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Sexual Dysfunction 

Almost two-thirds of the women may have had sexual difficulties at some time. Fifteen percent of women experience pain with intercourse, 18-48% experience difficulty becoming aroused, 46% note difficulty reaching orgasm, and 15-24% are not orgasmic. 

            
  1. Clinical evaluation of sexual dysfunction. Sexual difficulty can be caused by a lack of communication, insufficient stimulation, a lack of understanding of sexual response, lack of nurturing, physical discomfort, or fear of infection.
  2.   Treatment of sexual dysfunction
    1.   Lack of arousal
      1.  Difficulty becoming sexually aroused may occur if there is insufficient foreplay or if either partner is emotionally distracted. Arousal phase dysfunction may be manifest by insufficient vasocongestion.
      2.  Treatment consists of Sensate Focus exercises. In these exercises, the woman and her partner take turns caressing each other's body, except for the genital area. When caressing becomes pleasurable for both partners, they move on to manual genital stimulation, and then to further sexual activity.
    2.   Lack of orgasm
      1.  Lack of orgasm should be considered a problem if the patient or her partner perceives it as one. Ninety percent of women are able to experience orgasm.
      2.  At-home methods of overcoming dysfunction
        1.   The patient should increase self-awareness by examining her body and genitals at home. The patient should identify sensitive areas that produce pleasurable feelings. The intensity and duration of psychologic stimulation may be increased by sexual fantasy.
        2.   If, after completing the above steps, an orgasm has not been reached, the patient may find that the use of a vibrator on or around the clitoris is effective.
        3.   Once masturbation has resulted in orgasm, the patient should masturbate with her partner present and demonstrate pleasurable stimulation techniques.
        4.   Once high levels of arousal have been achieved, the couple may engage in intercourse. Manual stimulation of the clitoris during intercourse may be beneficial.
    3.   Dyspareunia
      1.  Dyspareunia consists of pain during intercourse. Organic disorders that may contribute to dyspareunia include hypoestrogenism, endometriosis, ovaries located in the cul-de-sac, fibroids, and pelvic infection.
      2.  Evaluation for dyspareunia should include careful assessment of the genital tract and an attempt to reproduce symptoms during bimanual examination.
    4.   Vaginismus
      1.  Vaginismus consists of spasm of the levator ani muscle, making penetration into the vagina painful. Some women may be unable to undergo pelvic examination
      2.  Treatment of vaginismus
        1. Vaginal dilators. Plastic syringe covers or vaginal dilators are available in sets of 4 graduated sizes. The smallest dilator (the size of the fifth finger) is placed in the vagina by the woman. As each dilator is replaced with the next larger size without pain, muscle relaxation occurs.
        2.   Muscle awareness exercises
          1.   The examiner places one finger inside the vaginal introitus, and the woman is instructed to contract the muscle that she uses to stop urine flow. The woman then inserts her own finger into the vagina and contracts. The process is continued at home.
          2.   Once a woman can identify the appropriate muscles, vaginal contractions can be done without placing a finger in the vagina.
    1.   Medications that interfere with sexual function. The most common of medications that interfere with sexual function are antihypertensive agents, anti-psychotics, and antidepressants.
    Medication Decreased Libido Delayed or No Orgasm
    Amphetamines and anorexic drugs   X
    Cimetidine X  
    Diazepam   X
    Fluoxetine   X
    Imipramine   X
    Propranolol X  
 
Copyright © MD Milos Kupresak, 2007