gynecology and obstetrics
Overview of Female Sexual Function and Dysfunction
Diagnosis of Female Sexual Dysfunction
Interview with the woman and, sometimes, her partner Pelvic examination Most sexual dysfunction disorders are diagnosed based on clinical criteria described by the DSM-5-TR. These disorders include genito-pelvic pain/penetration disorder, female orgasmic disorder, female sexual interest/arousal disorder, and substance/medication–induced sexual dysfunction. For diagnosis of all of these disorders, there must be no more likely alternative explanation for symptoms; for all except substance/medication–induced sexual dysfunction, symptoms must have been present for ≥ 6 months. If sexual dysfunction does not meet criteria for any of these disorders, dysfunction is categorized as other specified or unspecified sexual dysfunction according to DSM-5-TR. Diagnosis of sexual dysfunction and its causes is based on medical history and physical examination. Clinicians should routinely ask about sexual dysfunction to help decrease any related stigma. Validated questionnaires, such as the Female Sexual Function Index (FSFI), can help facilitate this practice ( Diagnosis reference ). History can be taken in an interview with the woman and, sometimes, her partner; it begins by asking the woman to describe the problem in her own words and should include specific elements (see table). Clinicians should also obtain a detailed sexual history. Problematic areas (eg, past negative sexual experiences, negative sexual self-image) identified at the first visit can be investigated more fully at a follow-up visit. Physical examination, including the pelvic examination, is done to identify any gynecologic abnormalities that may be causing sexual dysfunction; this examination can often pinpoint the location of pain. The technique may differ slightly from that used in a routine gynecologic examination. Explaining what will occur during the examination helps the woman relax and should be continued throughout the examination. The clinician may ask the woman whether she wants to sit up and view her genitals in a mirror during the examination; doing so may support a sense of control. During the examination, the clinician should look for signs of lowestrogen, particularly thinning of labia minora, loss of the labial fat pad, pale vaginal mucosa, and loss of vaginal folds. A moist cotton swab can be used to identify pain points on the vulva and vulvar vestibule. and chlamydiae are indicated when history or examination suggests vulvitis, Overview of Vaginitis , or levels, regardless of how they are measured. However, if hyperprolactinemia is clinically suspected, the prolactin level is measured. If a thyroid disorder is clinically suspected, appropriate testing is done; it includes thyroid-stimulating hormone if Hypothyroidism is suspected, thyroxine (T4) if 1.Rosen R, Brown C, Heiman J, et al: The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.J Sex Marital Ther26(2):191-208, 2000. doi:10.1080/009262300278597 