Gynecology Book

Menstrual Disorders

Miscellaneous

  • Female Sexual Dysfunction

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Female Sexual Dysfunction

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  1. Epidemiology
    1. Women with sexual concerns: >50%
    2. American women who have never had an orgasm: 8%
  2. Types: Sexual Dysfunction
    1. Desire phase disorders
      1. Hypoactive sexual desire (low sex drive)
      2. Sexual aversion disorder
        1. Panic Disorder
        2. Active revulsion from sexual stimulation
    2. Impaired female sexual arousal
      1. Failure to achieve or maintain vaginal lubrication
      2. Swelling of genitalia
      3. Dyspareunia may result
    3. Orgasmic phase dysfunction
      1. Orgasm in response to indirect stimulation
        1. Kissing
        2. Fantasy
        3. Breast stimulation
      2. Orgasm only in response to clitoral stimulation
      3. Lack of orgasm (Anorgasmy)
    4. Coital pain problems
      1. Dyspareunia
      2. Vaginismus
      3. Reduced genital sensation
  3. Causes: Psychological and Social
    1. Mood Disorder
      1. Major Depression
    2. Guilt about past sexual activities
      1. Masturbation
      2. Premarital and extramarital sex
      3. Sexually Transmitted Disease
      4. Abortion
      5. Multiple partners
    3. Sexual abuse history
    4. Substance Abuse
    5. Relationship problems
      1. Marital distress
      2. Couple mismatch on sexual preferences
        1. Frequency of intimacy
        2. Variety of intimate activities
  4. Causes: Drugs affecting sexual desire phase
    1. CNS Depressants
      1. Alcohol
      2. Sedative-Hypnotics
      3. Monoamine Oxidase Inhibitors (MAO inhibitors)
      4. Antianxiety agents
      5. Narcotics
      6. Antipsychotics
    2. Chemical abuse (may variably enhance libido)
      1. Cocaine
      2. Amphetamines
      3. Hallucinogens
      4. Marijuana
    3. Antihypertensives
      1. Beta Blockers
      2. Clonidine
      3. Methyldopa
    4. Cancer Chemotherapy agents (ovary damage)
    5. Cimetidine or Ranitidine (antiandrogen)
  5. Causes: Medical Conditions
    1. Genital anatomy changes
      1. Gynecologic cancer
      2. Hysterectomy
      3. Radiation therapy
    2. Nerve dysfunction
      1. Diabetes Mellitus
      2. Multiple Sclerosis
      3. Traumatic paraplegia
    3. Decreased Estrogen (e.g. Oophorectomy)
    4. Disruption of body image
      1. Ostomy
      2. Mastectomy
  6. Management: General
    1. Entitlement to sexual satisfaction
      1. Permission to initiate sex
      2. Permission to ask for more stimulation from partner
      3. Permission to ask for specific types of stimulation
      4. Permission to refuse sex when not interested
    2. Distribution of Information
      1. Educate (e.g. Women require longer excitement phase)
      2. Dispel myths (e.g. Masturbation is abnormal)
      3. Demonstrate on diagrams sexual anatomy and physiology
    3. Consider referral to sex therapist (AASECT)
    4. Specific Suggestions
      1. Privacy from children
      2. Modify sexual behavior for physical Impairments
      3. Consider changing sexual time of day or location
      4. Allow more time for sexual arousal and excitement
      5. Emphasize physical intimacy over the goal of orgasm
  7. Management: Postmenopausal
    1. General
      1. Sexual interest related to partner's interest in sex
      2. Estrogen Loss may decrease sexual interest
        1. Hot Flashes
        2. Dyspareunia
          1. Vaginal dryness
          2. Vaginal lubrication requires more stimulation
      3. Weaker orgasmic contractions
    2. Preparations
      1. Estrogen Cream
      2. Water soluble vaginal lubricants (e.g. Astroglide)
  8. References
    1. McCartney in Dornbrand (1992) Ambulatory Care, p. 380-3
    2. Clayton (2003) Psychiatr Clin North Am 26:673
    3. Philips (2000) Am Fam Physician 62(1):127

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