Chapter 17 – Female Sexual Interest and Arousal Disorder (FSIAD)

Female sexual dysfunction

Female sexual function is complex, as can be appreciated by the evolution of our understanding and models of function (described above). Logically, sexual dysfunction in women is therefore also often multifaceted, usually with several factors contributing to the problem. When diagnosing and treating sexual dysfunction in women, it is important to identify the particular issues and contributing factors in each individual case and employ targeted strategies. Consider what is driving the presentation, and whether these issues are causing them distress or if they are distressing to their partner and/or relationship.

The most common female sexual dysfunctions are:

lack of libido (reduced desire) lack of arousal orgasmic disorders sexual pain/dyspareunia

It is common to have more than one female sexual disorder present. Any overlap may make it difficult to attribute symptoms and signs to different diagnostic categories (see Table 17.1 and Table 17.2).

Table 17.1 Medical Conditions that may affect female sexual function

Conditions Effect  Diabetes  Impaired arousal and orgasm  Hypothyroidism  Decreased desire  Hypertension(7) Reduced vaginal lubrication

Less frequent orgasm

Increased sexual pain Cardiovascular disease(8) Reduced desire 

Impaired blood flow 

Reduced arousal response  Neurological disease e.g. Parkinson’s disease, multiple sclerosis, injury  Impaired arousal and orgasm  Decreased androgens e.g. age  Decreased desire  Decreased oestrogens e.g. menopause, chemotherapy  Vaginal atrophy and dryness  Hyperprolactinaemia e.g. prolactinoma, medications  Decreased arousal and orgasm  Pelvic floor weakness or injury  Decreased arousal ... Buy now

Sexual history taking

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Physical examination and investigations

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Overall management approaches

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