Female Sexual Dysfunction: Current Models and Treatment Options

Narrative review from Duke maps all 4 DSM-5 subtypes of female sexual dysfunction and finds evidence for multiple treatments—but measurement tools remain unstandardized

Journal: Obstetrical & Gynecological Survey | Published: 2026-05-07 | Type: Narrative Review | PMID: 42096620 Authors: Peek EEH (Medical Student), Kelly M, Kuller JA, Dotters-Katz S, Howell JO — all Duke University School of Medicine, Department of OB/GYN Funding/COI: Not listed for either

Summary

This narrative review from Duke's OB/GYN department maps the current landscape of female sexual dysfunction (FSD), covering etiology, vulnerable populations, and treatment options across all four DSM-5-defined subtypes: sexual pain disorder, sexual interest/arousal disorder, orgasmic disorder, and medication/substance-induced sexual dysfunction. The authors conclude that evidence supports multiple treatment approaches—pharmacological, behavioral, and physical therapy—but that the field is hampered by inconsistent outcome measurement tools. Populations including transgender women and lesbian women are flagged as critically understudied.

Claims

• Female sexual dysfunction is defined by four distinct DSM-5 diagnoses, not a single condition
• Evidence exists for pharmacological and non-pharmacological (behavioral and physical therapy) interventions specific to each subtype
• The last several decades have produced "a multitude of randomized clinical trials" across subtypes
• Measurement standardization is a persistent weakness—tools to assess sexual desire, satisfaction, and orgasm attainment vary widely across studies
• Data on FSD in transgender women and lesbian women are largely absent from the literature
• Optimal treatment requires a multidisciplinary team: partner, therapist, psychiatrist, physical therapist, and potentially pharmacological intervention

Study Quality

This is a PubMed keyword-search narrative review, the lowest tier of evidence synthesis. There is no PRISMA flow chart, no pre-registered protocol, no systematic inclusion/exclusion criteria, and no formal quality assessment of cited studies. The abstract provides no specific effect sizes, sample sizes from cited trials, or quantitative synthesis of any kind—readers have no way to evaluate the strength of the "evidence for multiple treatment options" claim without reading the full paper.

The lead author is listed as a medical student, with faculty co-authors from Duke OB/GYN. That's a reasonable training exercise, but the expertise weighting matters for a review of this scope. No funding or COI disclosures are provided, which is a transparency gap regardless of whether conflicts exist.

Red Flags

• Narrative review design: susceptible to selective citation and author-guided framing
• No PRISMA or equivalent methodology reported; search strategy is "relevant keywords" plus "pertinent citations from original research"—circular and vague
• Zero specific numbers in the abstract: no effect sizes, no sample sizes, no p-values
• Funding and COI both unlisted—unusual for a journal of this caliber
• Acknowledges lack of data on transgender and lesbian women but makes no structural recommendations for fixing it
• Conclusion that treatment "should include a team-based approach" approaches prescriptive territory with no comparative efficacy data cited

Strengths

• Organized by DSM-5 diagnostic subtypes, providing clinical structure that aids cross-referencing
• Explicitly acknowledges gaps in the literature rather than papering over them
• Covers both pharmacological and non-pharmacological options, not just pill-focused management
• Published in a peer-reviewed specialty journal with broad OB/GYN readership—field visibility value

Verdict

This review will be useful as an orientation map for clinicians new to FSD, but it contributes no new evidence and its methodology is too loosely described to function as a reliable evidence synthesis. The honest acknowledgment of measurement inconsistency and population gaps is genuinely useful framing—those are real structural problems in the field—but a narrative review written by a medical student and faculty without disclosed funding is not the paper to resolve them. Worth a skim for the DSM-5 organizational framework; not a source to cite for treatment efficacy claims.