Female Sexual Dysfunction

00:00 Hello. In this lecture we'll be addressing female sexual dysfunction, evaluation, and management.

00:08 Well, I don’t think you'll have a lot of test questions. This is valuable information as you start your rotations. Let's discuss the human sexual response. You may have read about Masters and Johnson. They were the first to describe the normal human response. First they said with sexual response that we have excitement, plateau, orgasm, and resolution. While this is very interesting, this only pertains to a man. The female sexual response is more complicated. It involves emotional intimacy, sexual stimuli, sexual arousal, arousal and sexual desire, emotional and physical satisfaction. A woman can enter their cycle at any point. She can also have spontaneous sexual drive. There are several factors in the biopsychosocial model of female sexuality. They include biology which can be an indication of her physical health, psychology which can be an indication of her emotional well-being, sociocultural which can actually refer to her upbringing and cultural expectations and interpersonal relationship that is the relationship she has with her partner and her family. There are different types of sexual dysfunction in the female and I doubt you'll have any test questions but they're good to know especially on your GYN rotations. The first I'd like to bring your attention to is HSDD or hypoactive sexual desire disorder. This is a deficiency or absence of sexual fantasies and a desire to be sexually active. You can also have sexual aversion disorder. This means that the patient actually wants to avoid sex or any contact at all with a partner. You can have female sexual arousal disorder which means that the patient cannot become aroused by normal stimuli, or you can have anorgasmia. This occurs in about 20% of the female population and this means a persistent or recurrent delay or absence of orgasm. Patients can also present with dyspareunia which is general pain associated with sexual intercourse.

02:25 This can be caused by vaginal dryness such as in women who are postmenopausal. Vaginismus is recurrent or persistent involuntary contractions that cause sex to be painful. Let's now talk about how these different disorders can overlap. That is to say you may have a patient who may have several of these disorders. Let's now talk about self-reported sexual problems. Patients may actually admit to having a lack of desire for sex. They may have arousal difficulties, inability to achieve climax or ejaculation, anxiety about sexual performance, they may have issues climaxing, they may have physical pain during intercourse or they may not find sex pleasurable at all and this is a problem if it bothers the patient. Let's now talk about the reproductive life span. When we are younger, we typically have a low incidence or prevalence of female sexual disorders; however, as we head towards the menopause we have more and more reported female sexual disorders. Let's now talk about how this presents. This can really have a negative impact on a women's life. It can also affect herself image. It can affect her mood and cause some depression and again it may strain relationships with partners. Let's now talk about how sexual health is important. Remember that sex is a vital and defying quality of life measure. Dysfunctions increase with age and can be aggravated during the perimenopause and menopause. There are effective interventions that are available but what I want you to remember from this lecture is that often physicians don’t ask, they're usually intimidated and are not sure how to refer patients if they do say they have a problem.