Introduction: A committee of five was convened to update the chapter on women's sexual dysfunctions from the perspective of diagnostic issues, pathophysiology, assessment, and treatment.

Aim: To review the literature since 2003 and provide recommendations based on evidence.

Methods: Research databases, conference proceedings, and articles in press were read for relevant new data on these topics for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), female orgasmic disorder (FOD), and persistent genital arousal disorder (PGAD).

Main outcome measures: Recommendations by five experts from five countries were formulated with associated grades.

Results: The definitions of HSDD, FSAD, and FOD in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text-Revised are imperfect and have been criticized over the last decade. Proposed new criteria that take into account empirical findings and the diversity across women are recommended. There has been a flurry of new epidemiological studies on women's sexual dysfunction; studies also assessing distress consistently find a much lower prevalence of dysfunction if distress is considered. Assessment of sexual difficulties is best achieved through a biopsychosocial clinical interview of the woman and her partner (if possible); though laboratory investigations, a physical examination, psychophysiological measurement, and self-report questionnaires can often supplement the interview information. There are currently no approved pharmacological treatments for women's sexual dysfunction in North America, though a number of promising agents have been studied. Evidence for the efficacy of psychological treatments is based on limited studies. There is an urgent need for more data on the assessment, etiology, and treatment of PGAD.

Conclusions: Specific recommendations for the assessment and treatment of women's desire, arousal, and orgasm disorders are forwarded; however, more research into these domains is needed.