Abstract

Sexual dysfunction is more common in women (43%) than men (31%), and the evaluating physician must consider the individual's chronological and physiologic age, personal and interpersonal sexual experiences, life events, and relationship issues that may have an effect on female sexual health. The medical history should include focused questions about medical and/or surgical illnesses, use of medications, and urogynecological history. Validated, reliable, standardized questionnaires are useful to identify the presence or absence of various domains of female sexuality such as sexual desire, sexual arousal, orgasm, and/or sexual pain (eg, the Female Sexual Function Index). Serum hormone testing should be dictated by clinical suspicion, and the physician also may assess multiple androgen and estrogen values, as well as pituitary function and levels of thyroid stimulating hormone. Systemic androgens (eg, systemic dehydroepiandrosterone and/or systemic testosterone) may improve mood, energy, stimulation, sensation, arousal, and orgasm in women with sexual health concerns. Combining a biomedical and psychosocial approach to any kind of sexual dysfunction helps to optimize patient outcomes. In the case of hypoactive sexual desire disorder (HSDD), individual or couples-based therapy with a sexual health therapist should be part of the consultation. If the biologic basis of the sexual health concern can be diagnosed by history, physical examination, laboratory testing, and directed imaging studies, then management can be directed to evidence-based management strategies.

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