May 15, 2020

Female Sexual Dysfunction:

Evaluation and Treatment

Part-2return to page-1 of sexual disorders

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.¹⁵

For patients with dyspareunia, a "monomanual" examination is appropriate, with the physician inserting one or two fingers into the vagina and the other hand held away from the abdomen so as not to confuse the source of discomfort.

The hypoestrogenic state of menopause may cause significant physical changes^16,17 (Table 4)¹⁷ and alterations in mood or a diminished sense of well-being, which have been found to have a significant, negative impact on sexuality.¹⁸ A decline in desire, arousal and frequency of intercourse and an increase in dyspareunia have been associated with menopause,^19-21 although these findings are not universal.¹⁸

The final goal is to elicit psychosocial information. Previous experiences and current intra- and interpersonal factors should be explored (Table 5).

Physical Examination
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.