Key Points

• Low sex drive is the most common sexual problem reported by women. A woman distressed by her low sexual drive has hypoactive sexual drive disorder.

• The cyclic model of sexual functioning postulates that arousal may be the initial trigger for a woman's sexual encounter, not desire.

• Ovarian androgens may play an important role in female sexual drive. Androgen levels in premenopausal women should be measured at the peak on days 8 to 10 of a 28-day menstrual cycle.

• Women may believe they have primary inhibited orgasm disorder because, unlike many men, they do not reach orgasm solely with vaginal intercourse.

• In most cases of orgasmic dysfunction, no specific physical examination or laboratory testing is necessary.

• Vaginismus is an involuntary, usually painful, spastic contraction of the pelvic musculature surrounding the outer third of the vagina and is complete, partial, or situational.

The linear model of sexual functioning classifies female sexual dysfunction as disorders of sexual interest/desire, arousal, orgasm, or pain. The cross-sectional, population-based PRESIDE study (Prevalence and Correlates of Female Sexual Disorders and Determinants of Treatment Seeking) estimated the prevalence of any female sexual problems was 44.2%, with "personal distress" reported by 22.8% of participants (Hatzichristou et al., 2004). Sexual dysfunction associated with personal distress became a disorder defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR).

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