Sunday, January 6, 2013

Female Sexual Dysfunction
Estimates suggest that as many as 43% of women complain of at least one sexual problem. 

Diagnosis of Female Sexual Dysfunction
1. Hypoactive sexual desire—the persistent or recurrent lack of sexual thoughts and/or receptivity to sexual activity, which causes personal distress. Hypoactive sexual desire may result from endocrine failure or may be associated with psychological or emotional disorders.

2. Sexual arousal disorder—the persistent or recurrent inability to attain or maintain sexual excitement, which causes personal distress. 

3. Orgasmic disorder—the persistent or recurrent loss of orgasmic potential after sufficient sexual stimulation and arousal, which causes personal distresz

4. Sexual pain disorder—persistent or recurrent genital pain associated with noncoital sexual stimulation, which causes personal distress. 

Treatment of Female Sexual Dysfunction:
1. Clitoral stimulation rather than coital intromission may be more beneficial.

2. The use of topical lubricants may address complaints of dyspareunia and dryness.

3. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire.

4. Contributing medications such as antidepressants may need to be altered, including the use of medications with less impact on sexual function, dose reduction, medication switching, or drug holidays.

5. Estrogen replacement in the form of local cream is the preferred method, as it avoids systemic side effects.

6. The widespread use of exogenous androgens is not supported by the literature except in select circumstances (premature ovarian failure or menopausal states) and in secondary arousal disorders.

7. In patients with arousal and orgasmic difficulties, the option of using a clitoral vacuum device may be explored. This handheld battery-operated device has a small soft plastic cup that applies a vacuum over the stimulated clitoris. This causes increased cavernosal blood flow, engorgement, and vaginal lubrication.