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Chapter 049. Sexual Dysfunction (Part 8)

Female Sexual Dysfunction: Treatment General An open discussion with the patient is important as couples may need to be educated about normal anatomy and physiologic responses, including role of orgasm in sexual encounters. Physiologic changes associated with aging and/or disease should be explained. Couples may need to be reminded that clitoral stimulation rather than coital intromission may be more beneficial. Behavioral modification and nonpharmacologic therapies should be a first step. Patient and partner counseling may improve communication and relationship strains. Lifestyle changes involving known risk factors can be an important part of the treatment process. Emphasis on maximizing physical health and. | Chapter 049. Sexual Dysfunction Part 8 Female Sexual Dysfunction Treatment General An open discussion with the patient is important as couples may need to be educated about normal anatomy and physiologic responses including role of orgasm in sexual encounters. Physiologic changes associated with aging and or disease should be explained. Couples may need to be reminded that clitoral stimulation rather than coital intromission may be more beneficial. Behavioral modification and nonpharmacologic therapies should be a first step. Patient and partner counseling may improve communication and relationship strains. Lifestyle changes involving known risk factors can be an important part of the treatment process. Emphasis on maximizing physical health and avoiding lifestyles e.g. smoking alcohol abuse and medications likely to produce FSD is important Table 49-2 . The use of topical lubricants may address complaints of dyspareunia and dryness. Contributing medications such as antidepressants may need to be altered including the use of medications with less impact on sexual function dose reduction medication switching or drug holidays. Hormonal Therapy In postmenopausal women estrogen replacement therapy may be helpful in treating vaginal atrophy decreasing coital pain and improving clitoral sensitivity Chap. 342 . Estrogen replacement in the form of local cream is the preferred method as it avoids systemic side effects. Androgen levels in women decline substantially before menopause. However low levels of testosterone or DHEA are not effective predictors of a positive therapeutic outcome with androgen therapy. The widespread use of exogenous androgens is not supported by the literature except in select circumstances premature ovarian failure or menopausal states and in secondary arousal disorders. Oral Agents The efficacy of PDE-5 inhibitors in FDS has been a marked disappointment given the proposed role of nitric oxide-dependent physiology in the normal female sexual .