Gynaecological aspects of female sexual dysfunction

Abstract

There are many ways of defining female sexual dysfunction. Standard definitions usually include loss of libido, failure of arousal, inorgasmia, dyspareunia and vaginismus. There are many good reviews of female sexual dysfunction including the recent series in the BMJ under the title ‘ABC of Sexual Health’. In gynaecology, as in family planning, genitourinary medicine and general practice, patients do not fit into neat diagnostic categories and often do not present directly with a sexual or psychosexual difficulty. This article is not about neat categories or definitions. It is about the types of problem that we all come across in busy clinics when the sexual difficulties are seen as part of a wider picture and the physical problems also have to be addressed. A gynaecological complaint may simply be a ‘calling card’ that a patient uses in the attempt to find a health professional sensitive to the sexual problem which she has been unable to voice elsewhere. A woman may have fears or have illusions about her body following physical or physiological events that have occurred during her life. Psychosexual problems may not, however, be related in any way to gynaecological problems. The problem may be within the relationship with her partner or connected with other family matters, e.g. loss of a parent. The partner may have a problem such as impotence or premature ejaculation, yet the woman, with her ‘cry for help’, ends up in a hospital clinic having been unable to disclose the real problem elsewhere.