Impairment assessment of female sexual dysfunction using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth or Sixth Edition, must be performed using appropriate evaluation and objective findings to support ratable sexual dysfunction. In both editions, sexual dysfunction is discussed in Chapter 7, The Urinary and Reproductive Systems, and Chapter 13, The Central and Peripheral Nervous System. In the fifth edition, the maximum impairment rating for female sexual functioning is 35% whole person impairment; in the sixth edition, the maximum is 20%. In terms of rating female reproductive organ impairment, the fifth edition gives consideration to the differences between premenopausal and postmenopausal women. Table 7-9, Criteria for Rating Permanent Impairment Due to Vulval and Vaginal Disease in the fifth edition is used to rate female sexual dysfunction; three classes are identified, and, although age is not a specific consideration, this edition discusses differences between premenopausal and postmenopausal women. In the AMA Guides, Sixth Edition, Table 7-10, Criteria for Rating Permanent Impairment Due to Vulval and Vaginal Disease, is used and provides four classes, two of which have severity grades. Each class addresses historical signs and symptoms of vulvar or vaginal diseases, vulval and vaginal physical alterations, and potential effect of altered vaginal anatomy for vaginal delivery (if premenopausal). Neurogenic sexual dysfunction is combined with other related impairments using the Combined Values Chart.