gynecology and obstetrics
Overview of Female Sexual Function and Dysfunction
Key Points
Female sexual dysfunction includes female sexual interest/arousal disorder, female orgasmic disorder, genito-pelvic pain/penetration disorder, substance/medication–induced sexual dysfunction, and other specified and unspecified disorders. Psychological and physical factors usually contribute to female sexual dysfunction; they may interact with each other, worsening dysfunction. Psychological factors include mood disorders, effects of past experiences, concerns about a negative outcome, the woman's specific circumstances (eg, low sexual self-image), and distractions. Physical factors include genital conditions, systemic and hormonal factors, and medications (particularly SSRIs). Interview the woman and, sometimes, her partner. Incorporate psychological therapies (eg, cognitive-behavioral therapy, mindfulness, a combination of the two [MBCT]) into treatment for most types of female sexual dysfunction. When indicated, use medications (eg, an estrogen) to treat some types of female sexual dysfunction. Recommend pelvic floor physical therapy, a mainstay of treatment for genito-pelvic pain/penetration disorder, and discuss which kinds of lubricants women should use if lubricants are needed. 