Female sexual dysfunction in obstetrics and gynecology

Abstract

Sexual dysfunction in women is common, with a community prevalence of 30% to 50%. The sexual response cycle in women is complex, with multiple overlapping dimensions, which necessitates a biopsychosocial approach for understanding the basis of dysfunction. Physiological events such as pregnancy, childbirth, menopause, aging as well as gynecological conditions like infertility, prolapse, urinary incontinence, and gynecological cancers, have an impact on sexual well-being. The interaction of these conditions with sexual health needs to be better understood to deal effectively with the problems as a whole. However, the woman concerned should be sufficiently distressed by her problem for the diagnosis of female sexual dysfunction to be made. Overall, gynecological surgery performed to alleviate symptoms which have an organic basis have the potential to improve sexual function, and this does not necessarily correlate with the anatomical outcome of the surgery. Hysterectomy done by any approach does not compromise sexual function. Sexual health enquiry and evaluation in clinical practice can be done with the help of simple screening questions, a comprehensive history followed by an adequate examination. As no single laboratory test is recommended as a marker of sexual dysfunction, investigations are best dictated by clinical judgment. Detailed assessment tools in the form of self-report questionnaires and diagnostic tests for objective measures of sexual dysfunction could be used in special circumstances. Therapy entails understanding the point of break in the sexual response cycle and the underlying pathophysiology. While there are multiple treatment options available, integrated therapy which deals with both the psyche and the soma yield best results. Sexual counseling plays a vital role when therapy becomes necessary.