Key content Female sexual dysfunction (FSD) is defined as any sexual complaint or problem resulting from disorders of desire, arousal, orgasm or sexual pain that causes marked distress or interpersonal difficulty. Various gynaecological problems such as pelvic organ prolapse and endometriosis affect sexual function and this impacts on their treatment. Management often requires the need to address different components of the sexual dysfunction. Women wish to keep their options relating to sexual function open well past the menopause, and more women are presenting in later life with FSD. Learning objectives To know how to assess FSD in clinical practice. To appreciate the reasons why all women attending a gynaecology clinic should have their sexual function assessed to establish a baseline. To establish realistic expectations of outcomes on sexual function following treatment of gynaecological problems. Ethical issues Failure to inform women of the risk of deterioration in sexual function following gynaecological surgery can lead to litigation. Some essential treatments, such as vulvectomy or prophylactic oophorectomy, will result in adverse effects on sexual function, and women should make informed choices regarding their treatment.