Women's sexual dysfunctions correlate most strongly with poor mental health and with negative feelings for the partner, rather than with any serum hormone (or hormone metabolite) levels.
Normal changes with age and relationship duration must not be mistaken for desire/interest disorder. Desire disorder is diagnosed when there is a lack of anticipatory sexual desire, and desire (along with pleasure, arousal, and excitement) cannot be triggered during sexual activity and results in distress.
The most common syndrome is lack of initial desire, little subjective arousal (mental sexual excitement) such that desire is not triggered during any portion of the sexual engagement, and infrequent or no orgasm.
Given the sensitive nature of the information collected and reluctance or embarrassment to disclose at initial appointments, the clinician should continue to assess relevant information and integrate into treatment throughout contact with the patient.
Treatment includes components of psychoeducation, cognitive behavioral therapy (CBT), sex therapy, mindfulness and psychotherapy, and occasionally medications.