Sexual dysfunction in women: A practical approach

Sexual dysfunction in women is a common and often distressing problem that has a negative impact on quality of life and medication compliance. The problem is often multifactorial, necessitating a multidisciplinary evaluation and treatment approach that addresses biological, psychological, sociocultural, and relational factors. Criteria for sexual interest/arousal disorder require the presence of at least three specific symptoms lasting for at least six months. Lifelong anorgasmia may suggest the patient is unfamiliar or uncomfortable with self-stimulation or sexual communication with her partner. Delayed or less intense orgasms may be a natural process of aging due to decreased genital blood flow and dulled genital sensations. Genito-pelvic pain/penetration disorder includes fear or anxiety, marked tightening or tensing of the abdominal and pelvic muscles, or actual pain associated with attempts toward vaginal penetration that is persistent or recurrent for at least six months. Treatment depends on the etiology. Estrogen is effective for the treatment of dyspareunia associated with genitourinary syndrome of menopause. Testosterone, with and without concomitant use of estrogen, is associated with improvements in sexual functioning in naturally and surgically menopausal women, although data on long-term risks and benefits are lacking. Bupropion has been shown to improve the adverse sexual effects associated with antidepressant use; however, data are limited. Psychotherapy or sex therapy is useful for management of the psychological, relational, and sociocultural factors impacting a woman’s sexual function. Clinicians can address many of these issues in addition to providing education and validating women’s sexual health concerns.