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Health condition

Female sexual dysfunction, common, treatable and worth talking about.

Up to 40 per cent of women experience sexual difficulties in their lifetime. With a sensitive assessment and the right combination of treatment, most improve.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE, BSSM, IMS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including local vaginal oestrogen, DHEA, testosterone off-label and psychosexual pathways.

Key facts

Female sexual dysfunction at a glance.

The essentials, in plain English - what it covers, how common it is and the modern UK approach to treatment.

  • What it is

    A cluster of conditions covering desire, arousal, orgasm and pain that cause distress and affect quality of life.

  • How common

    Up to 40 per cent of women experience sexual difficulties at some point in their lifetime.

  • Most common form

    Female sexual interest and arousal disorder (FSIAD) combining reduced desire and arousal.

  • DSM-5-TR categories

    FSIAD, female orgasmic disorder, genito-pelvic pain and penetration disorder, and substance or medication-induced.

  • Biopsychosocial model

    Almost always multifactorial - biological, psychological, interpersonal and cultural factors interact.

  • Treatable

    From local vaginal oestrogen and pelvic floor physiotherapy to psychosexual therapy - options work best in combination.

Why this guide matters

A biopsychosocial map, not a single fix.

Sexual difficulties almost always sit at the intersection of biology, psychology, relationship and context. Good care addresses each layer.

  • Biology matters

    Hormones, medications, chronic disease and gynaecological conditions such as endometriosis and prolapse drive many symptoms - and are treatable.

  • Psychology matters

    Anxiety, depression, trauma, body image and self-esteem shape desire, arousal and orgasm - psychosexual therapy is an evidence-based option.

  • Relationship and context matter

    Communication, partner health and cultural expectations all influence outcomes - couple work is often part of the plan.

How the assessment is done

From first conversation to a clear plan.

The steps a UK GP, psychosexual medicine or menopause specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Sensitive, trauma-informed history

    Private consultation exploring desire, arousal, orgasm, pain, context, relationship and distress - at the patient's pace.

  2. 02

    Assessing

    Validated questionnaires

    Tools such as the Female Sexual Function Index (FSFI) and BISHOP score help quantify symptoms and track change.

  3. 03

    Assessing

    Medication and medical review

    SSRIs, antipsychotics, antihypertensives and hormonal contraception can all contribute - a careful review often opens options.

  4. 04

    Confirming

    Focused examination

    PV bimanual and speculum looking for vaginal atrophy, prolapse, dermatological changes and pelvic floor trigger points.

  5. 05

    Confirming

    Targeted blood tests

    FSH, LH, oestradiol, testosterone, SHBG, prolactin, TFTs, fasting glucose and lipids where clinically indicated.

  6. 06

    Planning

    Specialist referral

    Psychosexual medicine, menopause, gynaecology or urogynaecology depending on the pattern - often more than one.

  7. 07

    Planning

    MDT plan

    The best outcomes combine medical treatment of underlying causes with pelvic floor and psychosexual input.

Typical timeline: a first sensitive consultation to a settled MDT plan in a few weeks.

Symptoms

What female sexual dysfunction looks like.

The DSM-5-TR groups symptoms into desire and arousal, orgasm and genito-pelvic pain and penetration - with distress as the shared thread.

  • Reduced desire

    Loss of interest in sexual activity, thoughts or fantasies - the core feature of FSIAD.

  • Arousal difficulties

    Reduced genital or subjective arousal despite adequate stimulation - often overlapping with desire changes.

  • Orgasmic dysfunction

    Delayed, reduced intensity or absent orgasm - primary lifelong or acquired.

  • Dyspareunia

    Pain during or after intercourse - superficial or deep. See our guide to dyspareunia for detail.

  • Vaginismus

    Involuntary pelvic floor muscle spasm making penetration painful or impossible, often with fear and anticipatory anxiety.

  • Vulvovaginal atrophy

    Dryness, burning and dyspareunia driven by oestrogen deficiency - very treatable with local therapy.

  • Distress and relationship impact

    The defining feature - symptoms only meet criteria for a disorder when they cause distress.

  • Red flag - trauma disclosure

    History of sexual trauma or ongoing coercion needs a safe, trauma-informed pathway before any physical treatment.

Treatment

How female sexual dysfunction is treated in the UK.

Treat the underlying cause, layer in psychosexual therapy and pelvic floor work, and use hormonal or specialist options where they fit.

  • Lifestyle and communication

    Stress reduction, sleep, exercise, alcohol moderation and open partner communication - the foundation of every plan.

  • Local vaginal oestrogen

    Creams, pessaries or rings for vulvovaginal atrophy - safe, effective and often first-line in the peri- and post-menopause.

  • Systemic HRT

    Where broader menopausal symptoms drive desire and arousal loss - see our HRT clinic guide.

  • Vaginal DHEA (prasterone)

    Intrarosa - a nightly vaginal pessary for moderate-to-severe atrophy. Specialist-initiated.

  • Ospemifene

    A selective oestrogen receptor modulator (SERM) for vulvovaginal atrophy where local oestrogen is unsuitable - specialist care.

  • Testosterone off-label

    Compounded cream or transdermal gel for post-menopausal hypoactive sexual desire disorder - menopause-specialist-led.

  • Psychosexual therapy

    CBT, sensate focus and couple therapy delivered by COSRT-registered psychosexual therapists. See our psychosexual therapy clinic.

  • Pelvic floor physiotherapy

    For hypertonic pelvic floor, vaginismus and dyspareunia - dilator programmes, biofeedback and manual therapy.

  • Botulinum toxin (specialist)

    For refractory vaginismus and severe hypertonic pelvic floor - a specialist option after physiotherapy.

  • Lubricants and moisturisers

    Water-based and silicone lubricants for intercourse, plus longer-acting moisturisers (Replens, hyaluronic acid) for daily comfort.

  • Medication switch

    Reviewing SSRIs, antipsychotics and hormonal contraception - a switch or dose change can restore desire and orgasm.

  • MDT specialist input

    Gynaecology, menopause, urogynaecology and psychosexual medicine working together for complex or refractory cases.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, gynaecologist or menopause specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • British Society for Sexual Medicine (BSSM). Guidelines on female sexual dysfunction.

  • International Society for the Study of Women's Sexual Health (ISSWSH). Consensus statements.

  • NICE. Menopause: identification and management (NG23) and related guidance.

  • DSM-5-TR. Sexual dysfunctions classification.

  • British Menopause Society (BMS) and International Menopause Society (IMS) position statements on testosterone use in women.

  • College of Sexual and Relationship Therapists (COSRT). Standards for psychosexual therapy.

Red flags

When sexual difficulties need urgent attention.

Most sexual difficulties are manageable in primary care and specialist outpatient clinics. These are the situations that need faster action.

  • Sudden severe pelvic pain

    New severe pelvic pain, bleeding on intercourse or post-coital bleeding needs urgent gynaecological assessment.

  • Post-menopausal bleeding

    Any bleeding after the menopause is a red flag - two-week wait referral to exclude endometrial pathology.

  • Disclosure of sexual trauma or abuse

    Requires a safe, trauma-informed pathway and, where relevant, safeguarding - before any physical intervention.

  • Ongoing coercion or intimate partner violence

    Safety comes first - specialist services and safeguarding routes take priority over sexual medicine.

  • Suspicious vulval lesion

    Persistent ulcer, lump or white patch that is not resolving needs vulval-clinic assessment to exclude VIN or vulval cancer.

  • Suspected hyperandrogenism

    Rapid virilisation, hirsutism or voice change needs urgent endocrine assessment.

  • Severe distress or self-harm

    Low mood, suicidal thoughts or self-harm around sexual difficulties need urgent GP or crisis mental-health support.

  • Refractory vaginismus

    Failure of physiotherapy and psychosexual therapy warrants specialist review and consideration of botulinum toxin.

  • Neurological red flags

    New saddle anaesthesia, urinary or faecal incontinence with sexual dysfunction can indicate cauda equina - emergency referral.

Living with it

A treatable condition, with layered options.

Four things that make the biggest difference day to day - honest conversation, patience with treatment, everyday comfort and asking for specialist help when you need it.

A quiet reminder

You do not have to accept ongoing distress.

Sexual health is health. A good clinician will hear you, take the time and offer real options.

  1. 01 Together

    Talk before you treat

    Sexual difficulties rarely sit only in one partner - open, blame-free conversation is the first move.

  2. 02 Patience

    Give treatment 8 to 12 weeks

    Local vaginal oestrogen, physiotherapy and psychosexual work all take weeks - judge progress in months, not days.

  3. 03 Comfort

    Lubricants and moisturisers

    A good silicone lubricant for sex and a daily moisturiser for comfort can transform quality of life while other treatments take hold.

  4. 04 Escalate

    Ask for specialist help early

    You do not have to accept ongoing pain, distress or loss of desire - a psychosexual and menopause opinion is worth asking for.

Frequently asked

Everything we get asked about female sexual dysfunction.

Quick answers on desire, arousal, orgasm, pain and the treatments that help.

  • What is female sexual dysfunction?

    An umbrella term for problems with desire, arousal, orgasm or genito-pelvic pain and penetration that cause personal distress or affect a relationship. The DSM-5-TR recognises four main groups, and almost all cases are multifactorial - biological, psychological, interpersonal and cultural factors combining.

  • How common is it?

    Very common - up to 40 per cent of women report sexual difficulties at some point, with peaks around the perinatal period and the menopause. Not all difficulties meet criteria for a disorder - distress is the defining feature.

  • Is loss of desire in the menopause treatable?

    Yes. Local vaginal oestrogen treats atrophy and dyspareunia effectively. Systemic HRT can help where broader menopause symptoms drive the picture, and testosterone off-label is used by menopause specialists for post-menopausal hypoactive sexual desire disorder when standard treatment is not enough.

  • Can SSRIs cause sexual side effects?

    Yes - SSRIs are a common cause of reduced desire, delayed orgasm and anorgasmia. A medication review with your GP or psychiatrist may open options: a dose change, a drug holiday or a switch to a different antidepressant with fewer sexual side effects.

  • What is vaginismus and how is it treated?

    Involuntary tightening of the pelvic floor muscles making penetration painful or impossible, usually with fear and anticipation. Treatment combines pelvic floor physiotherapy with dilators, psychosexual therapy - CBT and sensate focus - and, in refractory cases, specialist botulinum toxin.

  • Is testosterone available on the NHS?

    Testosterone for female sexual dysfunction is prescribed off-label in the UK and typically initiated by a menopause specialist. Availability varies by NHS area - private menopause clinics can offer it where the criteria are met.

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