Managing female sexual dysfunction John E. Buster, M.D.  Fertility and Sterility  Volume 100, Issue 4, Pages 905-915 (October 2013) DOI: 10.1016/j.fertnstert.2013.08.026 Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 1 The four female sexual dysfunctions, hypoactive sexual desire disorder (HSDD), sexual arousal disorder, orgasmic disorder, and sexual pain disorder, flow into each other and outward as a continuum from HSDD. Successful resolution of HSDD frequently resolves or significantly augments resolution of the others. Resolution of any one of the others, when they are the primary complaint, also helps to resolve HSDD. This model is based on DSM-IV, which was replaced by DSM-V after May 2013. Adapted from Buster (1). Fertility and Sterility 2013 100, 905-915DOI: (10.1016/j.fertnstert.2013.08.026) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Circulating DHEAS in girls and women from birth to age 100 years. Graph is a composite of two studies. Circulating DHEAS, a direct reflection of adrenal secretion of DHEAS, begins to increase in girls aged 7–8 years. Maximum concentrations are achieved during the decades of the 20s and 30s and then there is a sustained decline until age 90. Adapted from Buster JE. Managing femal sexual dysfunction. In Lobo RA, ed., Treatment of the post menopausal woman, New York: Lippincott Williams and Wilkins, 1999. Fertility and Sterility 2013 100, 905-915DOI: (10.1016/j.fertnstert.2013.08.026) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Midcycle rise in ovarian T in a group of ovulating reproductive-age women before and after 1 month of dexamathesone suppression. Adrenal androgen suppression demonstrates the ovary as the source of midcycle T. During reproductive years, a periovulatory rise in T occurs in conjunction with the LH surge and is directly linked to increased midcycle sexual desire, which occurs during reproductive years but is lost after menopause. Adapted from Buster JE, in Lobo RA, ed., Treatment of the post menopausal woman, New York: Lippincott Williams and Wilkins, 1999. Fertility and Sterility 2013 100, 905-915DOI: (10.1016/j.fertnstert.2013.08.026) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions