When is low sexual function problematic for women? A systematic review of factors associated with distress about low sexual function

Introduction While many women experience low levels of sexual desire and arousal, difficulty orgasming, or pain during intercourse, relatively few report distress about their sexual functioning. Distress about low sexual function is necessary for a sexual dysfunction to be diagnosed. However, it is not clear why some women report distress while others do not. Objectives The aim of the current study was to review systematically factors associated with distress about low sexual function among premenopausal women. Methods Six databases (CINAHL, Psychology and Behavioural Sciences Collection, PubMed, Web of Science, PsycNET, Scopus) were searched on January 1, 2025. The quality of each study was evaluated using the Mixed Methods Appraisal Tool. Results Nineteen studies met the inclusion criteria. Most samples consisted of women in a heterosexual relationship, and the majority of articles focused on sexual pain disorders. Factors associated with distress about low sexual function were grouped into four factors: sexual, psychological, relationship, and partner-related. Sexual distress was positively associated with severity of low sexual function, depressive, or anxiety symptoms, sexual dissatisfaction, poor relationship communication, low partner support, and partner’s sexual distress and dissatisfaction. Conclusion Sexual satisfaction and relational factors influence whether women experience low sexual function as problematic. However, more research is needed to investigate sexual distress among women who are not in a heterosexual relationship, and those reporting low sexual functioning in domains of sexual arousal, desire, and orgasm.