This woman most likely has sexual interest/arousal disorder. She reports persistent lack of interest and decreased receptiveness to sexual activity over the past 2 years, and these issues have caused her personal distress. Sexual dysfunction comprises various sexual problems with overlapping biologic, psychological, and interpersonal components. Rather than discrete diagnostic categories, the DSM-5 categorizes female sexual dysfunction into broad domains that allow for increased complexity within a diagnosis. Sexual interest/arousal disorder is characterized by the presence of at least three of the following symptoms: lack of sexual interest, lack of sexual thoughts or fantasies, decreased initiation of sexual activity or decreased responsiveness to partner's initiation attempts, reduced excitement or pleasure during sexual activity, decreased response to sexual cues, or decreased sensations during sexual activity; the presence of associated personal distress is required for diagnosis. Furthermore, a diagnosis of sexual dysfunction requires a duration of at least 6 months to distinguish transient sexual difficulties from more persistent dysfunction.

Genitopelvic pain/penetration disorder is characterized by persistent urogenital pain associated with intercourse that is not related exclusively to inadequate lubrication or vaginismus. Physiologic conditions that may cause dyspareunia and pelvic pain include interstitial cystitis, pelvic adhesions, infection, and endometriosis. This patient's absence of sexual pain and lack of other associated symptoms and signs make this disorder unlikely.

Orgasmic disorder is the persistent or recurrent delay or absence of orgasm following a normal excitement phase. In this patient, the distress is associated with a lack of interest and decreased libido, rather than lack of orgasm, so this is a less likely diagnosis.

Vulvodynia is a syndrome of persistent vulvar or vestibular discomfort or burning pain, generally occurring in the absence of clinically identifiable findings. The pain is marked and chronic, but variable in terms of severity, constancy, and provocative features. Its etiology is unknown. In this patient, pain is not a symptom, so this is not a correct diagnosis.