SEXUAL DYSFUNCTION

Each phase of the sexual response cycle can be dysfunctional.

Desire  disorders.  Decreased   sexual  desire  is  the most    common  female  sexual

complaint.  It  may be  organic (e.g.,  low androgens), medication  related (e.g.,

selective   serotonin   reuptake    inhibitors  [SSRIs]),   or  psychological   (e.g.,  poor

partner relationship).  Treatment   can be  difficult   if  it  is  relational  in  etiology.

Flibanserin (Addyi),    a   serotonin   5-HT    receptor    agonist,    is  approved    for

premenopausal   women   with    hypoactive  sexual  desire  disorder    that    causes

distress.   Alcohol is  contraindicated due to  risk    of  severe  hypotension and

syncope.

Excitement  disorders.  This    usually results in  difficulty  in  vaginal

lubrication.    The most    common  cause   is  estrogen    deficiency. Treatment   is

highly  successful.

Anorgasmia. This    can be  primary or  secondary.  Inadequate  clitoral

stimulation is  the most    common  cause.  Treatment   is  highly  successful  using

initially   self-stimulation    then    partner education.

Dyspareunia.    Since   pain    with    intercourse may arise   from    both    psychological

or  physical    causes, a   thorough    history and physical    examination is  essential.

Treatment   is  directed    at  the specific    cause   found.

Vaginismus. This    occurs  with    painful reflex  spasm   of  the paravaginal thigh

adductor    muscles.    It  is  the only    sexual  dysfunction that    can be  diagnosed   on

physical    examination.    Treatment   is  highly  successful  using   vaginal dilators.