Materiały źródłowe

• #1 Sexual dysfunction in women: Can we talk about it? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/367

  Sexual dysfunction in women is common and often goes unreported and untreated. Its management is part of patient-centered primary care. Primary care providers are uniquely positioned to identify and assess sexual health concerns of their patients, provide reassurance regarding normal sexual function, and treat sexual dysfunction or refer as appropriate. […] Many women experience some form of sexual dysfunction, be it lack of desire, lack of arousal, failure to achieve orgasm, or pain during sexual activity. […] The age-adjusted prevalence of sexual dysfunction in US women was reported at 44% in the Prevalence of Female Sexual Problems Associated With Distress and Determinants of Treatment Seeking (PRESIDE) study, but the prevalence of distress associated with sexual dysfunction was 12%. The most common type of sexual dysfunction reported by women was low sexual desire, a finding consistent with that of another large population-based study.

• #2 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Female sexual dysfunction can be subdivided into desire, arousal, orgasmic and sexual pain disorders. Sexual pain disorders include dyspareunia and vaginismus. […] Estimates of the number of women who have sexual dysfunction range from 19 to 50 percent in normal outpatient populations and increase to 68 to 75 percent when sexual dissatisfaction or problems (not dysfunctional in nature) are included. Yet, one review of physicians’ chart notes revealed a recorded sexual problem in only 2 percent. In another review, physician inquiry of patients in a gynecologic office setting about sexual problems increased reported complaints about sexual dysfunction sixfold. This discrepancy demonstrates a need for physician education in this area. […] The diagnosis of female sexual dysfunction requires the physician to obtain a detailed patient history that defines the dysfunction, identifies causative or confounding medical or gynecologic conditions, and elicits psychosocial information. Preappointment questionnaires or appointments at which only the history is taken allow patient-physician communication to be unhindered by time constraints or patient fears of an upcoming physical examination.

• #3 Female Sexual Interest and Arousal Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK603746/

  Female sexual interest/arousal disorder (FSIAD), previously termed hypoactive sexual desire disorder and female sexual arousal disorder, is a prevalent condition that primarily affects older and postmenopausal women. […] This condition is frequently underdiagnosed due to sociocultural barriers and limited clinician understanding. Diagnostic criteria include several symptoms, such as reduced sexual thoughts or fantasies, decreased initiation of sexual activity, and diminished sexual pleasure. Diagnosis also requires the presence of distress related to these symptoms for at least 6 months. […] The evaluation of a patient with FSIAD should encompass a thorough medical history and physical examination to help identify the underlying cause and duration of the sexual disorder, allowing the clinician to devise effective management strategies.

• #4 Sexual dysfunction in women – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/352

  Sexual dysfunction in women of all sexual orientations correlates most strongly with poor mental health and with negative feelings for the partner(s), rather than with any serum hormone (or hormone metabolite) levels. […] Normal changes with age and relationship duration must not be mistaken for desire/interest disorder. Desire disorder is diagnosed when there is a lack of anticipatory sexual desire, and desire (along with pleasure, arousal, and excitement) cannot be triggered during sexual activity and results in distress. […] There are three criteria for diagnosing a sexual disorder: symptoms need to have persisted for a minimum of 6 months, they need to have been experienced in all or almost all (75% to 100%) sexual encounters, and to have caused clinically significant distress. […] Key diagnostic factors include sexual symptoms leading to distress, absent/reduced interest in sexual activity, absent/reduced sexual/erotic thoughts or fantasies, absent/reduced sexual excitement/pleasure during sexual activity, and no subjective arousal from erotic or sexual cues. […] Diagnostic investigations include CBC, serum glucose level, renal function, thyroid function tests, and serum prolactin level.

• #5 Understanding and Treating Female Sexual Dysfunction: An Update on Current Literature

  https://evolvemeded.com/specialty/womens-health/understanding-and-treating-female-sexual-dysfunction-an-update-on-current-literature/27235/

  The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 reduces FSD classification into three dysfunctions: sexual interest/arousal disorder (which now includes HSDD); genito-pelvic pain/penetration disorder; and female orgasmic disorder (now differs from male sexual dysfunctions). Patients must experience symptoms of the disorder a minimum of 75% of the time before a diagnosis of FSD can be made (excluding substance-or medication induced disorders). Finally, and importantly, the condition must result in significant distress to the patient in order to qualify as FSD. […] A more appropriate nomenclature for FSD was posited by the International Society for the Study of Womens Sexual Health. Criteria require that an individual with HSDD has any of the following symptoms for at least 6 months: (1) a lack of motivation for sexual activity as manifested by reduced or absent spontaneous desire; (2) reduced or absent responsive desire to erotic cues and to stimulation; or (3) a loss of the desire to initiate or participate in sexual activity.

• #5 Understanding and Treating Female Sexual Dysfunction: An Update on Current Literature

  https://evolvemeded.com/specialty/womens-health/understanding-and-treating-female-sexual-dysfunction-an-update-on-current-literature/27235/

  Sexual problems are common in women across all ages. Female sexual dysfunction (FSD) is an umbrella of conditions that may affect as many as 40 million women in the United States, with a community prevalence ranging from 30% to 80%. There are several specific sexual dysfunctions that occur among women including hypoactive sexual desire disorder (HSDD), female sexual arousal disorder, female orgasmic disorder, and pain during sex, all of which are persistent, recurrent problems and cause personal distress. HSDD is the most prevalent sexual dysfunction in women, impacting 1 in 10 women across all ages. HSDD significantly reduces quality of life and self-worth, leading to profound societal and economic impact on patients. Despite its prevalence, health care providers struggle with asking about sexual concerns and treating sexual dysfunctions. This is due to several factors, including: lack of awareness of the latest guidelines; the uncomfortable nature of discussing the topic with patients; and the limited number of safe, effective therapies approved by the Food and Drug Administration (FDA). Flibanserin is currently the only FDA-approved treatment for premenopausal women with HSDD.

• #6 Sexual dysfunction in women: Can we talk about it? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/367

  The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines three categories of sexual dysfunction in women: Female sexual interest and arousal disorder, Female sexual orgasmic disorder, and Genitopelvic pain/penetration disorder. […] To meet the diagnosis of any of these, symptoms must persist for at least 6 months, occur in 75% to 100% of sexual encounters, be accompanied by personal distress, and not be related to another psychological or medical condition, medication or substance use, or relationship distress. […] Assessment of sexual health concerns should be a part of a routine health examination, particularly after childbirth and other major medical, surgical, psychological, and life events. […] No standard laboratory tests or imaging studies are required for the assessment of sexual dysfunction.

• #7 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  FSD can be lifelong or acquired, and generalised or situational. […] Exclusion criteria include nonsexual mental disorder, severe relationship distress (eg, partner violence) and other significant stressors. […] Sexual interest/arousal disorder. This is defined as reduced or absent sexual interest, responsiveness, erotic thoughts and sexual pleasure. […] Female orgasmic disorder (absence, infrequency, reduction, delay of orgasm): Lifelong anorgasmia may suggest unfamiliarity or discomfort with self-stimulation or sexual communication with her partner. […] Delayed or less intense orgasms may be a natural process of ageing, due to decreased genital blood flow, atrophy and reduction in sensitivity. […] Genito-pelvic pain/penetration disorder (difficulty in vaginal penetration, marked vulvovaginal or pelvic pain during penetration, fear or anxiety about pain in anticipation of, during, or after penetration, and tightening or tensing of pelvic floor muscles during attempted penetration).

• #8 Female Sexual Interest and Arousal Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK603746/

  Eliciting and documenting an adequate history is critical for diagnosing FSIAD. […] To diagnose FSIAD, establishing the presence of associated distress or interpersonal relationship concerns related to the expressed sexual disorder symptoms is critical. […] The presence of sexual disorder symptoms without associated distress excludes the diagnosis of FSIAD. […] To diagnose FSIAD, 3 of the following 6 symptoms must be present for at least 6 months and need to be causing clinically significant distress: Absent or reduced interest in sexual activity, Absent or reduced sexual or erotic thoughts or fantasies, Absent or reduced initiation of sexual activity and typically unreceptive to a partner’s attempts to initiate sex, Absent or reduced sexual excitement or pleasure during sexual activity in all or almost all, between 75% and 100%, of sexual encounters, Absent or reduced sexual interest or arousal in response to any internal or external sexual or erotic stimuli or cues, Absent or reduced genital or nongenital sensations during sexual activity in almost all or all, between 75% and 100 %, sexual encounters.

• #9 What is female arousal disorder? Symptoms and treatment

  https://www.medicalnewstoday.com/articles/female-arousal-disorder

  Female sexual interest/arousal disorder (FSIAD) is a type of sexual dysfunction. A person with the condition may experience a lack of sexual desire, a lack of physical arousal, or both. […] FSIAD describes a loss or significant reduction in sexual desire or physical arousal in females. It is a relatively new term that first appeared in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). […] According to the DSM-5, a person must have three of the following symptoms to have FSIAD: reduced or no interest in sex, few or no thoughts about sex, decreased sexual arousal or pleasure during sexual activity, reduced or no arousal in response to visual, written, or verbal cues, infrequent or no initiation of sexual activity within a relationship, reduced or no sensations in the genitals.

• #10 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Establishment of the patient’s sexual orientation is necessary for appropriate evaluation and management. Nonjudgmental, direct questions best achieve this goal. Because gender identity conflicts are often a cause of sexual dysfunction, the mode and type of questions asked by physicians should create an environment where patients may openly express their concerns. Specialized counseling is important for these patients. […] The sexual dysfunction should be defined in terms of onset and duration and situational versus global effect. A situational dysfunction occurs with a specific partner, in a certain setting or in a definable circumstance. […] The presence of more than one dysfunction should be ascertained, because considerable interdependence may exist. For example, a patient complaining about decreased desire might have a primary orgasmic disorder from insufficient stimulation, with decreased desire developing secondarily as a result of unsatisfying sexual encounters. Thus, treating the orgasmic disorder would indirectly enhance desire; whereas, treating a desire disorder would be unsuccessful and perhaps add to patient frustration and perpetuate the cycle of dysfunction.

• #11 Diagnosis and Treatment of Female Sexual Dysfunction | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0301/p635.html

  Female sexual complaints are common, occurring in approximately 40 percent of women. […] A complete history combined with a physical examination is warranted for the evaluation of women with sexual complaints or concerns. […] Although laboratory evaluation is rarely helpful in guiding diagnosis or treatment, it may be indicated in women with abnormal physical examination findings or suspected comorbidities. […] The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) or ALLOW (Ask, Legitimize, Limitations, Open up, Work together) method can be used to facilitate discussions about sexual concerns and initiation of treatment. […] Although patient education and therapy are the foundation of treatment, limited research has demonstrated the benefit of pharmacotherapy.

• #12 Female Sexual Dysfunction Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/2500107-clinical

  Many patients are reluctant to disclose sexual problems owing to social stigma; fear of embarrassment; nontraditional gender roles or different sexual orientation; concern about the embarrassment of the healthcare provider; distrust in the providers ability to help; or a history of sexual, physical, or emotional abuse. Using a routine screening question during history-taking is therefore essential to open a dialogue about sexual concerns. Examples of questionnaires include the 19 question Female Sexual Function Index, a 12 item Female Sexual Distress Scale, and the 4 item Brief Sexual Symptoms Checklist for Women. […] A thorough nonjudgmental sexual history with open-ended questions is vital to making a diagnosis of sexual dysfunction and to identifying contributing elements. Most elements of the sexual history will apply to any evaluation for sexual dysfunction; those that are particular to a specific diagnosis are outlined separately below.

• #13 Female Sexual Dysfunction Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/2500107-clinical

  Questions should specifically address the nature of the concern, and whether the patient has difficulty with sexual desire, arousal, orgasm, sexual pain, or some combination thereof. It is important to understand how long the problem has lasted, and whether the onset was abrupt or gradual. A temporal relationship to a historical element such as childbirth, assault, or surgery may shed some light on the cause of the problem. […] A careful social history is important, which should explore the nature of the patients relationship with her partner, whether this problem existed with other sexual partners, and for whom the sexual problem is causing distress. […] A psychological history is important, eliciting elements such as depression symptoms, history of psychiatric disease, and any history of alcohol or substance abuse. Understanding what the patient has tried to resolve the sexual problem can also be an important window into the patient history.

• #14 Female Sexual Dysfunction Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/2500107-clinical

  In taking a sexual history from a patient with a complaint of low libido or decreased sex drive, specific information about their libido is important. […] The next step is to establish what the level of desire was at baseline before the patient detected a problem. […] Sexual pain is often classified as being insertional, which usually involves external or vaginal structures, or deep, which would suggest intraperitoneal structures as a source. […] The sexual history of a woman complaining of sexual pain should target the nature and severity of the pain, sexual positions associated with the pain, the location, whether the patient needs to stop intercourse due to pain, the time course, and the previous evaluation and interventions attempted. […] For those patients with a primary complaint of orgasmic difficulty, questions should be directed to their experience of orgasm. It would be important to know whether orgasm was achieved previously, and if so under what circumstances (eg, with vibratory stimulation, with the same or different partner, or in a particular environment).

• #15 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Each patient should undergo a thorough examination, with the gynecologic examination individually guided by and tailored to patient comfort. The goal of the examination is detection of disease; however, the examination also provides an opportunity to educate the patient about normal anatomy and sexual function, and to reproduce and localize pain encountered during sexual activity. […] A routine examination seeks signs of general medical conditions. The gynecologic examination is comprehensive, beginning with inspection of the external genitalia, including a cotton swab test if indicated. For patients with dyspareunia, a mono-manual examination should follow, with one or two fingers in the vagina, and the other hand held away from the abdomen so as not to confuse the source of discomfort. Bimanual and rectovaginal examinations are then performed. The timing of the speculum examination is guided by patient symptoms. In patients with deep dyspareunia, the speculum examination should follow the bimanual examination because localization of pain is crucial in these patients. In patients in whom vaginitis, cervical cancer or a sexually transmitted disease is suspected, cultures and vaginal samples should be obtained first.

• #16 Female Sexual Dysfunction Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/2500107-clinical

  Most female sexual dysfunction (FSD) issues do not directly relate to physical findings, and the physical examination may be focused with the following in mind. […] Thyroid disease may be contributory to female sexual interest/arousal disorder (FSIAD), and a thyroid examination may be included. […] Pelvic examination is most helpful in women who complain of sexual pain and should specifically look for findings of atrophy or areas of tenderness that may relate to their complaints. […] The bimanual examination should specifically identify areas of tenderness that contribute to pain with penetration. Some specific areas of focus in the pelvic exam include the vulvar vestibule (as occurs with localized provoked vulvodynia), levator and perineal body muscle soreness (vaginismus), rectovaginal nodularity (endometriosis), pelvic side wall tension or tenderness (myofascial pain syndrome), and anterior wall/ bladder (interstitial cystitis or painful bladder syndrome). […] Common gynecologic conditions including vaginitis, sexually transmitted infection, leiomyomata, endometriosis, adnexal masses, cervical cancer, vulvar dermatoses, pelvic organ prolapse, vulvodynia, vaginismus, and adenomyosis may be identified on pelvic examination.

• #17 Diagnosis and Treatment of Female Sexual Dysfunction | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0301/p635.html

  Laboratory evaluation is rarely helpful in guiding the diagnosis or treatment of female sexual dysfunction. However, a focused evaluation is appropriate, particularly if the history or examination suggests a medical condition. […] Sexual dysfunction may be the manifestation of psychiatric illness or an adverse effect of psychotropic medication use. […] Treatment of female sexual dysfunction is complicated by the lack of a single causative factor, limited proven treatment options, physician unfamiliarity with available treatments, overlap of different types of dysfunction, limited availability of treatment, and limited expertise in the treatment of female sexual dysfunction.

• #18 Overview of Female Sexual Function and Dysfunction – Gynecology and Obstetrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/overview-of-female-sexual-function-and-dysfunction

  During the examination, the clinician should look for signs of low estrogen, particularly thinning of labia minora, loss of the labial fat pad, pale vaginal mucosa, and loss of vaginal folds. A moist cotton swab can be used to identify pain points on the vulva and vulvar vestibule. […] Unless an undiagnosed disorder is suspected, the initial evaluation of female sexual dysfunction typically does not require laboratory evaluation. Low estrogen is detected clinically during the examination. Sexual function does not correlate with testosterone levels, regardless of how they are measured. However, if hyperprolactinemia is clinically suspected, the prolactin level is measured. If a thyroid disorder is clinically suspected, appropriate testing is done.

• #19 Diagnosis of FSD » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/physicianinformation/diagnosis-of-fsd/

  A modified process of care approach is used for the management of women with sexual health problems in our sexual health clinic. […] We start with identification of the sexual problem through history (sexual, medical, gynecologic, psychosocial), physical examination, laboratory blood tests, psychologic interview and specialized genital sensory, pelvic floor and blood flow testing. […] During identification of the sexual problem genital function testing has revealed that abnormal genital sensation was found in more than half of the women. In addition, approximately 75% of these patients also showed abnormal genital blood flow (abnormal duplex Doppler ultrasound) before and after sexual stimulation. […] Most significantly, when we evaluated hormone levels, we found that approximately two thirds of these women had low levels of dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione, dihydrotestosterone, free testosterone and total testosterone.

• #20 Diagnosis and Treatment of Female Sexual Dysfunction | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0301/p635.html

  Evaluation of sexual complaints may be limited by time constraints, physician or patient discomfort, difficulty with diagnosis, lack of available referral services, and limited treatment options. […] Physicians are often uncomfortable with and poorly educated about obtaining a comprehensive sexual history, even though this is an important component of primary health care. […] There are a number of validated self-report and interview-based tools for assessing female sexual dysfunction, but they are primarily used in research settings. […] The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) model is used to initiate discussions about sexual dysfunction and its management. […] Although physical examination findings are often normal, a complete examination, including a focused pelvic examination, can identify pathology and provide patient education about normal anatomy and reassurance that no abnormality is present.

• #21 Female Sexual Interest/Arousal Disorders

  https://labs.la.utexas.edu/mestonlab/female-sexual-interestarousal-disorders/

  Given that FSIAD is new to DSM-5, there are no assessment tools based on the new diagnostic criteria, and there are no published treatment studies that use the new criteria. Therefore, this section draws on the HSDD and FSAD literature. […] The assessment of sexual interest in women is difficult due to the subjective and complex nature of sexual desire. In her model of the female sexual response, Basson (2000) described the concept of receptive desire. She explained that, though many women do not seek out sexual activity, they respond sexually when approached by partner. Basson was the first to suggest that level of responsiveness to sexual stimuli was indicative of desire in women. Assessing for low sexual desire may include inquiring about sexual thoughts, fantasies, and daydreams; examining the degree to which patients seek out sexually suggestive material; questioning how often patients have the urge to masturbate or engage in sensual self-touching; and determining level of motivation for partnered sexual activity. Overall, assessment of sexual desire needs to be carefully considered within the context of the dyadic relationship, and must take into consideration factors known to affect sexual functioning such as the persons age, religion, culture, the length of the relationship, the partners sexual function, and the context of the persons life.

• #22 Female Sexual Interest/Arousal Disorder – A New Mental Health Diagnosis – Promises Behavioral Health

  https://www.promises.com/addiction-blog/female-sexual-interestarousal-disorder-a-new-mental-health-diagnosis/

  Female sexual interest/arousal disorder is a mental health condition first defined in May 2013 in the new fifth edition of the reference guide called the Diagnostic and Statistical Manual of Mental Disorders or DSM. […] According to the guidelines established by the APA, all conditions that primarily involve a lack of sexual desire or sexual arousal belong to a group of disorders called sexual dysfunctions. […] Before making a diagnosis, a doctor must determine that the lack of sexual desire has a clearly identifiable physical cause and does not stem from some sort of mental health problem. […] In order to qualify for a diagnosis, an affected woman must also suffer mentally/emotionally from her inability to experience or sustain arousal, or experience interpersonal problems stemming from the same cause.

• #23 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Gynecologic changes related to a woman’s reproductive life (e.g., puberty, pregnancy, the postpartum period and menopause) present unique problems and potential obstacles to sexuality. Puberty may lead to concerns regarding sexual identity. Pregnancy and the postpartum period are often associated with a decrease in sexual activity, desire and satisfaction, which may be prolonged with lactation. The hypoestrogenic state of menopause may cause significant physical changes and alterations in mood or a diminished sense of well-being, which have been found to have a significant, negative impact on sexuality. A decline in desire, arousal and frequency of intercourse and an increase in dyspareunia have been associated with menopause, although these findings are not universal. […] The final goal is to elicit psychosocial information. Previous experiences and current intra- and interpersonal factors should be explored.

• #24 Female Sexual Function and Dysfunction: Assessment and Treatment | Obgyn Key

  https://obgynkey.com/female-sexual-function-and-dysfunction-assessment-and-treatment/

  To make a diagnosis of a sexual disorder, the symptoms must cause personal or interpersonal distress or difficulty and must not be better accounted for by another category of psychiatric disorder or due exclusively to the direct physiological effects of a substance or gynecologic or general medical condition. […] Each disorder is then further subtyped into lifelong versus acquired and generalized versus situational. […] The prevalence of HSDD is difficult to determine as it varies depending on the population surveyed. […] The typical comorbid medical conditions associated with FSAD are menopause, vascular disease associate with coronary artery disease and diabetes, smoking, and side effects of medications. […] The cause of orgasmic dysfunction is likely multifactorial, making the prevalence difficult to evaluate, but it has been reported as 3.4% to 5.8%.

• #25 Female Orgasmic Disorder – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/female-orgasmic-disorder

  Female orgasmic disorder involves orgasm that is absent, infrequent, markedly diminished in intensity, or markedly delayed in response to stimulation despite normal levels of subjective arousal. […] Diagnosis of orgasmic disorder is clinical, based on criteria in the DSM-5-TR: […] Symptoms must have been present for 6 months. […] Diagnose orgasmic disorder based on DSM-5-TR clinical criteria. […] Treat with directed masturbation, usually as first-line therapy. […] Recommend sex therapy and other psychological therapies to help women identify and manage factors that contribute to orgasmic disorder.

• #26 Female Orgasmic Disorder in Adults

  https://www.mindyra.com/solutions/adults/femaleorgasmicdisorder

  Female orgasmic disorder is part of a cluster of diagnoses called the sexual dysfunctions. Sexual dysfunctions are characterized by a significant impairment in a person’s ability to respond sexually or to experience sexual pleasure. […] Female orgasmic disorder is a sexual dysfunction disorder that affects as many as 28% of women. The disorder is characterized by a delay, infrequency or absence of orgasm. There may also be a reduced intensity of orgasm sensations. […] There are five factors that should be taken into consideration during the assessment and diagnosis of female orgasmic disorder: Partners sexual history and health status, Relationship quality such as ability to effectively communication, differences in sexual activity preference, Individual factors such as body image, history of physical or sexual abuse, psychiatric comorbidity, life stressors, Cultural and religious background such as rules and attitudes towards sexual activity and sexuality, Medical background and treatment.

• #27 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Dyspareunia can be divided into three types of pain: superficial, vaginal and deep. Superficial dyspareunia occurs with attempted penetration, usually secondary to anatomic or irritative conditions, or vaginismus. Vaginal dyspareunia is pain related to friction, including arousal disorders. Deep dyspareunia is pain related to thrusting, often associated with pelvic disease or relaxation. […] Diagnosis of an underlying etiology should be aggressively sought, even if surgical investigation is required. The physical examination must include meticulous detail, with the physician’s focus on recreating the pain. Treatment of the underlying etiology is fundamental, but as in long-term pain disorders, counseling and pain control strategies are essential.

• #28 Self-Assessment Questions – Course #93032: Female Sexual Dysfunction – NetCE

  https://www.netce.com/studypoints.php?courseid=2510&printable=yes&page=printquestions

  Individual vulnerability factors that increase the risk for sexual dysfunction in women include a history of sexual or emotional abuse, current psychiatric conditions (e.g., depression), and life stressors (e.g., job loss). […] Vaginismus is difficult to delineate from provoked vestibulodynia, and they often co-occur. […] As noted, in 2015 flibanserin became the first medication approved for the treatment of female sexual dysfunction (specifically HSDD) and the first medication approved to treat sexual desire disorders in either sex. […] A guideline for testosterone therapy in FSIAD was jointly updated in 2014 by the Endocrine Society and other professional organizations.

• #29 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Questioning the patient about what she thinks is causing the problem may add insight. She may reveal fear of redeveloping an abnormal Papanicolaou smear from penile penetration, or she may admit that she is not attracted to her partner. Obtaining this information early in the evaluation process will expedite diagnosis and initiation of treatment. […] Medical conditions are a frequent source of direct or indirect sexual difficulties. Vascular disease associated with diabetes might preclude adequate arousal; cardiovascular disease may inhibit intercourse secondary to dyspnea. Arthritis or urinary incontinence may cause discomfort or embarrassment, leading to dysfunction or decreased sexual activity. Aggressive treatment of long-term disease and minor ailments, with attention to their sexual implications, will help enhance sexuality.

• #30 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Chronic or recurrent headaches, fibromyalgia and chronic fatigue syndrome, together with many types of cancer and the medical or surgical consequences of their treatment, can also lead to FSD. […] The factors associated with an increased risk of FSD include increasing age, menopause (including premature ovarian failure), the postpartum period, genital surgery, genital atrophy, genital mutilation, sexual abuse, psychological factors, relationship problems, alcohol, substance use disorders, smoking, and obesity. […] Medical and psychiatric conditions that are associated with female sexual dysfunction include: Cardiovascular disease. […] Diabetes mellitus. […] Neurologic disease (stroke, multiple sclerosis, spinal cord injury). […] Hypertension. […] Genitourinary syndrome of menopause.

• #31 Female Sexual Dysfunction: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p127.html

  Prescription and over-the-counter medications, illicit drugs and alcohol abuse contribute to sexual dysfunction. Medication changes, drug discontinuation, or dosage or schedule alterations may provide relief. Cigarette smoking, known to cause erectile dysfunction in men, may have a similar negative effect on arousal in women. […] Gynecologic conditions contribute physically to sexual difficulties, and treatment must address both of these issues. For example, treatment of a patient with recurrent cystitis as a cause of dyspareunia should include the use of lubricants and distraction techniques at first intercourse to assure adequate lubrication and relaxation, respectively. […] Hysterectomy, gynecologic malignancies and breast cancer present medical and mortality concerns, and alter or remove physical and psychologic symbols of femininity that may result in feelings of decreased sexuality. In one study, 74 percent of patients who underwent surgery for gynecologic malignancy reported decreased desire, and 40 percent reported dyspareunia. In another study of patients who had undergone hysterectomy for benign disease, a decrease in sexual responsiveness of up to 30 percent was noted. Breast cancer survivors report a 21 to 39 percent incidence of sexual dysfunction, although a recent study suggests that this may be related to chemotherapy or hypoestrogenism secondary to ovarian failure. Preoperative counseling, including explanations of postoperative anatomy and potential effects on sexuality, is essential in these patient populations. Continued postoperative counseling and early recognition and treatment of sexual difficulties may also help these patients maintain satisfying sexual relationships.

• #32 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Breast, ovarian, uterine, and cervical cancer. […] History of gynaecological surgery. […] Chronic renal failure. […] Urinary incontinence. […] It is important to identify which type or types of FSD are present: if pain is present this may drive the history towards organic causes, but there may be other contributing factors. […] Careful, open questions regarding particular sexual practices or positions which particularly trigger pain are needed. […] Several self-reported questionnaires are available to assess sexual dysfunction. […] The Female Sexual Function Index is the most commonly used validated questionnaire. […] The management of FSD will depend on the predominant underlying causes and there will often be several. […] Traditionally a psychological-behavioural approach was recommended.

• #33 Sexual dysfunction in women: Can we talk about it? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/367

  Evaluation and treatment of female sexual dysfunction is guided by the biopsychosocial model, with potential influences from the biological, psychological, sociocultural, and interpersonal realms. […] As sexual dysfunction in women is often multifactorial, management of the problem is well suited to a multidisciplinary approach. […] Even in the initial visit, the primary care provider can educate, reassure regarding normal sexual function, and treat conditions such as genitourinary syndrome of menopause and antidepressant-associated sexual dysfunction. […] Hypoactive sexual desire disorder is defined as persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity associated with marked distress and not due exclusively to a medication, substance abuse, or a medical condition.

• #34 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  The prevalence of FSD among pregnant women is reported in 50-80% of women, mainly in the first and third trimesters. […] Contributory factors are physical and hormonal changes, perceived loss of attractiveness, concerns about the baby, breast tenderness and vaginal dryness. […] Sexual function declines during pregnancy and does not return to its baseline levels during the postpartum period. […] Irrespective of the type of delivery, short-term postpartum sexual changes, such as dyspareunia and loss of desire, are highly prevalent in postpartum women. […] Cardiovascular disease (CVD) is associated with an increased prevalence of FSD. […] Atherosclerosis affecting the hypogastric/pudendal arterial bed decreases the blood flow to the clitoris and vagina; this is called clitoral vascular insufficiency syndrome.

• #35 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  To diagnose female sexual dysfunction, your healthcare professional may: […] Discuss your sexual and medical history and your gender identity. […] Do a pelvic exam. […] Order blood tests. […] Your healthcare professional also may suggest that you see a counselor or therapist who treats sexual and couples’ problems. […] Treatment for sexual dysfunction often involves dealing with a medical condition or hormonal change. Your healthcare professional may suggest changing a medicine you take or lowering the dose. […] Treatments for female sexual dysfunction might include: […] Vaginal estrogen. […] Ospemifene (Osphena). […] Testosterone therapy. […] Flibanserin (Addyi). […] Bremelanotide (Vyleesi). […] Prasterone (Intrarosa). […] Because female sexual dysfunction is complex, even the best medicines aren’t likely to work if other emotional or social factors are not resolved.

• #36 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  If you have sex problems that upset you, make an appointment with your healthcare professional. […] Your main healthcare professional will either diagnose and treat the problem or refer you to a specialist. […] Your healthcare professional might ask personal questions and might want to include your partner in the interview. […] Be sure to ask all the questions you have.

• #37 Female sexual dysfunction: Classification, physiology, diagnosis and treatment

  https://www.pulsus.com/scholarly-articles/female-sexual-dysfunction-classification-physiology-diagnosis-and-treatment.html

  Female sexual dysfunction was defined and classified by the Consensus Development Panel on Female Sexual Dysfunction in 1998. During this meeting, experts in the field of sexual dysfunction, including urologists, psychologists and psychiatrists, developed a definitive classification system. This new system replaced the previous two confounding definitions in the International Classification of Diseases, ninth revision, and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, systems. According to the new classification, there are four distinct female sexual disorders: sexual desire disorder, sexual arousal disorder, orgasmic disorder and sexual pain disorder. […] The diagnostic approach consists of taking a thorough history, performing a physical examination, a careful review of medications, taking a thorough social history and a few laboratory assays.

• #38 Female sexual dysfunction: Classification, physiology, diagnosis and treatment

  https://www.pulsus.com/scholarly-articles/female-sexual-dysfunction-classification-physiology-diagnosis-and-treatment.html

  The history may be the most difficult part of the examination for physicians who may be uncomfortable discussing sexual issues, but this must be considered a part of the screening process. […] Once it is established that the patient has some sort of sexual difficulty, it is important then to establish what type of sexual dysfunction the patient has. Is it problems with libido, arousal or lubrication, orgasmic dysfunction or pain? […] The correction of medical disorders, such as hyperprolactinemia, is essential. Just as with erectile dysfunction, elimination of risk factors, such as tobacco use and obesity, and attention to exercise and stress management are an important part of treatment in this patient population. […] Physicians should tailor the treatment of female sexual dysfunction to the underlying cause.

• #39 Female Sexual Dysfunction: Symptoms, Types, Causes & Treatments

  https://resources.healthgrades.com/right-care/sexual-health/female-sexual-dysfunction

  Doctors recommend treatment of female sexual dysfunction if the problem bothers you or interferes with your relationships. Because the symptoms and causes of FSD are often interrelated, treatment usually relies on more than one approach including: […] Your healthcare provider will tailor the treatment based on your individual needs. Be upfront and honest about the symptoms that bother you and your goals. […] There are several drugs under investigation for the treatment of FSD. This includes phosphodiesterase inhibitors, such as sildenafil (Viagra), that are approved treatments for male erectile dysfunction. Researchers also continue to study testosterone therapy for female sexual dysfunction in women who have low levels of it. […] Female sexual dysfunction is a problem if the symptoms cause distress or interfere with your relationships. Occasional sexual problems are a normal part of life. However, if sexual problems persist or recur, not addressing them can cause more problems if it strains your enjoyment of life or your relationship with your partner.

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