74 - Sexual Function and Dysfunction in the Female

Abstract

Female sexual function and dysfunction are important aspects of urologic practice. The female sexual response cycle is dependent on anatomic, hormonal, neuronal, and psychological factors. Female sexual dysfunction (FSD) is not an uncommon clinical entity. Patients are often reluctant to give information about sexual health–related issues. Physicians are responsible for bringing up the topic and screening for possible sexual dysfunction with the help of open-ended, gender-neutral questions and validated questionnaires. Special patient populations (such as transgender people and neurologically disabled individuals) also need to be evaluated in terms of sexual dysfunction, as sexual wellness is an important part of their quality of life (QoL). Physical examination and laboratory tests might provide clues regarding the etiology behind sexual dysfunction. The International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) represent the most widely used systems to define sexual dysfunctions in the female. Hypoactive sexual desire disorder (HSDD) is the most common type of FSD. Arousal disorder, orgasmic disorder, and pain disorder are the other main subtypes. Numerous medical conditions (cardiovascular, neurologic, psychiatric, endocrinologic, urogynecologic), medications, and the history of pelvic surgeries have been associated with increased likelihood of FSD. Psychological approaches, hormonal pharmacotherapy, and nonhormonal pharmacotherapy represent the mainstay of treatment. Surgical intervention is seldom necessary to treat FSD, though it might be of benefit in selected patients with chronic genital pain–related sexual issues. The active involvement of the patient's sexual partner in the diagnosis and treatment process may be necessary for a successful outcome.