Abstract Introduction Female sexual dysfunction (FSD) is a highly prevalent and distressing condition, yet limited treatment modalities have been established and incorporated into clinical practice to address this condition. 3,4-Methylenedioxy-methamphetamine (MDMA, ‘Ecstasy’ or ‘Molly’) is a psychostimulant affecting central serotonin, dopamine, and norepinephrine neurotransmission. These same neurotransmitters play important roles in sexual function which suggests that MDMA has potential to be utilized as a novel treatment strategy for FSD. Objective The purpose of this systematic review is to evaluate effects of MDMA on different domains of female sexual response cycle. Methods We conducted a systematic review on the effects of MDMA on the various domains of the female sexual response cycle. PubMed, MEDLINE, and EMBASE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms, including “MDMA” or “ecstasy” in combination with “desire,” “arousal”, “lubrication”, “orgasm”, “pleasure”, “libido,” were utilized. Inclusion criteria for this review were: MDMA was used by study subjects, sexual outcomes in at least one domain of female sexual cycle were described and measured, and the manuscript was written in English between January 2000 to June 2022. Case reports and studies that did not address conditions of interest were excluded from analysis. Results We identified a total of 175 studies. Of these, six studies including 155 women met our inclusion and exclusion criteria. Four of the six studies, including one randomized control study, reported increased sexual desire with MDMA use. Arousal and lubrication were improved in three of four studies but were not affected based on one randomized control study. Orgasm after using MDMA was delayed or difficult to reach, but more intense and pleasurable if achieved. Conclusions This systematic review demonstrates the need for further investigation of the effect of MDMA on different domains of the female sexual response cycle. While effect on orgasm and desire is more certain based on the available data, there is conflicting evidence about MDMA enhancing sexual arousal. MDMA is illicit and unregulated recreational drug, our findings should be interpreted with caution. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast, Sprout Pharmaceuticals.