Female Sexual Desire, Arousal, and Orgasmic Dysfunctions: A Systematic Review and Meta-Analysis of Treatment Options.
Toledo. Rafaela Germano RG; Winkelman. William D WD; Reyes-Gonzalez. Daniela D; Bergeron. Sophie S; Fladger. Anne A; Hacker. Michele R MR; Anand. Mallika M
Key Findings
- Mindfulness‑based CBT improves overall sexual function and the desire, arousal, and orgasm sub‑scores.
- Flibanserin improves total sexual function scores and specifically boosts desire.
- Bremelanotide (pt‑141) improves total sexual function scores and boosts desire and arousal, but not orgasm.
- All three treatments reduce sexual distress.
- No head‑to‑head trials comparing CBT to drug treatments were found.
Practical Outcomes
- For self‑experimenters interested in enhancing sexual desire and arousal, bremelanotide appears to be an effective option, though it may not help with orgasm. It can be considered alongside non‑pharmacologic approaches like mindfulness CBT. Since dosage and safety details aren’t covered in this review, users should seek additional clinical data before trying it.
Summary
A big review looked at how to treat women who have trouble with sexual desire, arousal, or orgasm (but no pain). It found that a talk‑therapy called mindfulness CBT helps all three areas, a pill called flibanserin helps desire, and the peptide bremelanotide (pt‑141) helps desire and arousal. All three also lower sexual distress, but the studies didn’t compare the therapies directly.
Abstract
To conduct a systematic review and meta-analysis of treatments for female sexual desire, arousal, and orgasmic dysfunction in patients without sexual pain conditions. MEDLINE, Embase, Web of Science, Cochrane Library, PsycINFO, and ClinicalTrials.gov. Following the initial search in December 2024, a total of 8994 abstracts were screened, 278 full-text articles were reviewed, and 36 studies met criteria for data abstraction including a patient population with female sexual dysfunction (FSD) of desire, arousal, and/or orgasm (DAO) and outcome measures including the Female Sexual Function Index (FSFI), its DAO subscales, and the Female Sexual Distress Scale (FSDS). Studies including patients with sexual pain conditions were excluded. Two reviewers independently conducted each phase. Of the 36 studies, 26 were RCTs and 10 were single-arm trials. Ten studies evaluated cognitive behavioral therapy (CBT), 24 investigated medication therapy, and 2 investigated devices. Meta-analyses were conducted for mindfulness-based CBT, flibanserin, and bremelanotide. Mindfulness-based CBT significantly improved total FSFI and subscales of desire, arousal, and orgasm. Conversely, flibanserin improved total FSFI and desire while bremelanotide improved total FSFI and its desire and arousal subscales. No studies directly compared CBT to pharmacotherapy. In this systematic review of treatments of females with sexual DAO dysfunctions without pain, we found that CBT improves DAO; flibanserin improves desire; and bremelanotide improves both desire and arousal; and all 3 treatments reduce distress. Our findings align with previous literature and expand upon it to include multiple treatment modalities. This broader perspective offers a starting point for clinicians, including gynecologists, who frequently serve as the first point of care for FSD. Conclusions regarding most other treatments could not be drawn due to limited numbers of studies of FSD excluding pain, heterogeneous terminology for DAO disorders, and varying outcome measures across studies.
Study Information
pubmed
2025
2025-06-19T00:00:00.000Z
10.1016/j.jmig.2025.06.004
1
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