Female Sexual Dysfunctions: A Clinical Perspective on HSDD, FAD, PGAD, and FOD

Abstract

The multidimensionality and interpersonal dimension of human sexuality make the study of female sexual dysfunction (FSD) a challenge. The aspiration to pursue a patient-centered, holistic approach collides with the need to establish commonly accepted diagnostic criteria for different disturbances in sexual functioning, involving one or multiple phases of the sexual response cycle and pain associated with sexual activity. According to recently proposed classifications, which are continuously evolving, the most relevant FSDs include hypoactive sexual desire disorder, female arousal disorder, persistent genital arousal disorder, and female orgasm disorder. The present chapter aims to provide a clinical perspective on these disorders by reviewing the most recent evidence on the pathophysiology, definitions, prevalence, leading etiologies, diagnostic tools, and key therapeutic approaches. Sexual pain-related conditions will be reviewed in another chapter.It is evident that a gender bias still exists, with prominent biological etiologies of FSDs being neglected and understudied at the expense of psychodynamic and relational determinants. Moreover, classifications should serve to advocate the advancement of our knowledge of female sexual functioning. This process goes through the practical translation of the updated nosology in a language that is intelligible to primary healthcare providers all over the world, and ultimately, to women.