vulvovaginal atrophy of menopause. Menopause. 2017;24:1246–56.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Constantine G, Graham S, Portman DJ, Rosen RC, Kingsberg SA. Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial. Climacteric. 2015;18:226–32.CrossRefGoogle Scholar
  78. 78.
    Lowenstein L, Gamble T, Sanses TV, van Raalte H, Carberry C, Jakus S, Kambiss S, McAchran S, Pham T, Aschkenazi S, Hoskey K, Kenton K, Fellow’s Pelvic Research Network. Sexual function is related to body image perception in women with pelvic organ prolapse. J Sex Med. 2009;6:2286–91.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Yount SM. The impact of pelvic floor disorders and pelvic surgery on women’s sexual satisfaction and function. J Midwifery Womens Health. 2013;58:538–45.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Uçar MG, İlhan TT, Şanlıkan F, Çelik Ç. Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study. Eur J Obstet Gynecol Reprod Biol. 2016;206:1–5.PubMedCrossRefGoogle Scholar
  81. 81.
    Barski D, Otto T, Gerullis H. Systematic review and classification of complications after anterior, posterior, apical, and total vaginal mesh implantation for prolapse repair. Surg Technol Int. 2014;24:217–24.PubMedGoogle Scholar
  82. 82.
    Mota RL. Female urinary incontinence and sexuality. Int Braz J Urol. 2017;43:20–8.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Lee UJ, Kerkhof MH, van Leijsen SA, Heesakkers JP. Obesity and pelvic organ prolapse. Curr Opin Urol. 2017;27:428–34.PubMedCrossRefGoogle Scholar
  84. 84.
    Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762–74.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    North American Menopause Society. The role of testosterone therapy in postmenopausal women: position statement of the North American Menopause Society. Menopause. 2005;12:497–511.CrossRefGoogle Scholar
  86. 86.
    Bhasin S, Enzlin P, Coviello A, Basson R. Sexual dysfunction in men and women with endocrine disorders. Lancet (London, England). 2007;369:597–611.CrossRefGoogle Scholar
  87. 87.
    Basson R. Review: testosterone therapy for reduced libido in women. Ther Adv Endocrinol Metab. 2010;1:155–64.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Gass ML, Cochrane BB, Larson JC, Manson JE, Barnabei VM, Brzyski RG, Lane DS, LaValleur J, Ockene JK, Mouton CP, Barad DH. Patterns and predictors of sexual activity among women in the hormone therapy trials of the Women’s Health Initiative. Menopause. 2011;18:1160–71.PubMedCrossRefGoogle Scholar
  89. 89.
    Shufelt CL, Braunstein GD. Safety of testosterone use in women. Maturitas. 2009;63:63–6.PubMedCrossRefGoogle Scholar
  90. 90.
    Davis SR, Braunstein GD. Efficacy and safety of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. J Sex Med. 2012;9:1134–48.PubMedCrossRefGoogle Scholar
  91. 91.
    NICE guideline [NG23]. Menopause: diagnosis and management. 2015. Accessed 12 Aug 2018.
  92. 92.
    Davis SR, Panjari M, Stanczyk FZ. Clinical review: DHEA replacement for postmenopausal women. J Clin Endocrinol Metab. 2011;96:1642–53.PubMedCrossRefGoogle Scholar
  93. 93.
    Scheffers CS, Armstrong S, Cantineau AE, Farquhar C, Jordan V. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev. 2015;(1):CD011066.Google Scholar
  94. 94.
    Wu MH, Pan HA, Wang ST, Hsu CC, Chang FM, Huang KE. Quality of life and sexuality changes in postmenopausal women receiving tibolone therapy. Climacteric. 2001;4:314–9.PubMedCrossRefGoogle Scholar
  95. 95.
    Nijland EA, Weijmar Schultz WC, Nathorst-Boös J, Helmond FA, Van Lunsen RH, Palacios S, Norman RJ, Mulder RJ, Davis SR, LISA Study Investigators. Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women: results of a randomized active-controlled trial. J Sex Med. 2008;5:646–56.PubMedCrossRefGoogle Scholar
  96. 96.
    Biglia N, Maffei S, Lello S, Nappi RE. Tibolone in postmenopausal women: a review based on recent randomised controlled clinical trials. Gynecol Endocrinol. 2010;26:804–14.PubMedCrossRefGoogle Scholar
  97. 97.
    Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R, Côté I, Labrie C, Lavoie L, Berger L, Gilbert L, Martel C, Balser J. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause. 2009;16:923–31.PubMedCrossRefGoogle Scholar
  98. 98.
    Joffe HV, Chang C, Sewell C, Easley O, Nguyen C, Dunn S, Lehrfeld K, Lee L, Kim MJ, Slagle AF, Beitz J. FDA approval of flibanserin—treating hypoactive sexual desire disorder. N Engl J Med. 2016;374:101–4.PubMedCrossRefGoogle Scholar
  99. 99.
    Simon JA, Kingsberg SA, Shumel B, Hanes V, Garcia M Jr, Sand M. Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial. Menopause. 2014;21:633–40.PubMedCrossRefGoogle Scholar
  100. 100.
    Portman DJ, Brown L, Yuan J, Kissling R, Kingsberg SA. Flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the PLUMERIA study. J Sex Med. 2017;14:834–42.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med. 2016;176:453–62.PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Safarinejad MR, Hosseini SY, Asgari MA, Dadkhah F, Taghva A. A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women. BJU Int. 2010;106:832–9.PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    Clayton AH, Althof SE, Kingsberg S, DeRogatis LR, Kroll R, Goldstein I, Kaminetsky J, Spana C, Lucas J, Jordan R, Portman DJ. Bremelanotide for female sexual dysfunctions in premenopausal women: a randomized, placebo-controlled dose-finding trial. Womens Health (London). 2016;12:325–37.CrossRefGoogle Scholar
  104. 104.
    Akhtari E, Raisi F, Keshavarz M, Hosseini H, Sohrabvand F, Bioos S, Kamalinejad M, Ghobadi A. Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo—controlled study. Daru. 2014;22:40.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Steels E, Steele ML, Harold M, Coulson S. Efficacy of a proprietary Trigonella foenum-graecum L. de-husked seed extract in reducing menopausal symptoms in otherwise healthy women: a double-blind, randomized, placebo-controlled study. Phytother Res. 2017;31:1316–22.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    LoPiccolo J, Lobitz WC. The role of masturbation in the treatment of orgasmic dysfunction. Arch Sex Behav. 1972;2:163–71.PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Andersen BL. A comparison of systematic desensitization and directed masturbation in the treatment of primary orgasmic dysfunction in females. J Consult Clin Psychol. 1981;49:568–70.PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Eichel EW, Eichel JD, Kule S. The technique of coital alignment and its relation to female orgasmic response and simultaneous orgasm. J Sex Marital Ther. 1988;14:129–41.PubMedCrossRefPubMedCentralGoogle Scholar
  109. 109.
    Hurlbert DF, Apt C. The coital alignment technique and directed masturbation: a comparative study on female orgasm. J Sex Marital Ther. 1995;21:21–9.PubMedCrossRefPubMedCentralGoogle Scholar
  110. 110.
    Marcus BS. Changes in a woman’s sexual experience and expectations following the introduction of electric vibrator assistance. J Sex Med. 2011;8:3398–406.PubMedCrossRefGoogle Scholar
  111. 111.
    Herbenick D, Barnhart KJ, Beavers K, Benge S. Vibrators and other sex toys are commonly recommended to patients, but does size matter? Dimensions of commonly sold products. J Sex Med. 2015;12:641–5.PubMedCrossRefGoogle Scholar
  112. 112.
    Chivers ML, Rosen RC. Phosphodiesterase type 5 inhibitors and female sexual response: faulty protocols or paradigms? J Sex Med. 2010;7:858–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ana M. Fernández-Alonso
    • 1
  • Marcos J. Cuerva
    • 2
  • Peter Chedraui
    • 3
  • Faustino R. Pérez-López
    • 4
  1. 1.Department of Obstetrics and GynecologyHospital TorrecárdenasAlmeríaSpain
  2. 2.Department of Obstetrics and GynecologyHospital Universitario La PazMadridSpain
  3. 3.Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias MédicasUniversidad Católica de Santiago de GuayaquilGuayaquilEcuador
  4. 4.Department of Obstetrics and GynecologyUniversity of Zaragoza Facultad de MedicinaZaragozaSpain

Personalised recommendations