Management strategies for pain disorders include treatment of underlying gynecologic conditions such as endometriosis, physical therapy to teach relaxation of the pelvicfloor musculature, perineal hygiene to relieve dry, inelastic external genitalia, and estrogen to treat atrophic changes.
TABLE 1
Types of female sexual dysfunction
| TYPE* | SYMPTOMS | TREATMENT | COMMENTS |
|---|---|---|---|
| Disorders of desire or libido: –Hypoactive sexual desire disorder (HSDD) –Sexual aversion disorder (SAD) | HSDD: Deficiency or absence of sexual fantasies or desire SAD: Phobic aversion to and avoidance of sexual contact with a partner | HSDD: Trial of testosterone in deficient women. Modify medications for underlying diseases SAD: Refer for psychologic counseling | Most women with low libido and normal ovarian function will not respond to normal levels of testosterone treatment |
| Disorders of arousal | Inability to attain or maintain sexual excitement | Treat underlying physical disorder. Consider sildenafil, local vasodilating agents, and appropriate estrogen replacement. Refer for psychologic/sexual counseling | Isolated arousal disorders are uncommon in women |
| Orgasmic disorders | Primary: The patient has never experienced orgasm Secondary: The patient has recently become anorgasmic | Correct underlying pharmacologic problem (change of dosage or medication) and/or refer for psychologic/sexual counseling | Look for over-thecounter and herbal supplements as etiologies as well |
| Pain disorders –Dyspareunia –Vaginismus –Noncoital sexual pain | Dyspareunia: Genital pain with intercourse Vaginismus: Involuntary spasm of the muscles comprising the outer third of the vagina Noncoital pain: Genital pain with noncoital sexual stimulation | Correct underlying perineal trauma (eliminate soaps and harsh chemicals) and medical conditions (infection and endometriosis). Try physical therapy (pelvic-floor biofeedback). Refer for counseling | Pelvic pain is multifactorial. Search for history of molestation or abuse in these women |
| *These categories also may be classified according to the etiology of the disorder and whether it is lifelong or acquired, generalized or situational. | |||
TABLE 2
Medications* and medical conditions that may affect sexual functioning
| MEDICATIONS | |
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| MEDICAL AND OTHER CONDITIONS | |
| Organic disorders | Chronic diseases |
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| Conditions | |
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| *Source: The Medical Letter. 1992;43(August 7). | |
The author reports no financial relationship with any companies whose products are mentioned in this article.