Clinical recommendation	Evidence rating	References
Bupropion (Wellbutrin) in higher dosages (150 mg twice daily) has been shown to be effective as an adjunct for antidepressant-induced sexual dysfunction in women.	B	17
Sildenafil (Viagra) may benefit women with sexual dysfunction induced by selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor use.	B	18
Female genital sexual pain disorders are complex and most effectively managed with a comprehensive, multidisciplinary approach that addresses contributing biopsychosocial factors.	C	19
Group cognitive behavior therapy has been shown to effectively treat low sexual desire.	C	7
Mindfulness-based interventions have been shown to effectively treat low sexual desire and arousal, and acquired anorgasmia.	B	7, 25, 26
Directed masturbation is recommended for lifelong anorgasmia.	A [corrected]	27–29
Local vaginal estrogen therapy is recommended and preferred over systemic estrogen therapy for treatment of genitourinary syndrome of menopause and related dyspareunia when vaginal dryness is the primary concern. Because of potential adverse effects, the use of estrogens, especially systemic estrogens, should be limited to the shortest duration compatible with treatment goals.	A	14, 21, 31
Ospemifene (Osphena) is modestly effective for treatment of dyspareunia.	B	21, 32, 33
Transdermal testosterone, with or without concomitant estrogen therapy, has been shown to be effective for short-term treatment of low sexual desire or arousal in natural and surgically induced menopause.	B	35, 36