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sexual dysfunction

Etiology: - women* - hypoactive sexual desire disorder - screen for depression - atrophic vaginitis - estrogen receptor antagonists - parasympatholytic agents - delayed or absent orgasms - neurologic disorders - psychiatric disorder - diabetes mellitus - medications (may be same as men, see below) - dyspareunia * importance of sex to a woman predicts continued sexual activity in midlife [6] * women may adapt to menopausal changes by prioritizing different aspects of sexual activity [5] - men (also see impotence & erectile dysfunction) - peripheral vascular disease - neurologic disease - radiation therapy - spinal cord injury - autonomic dysfunction - surgery - medications - parasympatholytics - antihypertensives - antidepressants (bupropion is exception) - alcohol - psychogenic - relationship conflicts - performance anxiety - childhood sexual abuse - fear of STD - 'widower's syndrome' - hypogonadism - endocrine disorders - hypothyroidism - hyperthyroidism - hyperprolactinemia History: women 1) patient description of the problem 2) problem duration 3) onset: sudden vs gradual 4) problem specific to a situation or partner or generalized 5) likely precipitating event 6) problems in the relationship in which the sexual problem occurs 7) life stressors that may be contributory 8) guilt, depression or anger 9) physical problems such as pain 10) problems is desire, arousal or orgasm 11) history of physical, emotional, or sexual abuse 12) does the partner have sexual problems? Clinical manifestations: - postmenopausal women - atrophic vaginitis Laboratory: - only as indicated by differential diagnosis Management: - treat specific etiology - treat underlying illness - medication reconciliation - eliminate unnecessary medications - counseling - psychotherapy - cognitive behavioral therapy - treat depression - bupropion antidepressant of choice - smoking cessation - alcohol in moderation or not at all - postmenopausal women - decreased lubrication - longer foreplay - regular intercourse - topical estrogens - flibanserin for hypoactive sexual desire disorder - use limited by adverse effects [1] - do not treat female sexual disfunction with testosterone or phosphodiesterase-5 inhibitors [1]

Related

reproductive failure

Specific

dyspareunia ejaculatory dysfunction frequent erections hypersexuality hypoactive sexual desire disorder (HSDD); sexual interest/arousal disorder hypogonadism impotence male infertility sexual deviation disorder

General

reproductive system disorder

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Kingsberg S, Althof SE. Evaluation and treatment of female sexual disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May;20 Suppl 1:S33-43 PMID: 19440781
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Lindau ST, Schumm LP, Laumann EO et al A study of sexuality and health among older adults in the United States. N Engl J Med. 2007 Aug 23;357(8):762-74. PMID: 17715410
  5. Basson R, Wierman ME, van Lankveld J, Brotto L Summary of the recommendations on sexual dysfunctions in women. J Sex Med. 2010 Jan;7(1 Pt 2):314-26. PMID: 20092441
  6. Thomas HN et al. Sexual activity in midlife women: Importance of sex matters. JAMA Intern Med 2014 Feb 10 PMID: 24515395 http://archinte.jamanetwork.com/article.aspx?articleid=1828742
  7. Burri A, Spector T. Recent and lifelong sexual dysfunction in a female UK population sample: prevalence and risk factors. J Sex Med. 2011 Sep;8(9):2420-30. PMID: 21676186
  8. Bhasin S, Enzlin P, Coviello A, Basson R. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007 Feb 17;369(9561):597-611 PMID: 17307107
  9. Latif EZ, Diamond MP. Arriving at the diagnosis of female sexual dysfunction. Fertil Steril. 2013 Oct;100(4):898-904. Review. PMID: 24012196
  10. Thomas HN et al. Changes in sexual function among midlife women: "I'm older and I'm wiser". Menopause 2018 Mar; 25:286. PMID: 29088016