The Waco Guide

Present
Present
Present
other
SSRI
Commorbidity
absent
Yes
Inadequate
response
Inadequate
response
Buspirone is
less studied, however, it
may be useful in some
circumstances
YesNo
Inadequate
response
Symptom
persistence
Present
Symptom
persistence
Consider
combination therapy
Inadequate response
Female Sexual Interest /
Arousal Disorder
Obtain full medical/sexual/
psychosocial history
History of physical/sexual/emotional abuse
and/or intimate partner violence?
Refer to appropriate
psychosocial services
and agencies available
in community
Evaluate for
gynecological etiology
Treat underlying
cause and reassess
Comorbid psychiatric
disorder present?
Substance use
disorder? See corresponding
decision support
Evaluate for non-gynecological
medical etiology
Assess for medications which
may affect sexual function
(i.e SSRI, TCA, contraceptives,
Benzodiazepines, antipsychotics)
Reassess need for
medication and transition if
Appropriate
See SSRI sexual dysfunction
decision support
Evaluate for partner
Sexual dysfunction
Is duration greater than 6 months
and causing significant distress?
Female with Sexual Interest Arousal Disorder
Assess and establish
treatment expectations and
goals
Psychotherapy:
Sexual therapy
Couples therapy
Mindfulness
Continue Psychotherapy and
Behavior modification interventions
Bupropion Buspirone
Postmenopausal?
Consider testosterone
therapy.
Consider consultation
Flibanserin
Bremelanotide
Consider topical oils
(i.e. Zestra) in addition to
Pharmacotherapy
Behavior Modification:
Lifestyle changes
Body image
Sleep hygiene
Stress reduction
Pelvic therapy
Relationship building
Sexual novelty
Trailored intervention
Based on H&P

Evaluate for history which may impact female sexual interest/arousal (Medical/Sexual/Psychosocial)