These results are supportive of the growing evidence against a simple model of midlife sexuality that depicts women as victims of their bodily and hormonal changes. Instead, life stressors, contextual factors, past sexuality, and mental health problems are more significant predictors of midlife women's sexual interest than menopause status itself. Evaluation and treatment approaches require consideration of the full range of contextual factors, including relationship quality, personality factors, past experience, and mental and physical health.

Lack of sexual interest is highly prevalent in the general female population and, for more than two decades, low sexual desire has been the most common presenting problem in clinical institutions. The renewed interest in female sexual dysfunction has recently focused on biological and classification aspects whilst personality- and partner-related factors, as well as theoretical concepts, have largely been neglected. After critically reviewing the current diagnostic systems for female desire disorders, this paper specifically addresses the issues of personality and life history factors. In two empirical studies, 50 patients with low sexual desire were compared to a group of 100 sexually functional women by employing both semi-structured clinical interviews and a set of self-developed and standardised questionnaires. The results of these studies indicate that women seeking help for desire disorders exhibit marked signs of mood instability and a low and fragile self-regulation and self-esteem. In addition, they tend to be more worried, anxious, introverted and conventional when compared to sexually functional women. Interestingly, no significant differences in the variables relating to partnership quality in general could be detected. Although caution is needed due to sample size and methodological limitations, our results suggest a substantial level of at least subclinical psychiatric symptoms like mood-disorders, low self-esteem and feelings of guilt in women with sexual desire disorders. These problems seem to be rather deep-rooted and particularly affect the self-regulation and the inner balance of the personality. Overall, female sexual dysfunctions and low desire, in particular, cannot be conceptualised as discrete phase disorders, but rather as a global inhibition of sexual response together with a history of mood disorder, specific personality factors and an elevated level of psychological stress. This combination calls for broad-band treatment approaches where individual and interpersonal aspects can be taken into account simultaneously. In addition, the ubiquitous comorbidity, both with other sexual dysfunctions and with various personality and psychological problems, and the developmental sequence of the sexual problems must be adequately considered.

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Reported sensations during sexual arousal and panic attacks were compared in women with panic disorder and in controls. Hypotheses: patients with panic disorders report:(1) similar sensations during sexual arousal and panic attacks, but (2) these sensations do not trigger panic during sexual activity, because (3) there is no sense of loss of control in sexual arousal. Thirty women with panic syndrome and 27 age-matched controls were included in this study. The two groups were compared using a self-developed questionnaire. The results do show a significant overlap of reported sensations (80% of sexual sensations identical with panic sensations), but with a different subjective perception for many women. Unexpectedly, most reported sensations during sex (masturbation and partner activity) were experienced as unpleasant. Contrary to our hypothesis, 30% of our sample did panic during sexual activity, 50% experienced a loss of control and 70% of the sample did not panic during sex, in spite of overlapping sensations. These results provide incentives for further studies on this topic.

Female sexuality is determined to a far greater extent by the woman's emotional receptiveness to sexual feelings than by her physiological reactions. Concerning sexual symptoms, female patients suffer much more from a lack of sexual desire and from a deficit in sexually stimulating feelings and sexual pleasure than from insufficient genital functions. The following sexual symptoms are presented: sexual arousal disorders, orgasm disorders, vaginismus, dyspareunia, sexual desire disorders, sexual aversion/sexual phobia. Sex consultation and sex therapy are recommended as preferential treatment options.