Female sexual dysfunction = a new schematic educational and clinical tool with enhanced etiology and classification

Abstract

Summary Rising awareness for women's health has also drawn increased focus on female sexual health. Improved diagnostic sexual medicine instruments are increasingly becoming available for addressing women's sexual function and dysfunction. The present article presents a new schematic biopsychosocial holistic “tool” that comes to narrow the existing educational and therapeutical instrumentation gap. This schematic is applied in a regular gynecological office environment with medical and physician assistant (PA) students, as well as gynecological residents, in managing patients’ sexual health problems both face-to-face and by telemedicine. The proposed new “tool” that incorporates the classification, etiology, and treatment (including medications) of the various female sexual dysfunctions, also offers the following practical recommendations: (1) to add “structural discomfort with sexual intercourse” due to pelvic organ prolapse (POP) and urinary incontinence, as a fifth, general form of women's sexual disorders; (2) to add “positional dyspareunia” as a third, specific, form of sexual pain dysfunction; (3) to integrate genitourinary syndrome of menopause (GSM) and sexual desire dysfunction into one comprehensive etiologically diagnostic and therapeutically indicative entity named “sex steroids insufficiency syndrome of menopause (SISM).” This terminological addition should not interfere with the GSM acronym that mostly concentrates on the physical urogenital changes of menopause, including dyspareunia. (“Tool” peer-testing is advisable for establishing utility). The pros and cons for the pointedly specific medicalization of sexuality and its influence on patient categorization, are also examined.