A systematic review found that mindfulness-based CBT, flibanserin, and bremelanotide all effectively treat different aspects of female sexual dysfunction, with bremelanotide improving both desire and arousal.
36 studies analyzedThe largest systematic review comparing behavioral and pharmacological treatments for female sexual desire, arousal, and orgasm dysfunction
What the researchers found
Meta-analyses showed distinct benefits for each treatment modality. Mindfulness-based CBT significantly improved total Female Sexual Function Index (FSFI) scores and subscales for desire, arousal, and orgasm. Flibanserin improved total FSFI and the desire subscale. Bremelanotide improved total FSFI along with desire and arousal subscales.
All three treatments reduced distress as measured by the Female Sexual Distress Scale. No head-to-head studies comparing CBT to pharmacotherapy were identified. Of 36 included studies, 26 were randomized controlled trials and 10 were single-arm trials.
Why it matters
Female sexual dysfunction affects a significant proportion of women but remains undertreated and under-discussed. This review provides the first comprehensive comparison across both behavioral and pharmacological treatments, giving clinicians — particularly gynecologists who are often the first point of care — evidence-based guidance for choosing among available treatment options.
How the study worked
Systematic review and meta-analysis following standard methodology. Researchers searched MEDLINE, Embase, Web of Science, Cochrane Library, PsycINFO, and ClinicalTrials.gov through December 2024. From 8,994 abstracts screened, 278 full-text articles were reviewed, and 36 studies met inclusion criteria. Two independent reviewers conducted each phase. Included studies had to assess female sexual dysfunction of desire, arousal, or orgasm using validated outcome measures (FSFI and FSDS).
What this study cannot tell us
No studies directly compared CBT to pharmacotherapy, making cross-modality comparisons indirect. Most treatments other than the three meta-analyzed had too few studies to draw conclusions. The field is hampered by heterogeneous terminology for sexual dysfunction disorders and varying outcome measures across studies. Studies including sexual pain conditions were excluded, limiting generalizability.
How to read the evidence
This is a systematic review and meta-analysis of 36 studies, including 26 randomized controlled trials — a high level of evidence. The meta-analyses for the three main treatments (CBT, flibanserin, bremelanotide) provide robust pooled estimates, though the overall evidence base for many other treatments remains limited.
When this study was published
Published in 2026 with a literature search through December 2024, this is a highly current and comprehensive review of the treatment landscape for female sexual dysfunction.
The bigger picture
This review reflects growing recognition that female sexual dysfunction requires a multi-modal treatment approach. The inclusion of bremelanotide — a synthetic melanocortin peptide — alongside behavioral therapy and traditional pharmacology highlights how peptide-based drugs are expanding treatment options in areas historically underserved by medicine. It also underscores the need for more research directly comparing these different approaches.
Questions still open
- How does bremelanotide compare directly to CBT or flibanserin in head-to-head trials for female sexual dysfunction?
- Could combining bremelanotide with mindfulness-based CBT provide additive benefits for desire and arousal?
- What are the long-term outcomes and sustained efficacy of bremelanotide for sexual dysfunction beyond clinical trial durations?
Common questions
What is bremelanotide and how does it work for sexual dysfunction?
Is therapy or medication better for female sexual dysfunction?
Read the original research
Female Sexual Desire, Arousal, and Orgasmic Dysfunctions: A Systematic Review and Meta-Analysis of Treatment Options.
Journal of minimally invasive gynecology, 33(1), 16-33.e3
Citation
Toledo, Rafaela Germano; Winkelman, William D; Reyes-Gonzalez, Daniela; Bergeron, Sophie; Fladger, Anne; Hacker, Michele R; Anand, Mallika. (2026). Female Sexual Desire, Arousal, and Orgasmic Dysfunctions: A Systematic Review and Meta-Analysis of Treatment Options.. Journal of minimally invasive gynecology, 33(1), 16-33.e3. https://doi.org/10.1016/j.jmig.2025.06.004