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. 2025 May 9;104(19):e42421. doi: 10.1097/MD.0000000000042421

Non-pharmacological interventions for female sexual dysfunction in low- and middle-income countries: A scoping review

Maryam Koochakzai a,b, Zahra Behboodi Moghadam b, Shahla Faal Siahkal c, Hayedeh Arbabi a, Elham Ebrahimi d,*
PMCID: PMC12074148  PMID: 40355189

Abstract

Background:

Sexual function is a multidimensional phenomenon affected by many different physical, physiological, and mental factors. Sexual dysfunction (SD) can affect the different aspects of personal and familial health. Non-pharmacological interventions for SD management have received great attention in recent years, though SD is still mostly managed using pharmacological interventions.

Methods:

In this scoping review, we searched the PubMed/Medline, Web of Science, Scopus, and Google Scholar databases to find relevant studies published between January 2014 and February 2024.

Results:

Twenty articles were included in the review. Non-pharmacological interventions such as cognitive-behavioral therapy, sexual education and counseling based on theories and models, mindfulness-based cognitive-behavioral sex therapy, phytotherapy and vaginal electrical stimulation, multimedia applications, and sexual health education programs can improve women’s sexual function.

Conclusion:

Given the effectiveness of non-pharmacological interventions and the heavy costs of pharmacological interventions, non-pharmacological interventions can be used for SD management in low- and middle-income countries.

Keywords: intervention, low- and middle-income countries, non-pharmacological, sexual dysfunction

1. Introduction

Sexual dysfunction (SD) is one of the most prevalent problems in marital life and can cause different problems for couples.[1,2] The World Health Organization defines SD as adult syndromes caused in gaining sexual satisfaction during sexual activity.[3] The American Psychiatric Association also defines SD as “a group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or experience sexual pleasure.”[4] The global prevalence of SD is 30% to 50% among all women and 45% among married women of reproductive age. Its prevalence among married women of reproductive age is also 40% in developed countries and 62% in developing countries.[5–8]

Women’s sexual function has 4 main dimensions, namely desire, arousal, orgasm, and pain.[2,7,9] Healthy sexual function has pivotal role in satisfactory marital relationships and pleasurable sexual encounters. SD in the 4 dimensions of sexual health is characterized by the reduction or absence of desire or arousal during sexual activity. Various factors can influence sexual function, including contextual factors such as culture, religion, and duration of marital life, biological factors such as hormones, health status, and medications, and psychological factors such as the history of sexual abuse and psychological disorders.[10–12]

SD has significant negative effects on interpersonal relationships, sexual comfort and satisfaction,[10–12] marital life, physical, mental, and social health,[7,13–15] quality of life,[10–12,16] and well-being.[16] A study in the United States reported that SD significantly reduced physical and emotional satisfaction and general happiness among women.[17] Another study in Turkey reported sexual health as an important component in improving quality of life and overall life satisfaction.[18] Moreover, a study in Japan showed that optimal sexual function is essential to improve sexual and physical satisfaction.[19] Therefore, employing effective interventions to manage SD and improve sexual health is essential.[7,13–15]

There are different approaches to manage female SD (FSD), including cognitive-behavioral therapy and counseling, psychotherapy, sexual-behavioral therapy, physiotherapy, and medication therapy.[20,21] Some studies recommended pharmacological interventions such as topical injection of botulinum neurotoxin, administration of anxiolytic agents, and management of muscular spasm for SD management.[22] However, these interventions are not evidence-based and further studies are necessary to confirm their effectiveness and safety.[7,23] For example, although evidence shows that botulinum neurotoxin is a safe and effective treatment option for women with SD, its mechanism and side effects are still poorly known and deserve further investigation.[24] Moreover, anxiolytic and antidepressant agents such as alprazolam, diazepam, lorazepam, and clonazepam may reduce sexual desire and orgasm.[25]

The various side effects of pharmacological interventions for SD management necessitate the use of non-pharmacological interventions. Non-pharmacological interventions such as electrical stimulation or biofeedback can improve sexual function among patients with urinary incontinence or hypertonic pelvic floor.[26–28] Educational and counseling interventions can also improve sexual function,[29] while some studies reported their ineffectiveness.[30]

In the field of sexual function disorders, it’s important to note that drug therapy alone is not sufficient, and behavioral interventions are also necessary. Women, due to reproductive hormones, may experience reduced satisfaction, pleasure, and orgasm during sexual activity. To effectively treat sexual dysfunctions, it’s crucial to understand the interplay between behavioral, psychological, and physiological processes. In developing countries, cultural factors often prevent women from seeking treatment for sexual dysfunction and adhering to medication. Limited access to certain medicines also hinders the medical treatment of this disorder in developing countries. In general, behavioral techniques can be used alone or in combination with drug therapy to effectively address this issue and produce positive results.[31,32]

Previous studies into the effects of non-pharmacological interventions had different limitations, including small sample size and unequal follow-up period and reported different results respecting the effectiveness of these interventions.[33] Moreover, to the best of our knowledge, no review study has yet reviewed the effects of non-pharmacological interventions on SD in low- and middle-income countries. This study sought to narrow these gaps. The aim of the study was to evaluate the effects of non-pharmacological interventions on FSD in low- and middle-income countries.

2. Methods

This systematic scoping review was conducted between January 2014 and February 2024. Scoping review is a precise and structured method for synthesizing and analyzing the published literature and identifying knowledge and research gaps.[34] This method has 5 stages, namely identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. In recent years, attempts have been made to improve the methodology of scoping review in the area of global health and this method has been used in the areas of neglected tropical diseases,[35] maternal health,[36] and breast screening in low- and middle-income countries.[37,38] In this study, we used a recently published guidance and method for performing systematic scoping reviews.[39] We aimed at reviewing the published studies respecting the effects of non-pharmacological interventions on FSD to assess their acceptability in low- and middle-income countries as well as to determine current research gaps and prospective research priorities. Our research question was, “Do non-pharmacological interventions improve FSD?” This review was conducted based on the guidance laid out in the PRISMA Extension for Scoping Reviews.[40]

2.1. Search strategy

We searched the PubMed/Medline, Web of Science, Scopus, and Google Scholar databases to find relevant studies published between January 2014 and February 2024. Search keywords were woman, women, cognitive-behavioral therapy, cognitive therapy, therapy, health education, education, sexual education, counseling, intervention, non-pharmacological intervention, psychological intervention, sexual function, female sexual function, sexual dysfunction, female sexual dysfunction, and randomized controlled trial (Table S1, Supplemental Digital Content, https://links.lww.com/MD/O862).

2.2. Inclusion and exclusion criteria

Inclusion criteria were a sample of women of reproductive age with SD, a design of clinical trial, a setting of low- or middle-income countries according to the World Bank reports, publication in English, non-pharmacological interventions, and no affliction of participants by chronic physical problems or history of surgeries. Studies on pregnant, postpartum, or menopausal women were not included.

2.3. Data extraction

Two of the authors (i.e., M.K. and E.E.) independently assessed the titles and the abstracts for the eligibility of the retrieved articles and then, assessed the full-texts of the potentially eligible articles. A third author (i.e., Z.B.) helped resolve any disagreement between them. Study data were extracted using a checklist with items on the first author, publication date, study population, study type, outcomes, follow-up duration, intervention duration, intervention type, Key findings, and outcome assessment instruments.

2.4. Study selection

In total, 784 articles were retrieved. The characteristics of them were entered into the EndNote software and 295 articles were omitted due to duplication. Then, the titles and the abstracts of the remaining articles were assessed and 412 articles were omitted due to irrelevance to study aim. Finally, the full-texts of 77 articles were assessed and 57 articles were excluded due to unclear data about intervention type, target population, or study type, and twenty articles were included in the study (Fig. 1).

Figure 1.

Figure 1.

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Flow chart showing the selection process.

2.5. Findings

Twenty articles published in 2014 to 2024 on non-pharmacological interventions for FSD management in low- and middle-income countries were reviewed. All studies were interventional and most of them had assessed the effects of educational interventions and some of them had assessed the effects of electrical stimulation, physical exercises, and multimedia applications. Table 1 shows their characteristics.

Table 1.

The characteristics of the reviewed studies.

First author, publication date, country Study type Study population Intervention type Intervention duration Follow-up assessment Outcome Outcome assessment instruments Key findings
Farnam F, 2014,[12] Iran RCT 60 women aged 20–52 years PLISSIT group: 6-hour personal counseling in 1–2 weeks
Sexual Health Model group: Two 3-hour group education sessions with a 1-month interval		 4 weeks 10 and 28 weeks after the intervention onset Sexual function and sexual distress (BISF-W and FSDS) The intervention significantly decreased sexual distress and significantly improved sexual composite.
Brotto LA, 2014,[41] Columbia RCT 95 women aged 19–65 years Four ninety-minute group sessions consisted of mindfulness meditation, cognitive therapy, and education 8 weeks For 6 months Sexual desire, sexual arousal, lubrication, sexual satisfaction, and overall sexual function SIDI, FSDS, FSFI, and BDI The intervention significantly improved sexual desire, sexual arousal, lubrication, sexual satisfaction, and overall sexual function
Aydin S, 2014,[42] Turkey RCT 42 women Vaginal electrical stimulation with an alternating medium-frequency (50 Hz) current for 5 seconds followed by a 5-second rest in twenty-minute weekly sessions 8 weeks 1 week after the intervention Sexual function and pelvic floor muscle strength PFM and FSFI The intervention significantly improved sexual function and all its dimensions
Behboodi-Moghadam Z, 2015,[43] Iran RCT 90 married women 4 weekly educational sessions 4 weeks 8 weeks after the intervention Sexual function FSFI and BDI The intervention significantly improved sexual function and all its dimensions
Sabbaghan M, 2017,[30] Iran RCT 124 Iranian women One-hour weekly educational sessions for 3 weeks 3 weeks For 4 weeks after the intervention Sexual function and genital self-image FSFI and Genital Self-image Scale The intervention had no significant effect on genital self-image and sexual function.
Babakhani N, 2018,[29] Iran RCT 198 women aged 15–45 years Four two-hour sessions of group cognitive-behavioral therapy 4 weeks 4 weeks after the intervention Sexual function FSFI The intervention improved all dimensions of sexual function.
Sabeti F, 2018,[44] Iran RCT 130 women Two ninety-minute educational focus group discussions 2 weeks For 3 months after the intervention Sexual function FSFI Sexual health education significantly improved sexual function
Alimohammadi L, 2018,[45] Iran RCT 96 newly married women aged 20–35 years Six 1.5-hour weekly group counseling sessions based on Bandura’s self-efficacy theory 6 weeks 8 weeks after the intervention Sexual function and sexual satisfaction FSFI and SSQ The intervention significantly improved sexual function but had no significant effect on sexual satisfaction.
Mohammadzadeh-Moghaddam M, 2019,[46] Iran RCT 61 married women One group and 3 personal weekly counseling sessions based on the PLISSIT model 4 weeks 4 weeks Sexual function and sexual satisfaction FSFI, Sexual Dysfunctional Beliefs Questionnaire, and Hudson’s Index of Sexual Satisfaction The intervention corrected sexual dysfunctional beliefs.
Marvi N, 2019,[47] Iran RCT 108 women with infertility Three 1.5-hour weekly sexual education sessions 1 week For 1 month after the intervention Sexual function FSFI The intervention had significant positive effect on sexual function.
Sahraeian M, 2019,[48] Iran RCT 52 women with infertility aged 20–45 years Six weekly sessions of sexual counseling based on cognitive-behavioral therapy 6 weeks For 4 weeks after the intervention Sexual function FSFI The intervention had significant positive effect on sexual function.
Mirzaee F, 2020,[49] Iran RCT 70 women aged above 25 years Psycho-educational and cognitive-behavioral counseling in 8 biweekly sessions 4 weeks 4 weeks Sexual function FSFI The intervention significantly improved sexual function.
Aalaie B, 2020,[50] Iran RCT 22 women Electrical stimulation (one group) and biofeedback (one group) in 100-minute sessions held biweekly in 6 consecutive weeks followed by fifteen-minute thrice-weekly sessions of Kegel exercise for 6 weeks 12 weeks For 2–3 months after the intervention Sexual function FSFI Biofeedback was more effective than electrical stimulation in improving sexual function.
Rezaei N, 2021,[51] Iran RCT 103 women Four weekly sexual health education sessions in 8–10-person groups 4 weeks For 4 weeks after the intervention Sexual female attitude, sexual function Sexual Female Attitude Questionnaire and FSFI The intervention had significant positive effect on sexual attitude and function.
Rashedi S, 2022,[52] Iran RCT 70 women of reproductive age Four 1.5–2-hour weekly sessions of sexual education, mindfulness-based exercises, and cognitive-behavioral therapy 4 weeks 4 and 12 weeks after the intervention Sexual desire, sexual distress, sexual self-disclosure, and sexual function HISD, FSDS-R, SSD, and FSFI The intervention had significant positive effect on sexual desire, sexual distress, sexual self-disclosure, and sexual function
Karami Z, 2023,[53] Iran RCT 80 women aged 18–30 years An intervention based on the REDI model in four 1–1.5-hour weekly sessions 4 weeks 4 weeks after the intervention Sexual knowledge, attitude, and function SKAS and FSFI The intervention significantly improved sexual knowledge, attitude, and function.
Yekefallah L, 2023,[54] Iran RCT 60 married women and men A multimedia package to promote sexual indices sent through the virtual network 1 month 1 month after the intervention Sexual desire, sexual function, and sexual satisfaction LSSQ, HISD, IIEF, and FSFI The intervention significantly improved sexual function, sexual desire, and sexual satisfaction.
Maasoumi R, 2023,[55] Iran RCT 140 newly married women Six-week psychosexual intervention using mobile applications 6 weeks 8 weeks after the intervention General help- seeking, actual help-seeking, and sexual function GHSQ, AHSQ, and FSFI-6 The intervention significantly promoted sexual help-seeking behavior.
Farahi Z, 2024,[56] Iran RCT 80 women Online and group sexual counseling based on the Good Enough model 4 weeks 3 months after the intervention Sexual desire, sexual satisfaction, and sexual function SIDI-F, FSFI, and DSCS The intervention significantly improved sexual desire and overall health status.
Barut S, 2024,[57] Iran RCT 106 women aged 15–49 years Weekly Reiki sessions 4 weeks 4 weeks of the intervention. Sexual distress, sexual function, and sexual self confidence FSDS-R and SSS The intervention had significant positive effect on sexual distress, sexual self-confidence, and sexual function.
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AHSQ = Actual Help-Seeking Questionnaire, BDI = Beck Depression Inventory, BISF-W = Brief Index of Sexual Functioning for Women, DSCS = Dyadic Sexual Communication Scale, FSDS = Female Sexual Distress Scale, FSDS-R = Female Sexual Distress Scale-Revised, FSDS-R = Revised Female Sexual Distress Scale, FSFI = Female Sexual Function Index, FSFI-6 = Female Sexual Function Index-Short Form, GHSQ = General Help-Seeking Questionnaire, HISD = Halbert Index of Sexual Desire, HISD = Hurlbert Index of Sexual Desire, IIEF = International Index of Erectile Function, LSSQ = Larson Sexual Satisfaction Questionnaire, PFM = Pelvic Floor Muscle, SIDI = Sexual Interest and Desire Inventory, SIDI = Sexual Interest and Desire Inventory, SIDI-F = Sexual Interest and Desire Inventory–Female, SKAS = Sexual Knowledge and Attitude Scale, SSD = Sexual Self-Disclosure, SSQ = Satisfaction Questionnaire, SSS = Sexual Self-confidence Scale.

Non-pharmacological interventions in the reviewed studies fell into 6 main categories, namely cognitive-behavioral therapy, sexual education and counseling based on theories and models, mindfulness-based cognitive-behavioral sex therapy, phytotherapy and vaginal electrical stimulation, multimedia applications, and sexual health education programs.

2.6. Cognitive-behavioral therapy

A study into the effects of cognitive-behavioral therapy provided cognitive-behavioral counseling in four two-hour group sessions and found it effective in significantly improving all dimensions of sexual function, namely arousal, orgasm, sexual desire, lubrication, dyspareunia, and sexual satisfaction.[29] Two other studies also reported the effectiveness of cognitive-behavioral therapy in significantly improving sexual function and its arousal, sexual desire, and sexual satisfaction dimensions and reducing dyspareunia.[48,49] These findings imply that cognitive-behavioral therapy is an appropriate approach for improving women’s sexual function and managing FSD, though further studies are necessary to produce firmer evidence in this area.

2.7. Sexual education and counseling based on theories and models

A study showed that group education based on the rapport building, exploring, decision making, and implementing the decision model significantly improved the mean scores of sexual knowledge, attitude, and function among young women.[53] Another study reported that counseling based on the PLISSIT model which focused on sexual dysfunctional beliefs and consisted of sex therapy for sexual disorders significantly improved sexual satisfaction and reduced ineffective sexual dysfunctional beliefs.[46] Moreover, a study showed that both 6-hour personal education based on the PLISSIT model and 6-hour group education based on the Sexual Health Model significantly improved sexual function and reduced sexual distress, and the latter intervention was more cost-effective.[12] Similarly, a study on women with infertility reported that sexual education based on the Sexual Health Model significantly improved the mean scores of all aspects of sexual function.[47] Another study into the effects of personal and group education and counseling provided through the question and answering, role playing, video presentation, and experience sharing methods in six ninety-minute sessions significantly improved self-confidence and sexual function and facilitated participants’ engagement in group discussions.[45] Similarly, a study found that education based on the Good Enough Sex model improved the parameters of women’s sexual health including sexual desire, sexual satisfaction, sexual function, sexual distress, and sexual relationship, and reduced sexual dysfunctional beliefs.[56] These findings confirm that education and counseling based on models and theories can modify individuals’ attitudes and knowledge about the different aspects of life, including sexual function, and thereby, modify their behaviors and improve their sexual function.

2.8. Mindfulness-based cognitive-behavioral sex therapy

A study in Columbia on eighty women with decreased sexual desire and arousal found that four ninety-minute group sessions of mindfulness-based therapy, consisted of cognitive therapy, mindfulness meditation, and education, significantly improved all dimensions of sexual function and reduced sexual distress.[41] Another study in Iran found that mindfulness-based cognitive-behavioral sex therapy had significant positive effects on women’s sexual desire, self-disclosure, distress, and function.[52] Mindfulness-based cognitive-behavioral therapy can modify individuals’ attitudes and functions. More studies are still needed in the area of the effects of mindfulness-based cognitive-behavioral therapy on sexual health and dysfunction.

2.9. Physiotherapy and vaginal electrical stimulation

Physical exercises and vaginal electrical stimulation are also among the non-pharmacological interventions with positive effects on FSD. A study in Iran reported that both electrical stimulation and biofeedback provided in twelve 100-minute sessions in 6 weeks significantly improved total sexual function, although the effect of biofeedback was significantly greater than electrical stimulation.[50] A study in Turkey also reported that vaginal electrical stimulation significantly improved sexual function, except for its pain and lubrication dimensions.[42] Another study in Turkey found Reiki exercises in forty-minute weekly sessions held for 4 weeks had significant positive effects on sexual discomfort, sexual function, and sexual self-confidence.[57] These findings indicate the effectiveness of physiotherapy and physical exercises in improving sexual function and reducing SD among women.

2.10. Multimedia applications

A study in Iran found that a multimedia sexual index promotion package sent through virtual network was effective in significantly improving sexual function, sexual satisfaction, and sexual desire.[54] Another study in Iran reported that a 6-week smartphone-based psychosexual intervention significantly improved the mean scores of general and actual help-seeking and sexual function among women, though the effects of the intervention on sexual function disappeared 8 weeks after the intervention.[55] These findings highlight the significant positive effects of smartphone-based interventions on sexual function and hence, these interventions can be used to provide sexual education to women.

2.11. Sexual health education programs

A study in Iran showed that sexual education about the physiology and anatomy of the genital system, sexual response cycle, sexually-transmitted diseases, and sexual disorders in two ninety-minute sessions significantly improved all aspects of sexual function.[44] Another study reported that sexual health education in four one-hour sessions significantly improved sexual attitudes and function and reduced dyspareunia.[51] Moreover, a study found that sexual health education about the physiology and anatomy of the genital system, factors influencing sexual cycle, sexual disorders, lifestyle modification, communication skills, and conflict management in four sixty-minute sessions in 4 weeks significantly improved sexual function.[43] However, a study found that sexual education in three one-hour weekly sessions had no significant effects on sexual function and genital self-image.[30] These contradictory results highlight the necessity of further investigations respecting the effects of sexual education on sexual outcomes.

3. Discussion

This study reviewed non-pharmacological interventions for FSD in low- and middle-income countries. Findings showed that cognitive-behavioral therapy, sexual education and counseling based on theories and models, mindfulness-based cognitive-behavioral sex therapy, phytotherapy and vaginal electrical stimulation, multimedia applications, and sexual health education programs can significantly improve sexual health and reduce FSD.

Improvement of sexual knowledge and awareness has significant role in improving sexual desires. Although couples like to talk about their sexual desires, they feel embarrassed and avoid it. Therefore, sexual counseling is necessary to facilitate sexual relationships and talking about sexual desires and concerns and improve sexual function and understanding about sexual relationships. Appropriate sexual relationships can in turn improve sexual pleasure and intimacy. Moreover, physical and educational exercises, low sexual distress, and great self-confidence can increase the motivation for engagement in sexual activities and improve sexual health.[58] Mental, sexual, and behavioral counseling can lead to more flexible sexual behaviors and improve self-confidence and thereby, improve sexual function.[59,60] A review study and an interventional study also introduced cognitive-behavioral therapy as a successful treatment for FSD.[61,62] Two review studies also showed that group psychotherapies had significant positive effects on women’s sexual function, and noted that group cognitive-behavioral therapy reduces anxiety, fosters positive attitude towards sexual health, and improves sexual function.[7,63] Mindfulness-based group therapy is also one of the most effective interventions for the management of problems in sexual desire and arousal. Women with SD usually have dysfunctional beliefs and thoughts about body during sexual activity and hence, mindfulness-based interventions can reduce their symptoms. Cognitive, behavioral, and emotional awareness helps individuals focus on their sexual feelings during sexual activities and thereby, improves sexual function.[64,65] Given the effectiveness of education and counseling in improving sexual function, sexual education and counseling, psychotherapy, behavioral therapy, and cognitive therapy can be used to reduce fear and embarrassment over sexual relationship and improve sexual function among women.

We also found physical exercises and physiotherapy as effective interventions for improving sexual function. One of the main causes of sexual dysfunction is the disorders of the pelvic floor muscles. In response to potentially threatening situations, such as sexual relationship, pelvic floor muscles go into spasm as a defense mechanism and thereby, sexual relationship may lead to pain. Fear of pain and the involuntary spasm of the muscles surrounding the vagina may require women to avoid sexual relationship. The rehabilitation of the pelvic floor muscles through interventions such as vaginal electrical stimulation may reduce these problems. In vaginal electrical stimulation, women with floor muscle spasm learn to relax their pelvic floor muscles during electrical stimulation and thereby, can relax their muscles and experience less pain during sexual relationship. Surface electromyography may also reduce dyspareunia. Low-frequency electrical stimulation leads to the local release of endorphins and progressive desensitization to pain. Consequently, physiotherapy and electrical stimulation can improve sexual function through reducing pain and spasm in pelvic floor muscles.[66,67]

We also found that multimedia applications may significantly improve sexual function. A study found that a brief motivational intervention significantly improved adolescents’ use of sexual health services.[68] Another study reported that a multimedia intervention increased the probability of patients’ talk to physicians about sexual issues by 40%.[69]

Various studies have been conducted in the field of utilizing internet platforms to enhance knowledge, awareness, and modify attitudes regarding sexual health.[70–72] New technologies like virtual reality and augmented reality are increasingly being utilized in the field of health promotion. These platforms facilitate the exchange of knowledge, attitudes, and successful approaches between individuals and experts. In the area of sexual health, these technologies can enable communication and online counseling services for women with specialists without the need for them to physically visit a clinic, which is especially beneficial for those living in remote areas. An additional advantage is the ability to receive services anonymously without the need to disclose personal information, which can help overcome cultural barriers and reluctance to seek help. Overall, the use of these applications in sexual health can lower costs, reduce cultural barriers, improve knowledge and awareness, and provide accessible treatment for sexual dysfunctions[70–72]

4. Limitations

Most of the studies reviewed in the present study were from Iran and hence, the results of this review may not easily be generalizable to women in some low- and middle-income countries in Africa, Asia, and America. Moreover, the findings may not be generalizable to women with physical problems that can contribute to SD such as diabetes mellitus and vulvodynia. It is worth noting that we did not include studies published before 2014 in our review.

5. Conclusion

This study concludes that non-pharmacological interventions such as counseling, education, behavioral therapy, physiotherapy, and multimedia applications can significantly improve women’s sexual function. Given the easy accessibility, low cost, and limited complications of non-pharmacological interventions, these interventions can be used to manage FSD and improve sexual function. Further investigations are necessary to provide firmer evidence regarding the effects of non-pharmacological interventions on FSD and sexual function.

Acknowledgments

The Research Administration of Tehran University of Medical Sciences, Tehran, Iran, granted this study. We would like to thank the authorities of the university for their support as well as the reviewers of this manuscript for their valuable comments.

Author contributions

Conceptualization: Maryam Koochakzai, Zahra Behboodi Moghadam, Elham Ebrahimi.

Data curation: Maryam Koochakzai, Hayedeh Arbabi.

Investigation: Hayedeh Arbabi.

Methodology: Zahra Behboodi Moghadam, Elham Ebrahimi.

Project administration: Elham Ebrahimi.

Supervision: Zahra Behboodi Moghadam, Elham Ebrahimi.

Validation: Elham Ebrahimi.

Visualization: Hayedeh Arbabi.

Writing – original draft: Maryam Koochakzai, Shahla Faal Siahkal.

Writing – review & editing: Shahla Faal Siahkal, Elham Ebrahimi.

Supplementary Material

medi-104-e42421-s001.doc (27.5KB, doc)

Abbreviations:

FSD
Female Sexual dysfunction
FSDS
Female Sexual Distress Scale
FSDS-3
Female Sexual Distress Scale-3
FSDS-R
Female Sexual Distress Scale-Revised
FSDS-R
Revised Female Sexual Distress Scale
FSFI
Female Sexual Function Index
FSFI-6
Female Sexual Function Index-Short Form
HISD
Halbert Index of Sexual Desire
MBCST
mindfulness-based cognitive-behavioral sex therapy
PLISSIT
Permission, Limited Information, Specific Suggestions, Intensive Therapy
SD
sexual dysfunction

This study received ethical approval from the Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (code: IR.TUMS.FNM.REC.1401.067).

The authors have no funding and conflicts of interest to disclose.

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Supplemental Digital Content is available for this article.

How to cite this article: Koochakzai M, Moghadam ZB, Siahkal SF, Arbabi H, Ebrahimi E. Non-pharmacological interventions for female sexual dysfunction in low- and middle-income countries: A scoping review. Medicine 2025;104:19(e42421).

Contributor Information

Maryam Koochakzai, Email: m61.parsa@gmail.com.

Zahra Behboodi Moghadam, Email: behboodi@tums.ac.ir.

Shahla Faal Siahkal, Email: faalshahla1@yahoo.com.

Hayedeh Arbabi, Email: hayedearbabi@gmail.com.

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