Female Sexual Dysfunction
Screening
Screening for sexual dysfunction should be considered part of the routine history and physical. This can be done during the review of systems (when discussing contraception, STD's, etc.) and the patient told that this is something you ask everyone. The exact words used will vary from practitioner to practitioner; most people eventually find a phrase that they are comfortable with. Examples include: "Do you have any sexual concerns that you would like to discuss?" "Do you ever have pain with intercourse? Do you have any difficulties getting aroused or having an orgasm?"
In specific situations, more detailed questions can be asked. For example:
- "One of the possible effects of multiple sclerosis is that it can be harder to have an orgasm? Has this been the case for you?"
- "Sometimes, but by no means always, people on drug x note changes in their sexual functioning. Has this happened to you?"
- "Women in perimenopause sometimes notice that their sex drive changes; have you noticed anything along those lines?"
- "Sometimes after menopause women notice that vaginal dryness makes intercourse uncomfortable. Has this been a problem for you?"
In a new patient, one would also want to ask about a history of sexual trauma. Again, one can explain that this is a routine question so that the patient doesn't think that the fact she has been abused is written on her forehead for all the world to see. "This is a question I ask all my patients. Have you ever had any unpleasant sexual experiences? For example, have you ever been molested or fondled as a child? Have you ever experienced date rape or otherwise been forced to have sex against your wishes?" The exact words used matter less than the tone used which should convey that this is a topic she can talk about with her doctor. If a history of abuse is disclosed, then ascertain whether or not the patient has dealt with the situation or should be referred for counselling.
A screening sexual history is also a good opportunity to practice preventive medicine. For example, asking post-partum patients at their six-week visit about dyspareunia and explaining what is normal and what isn't can prevent long-term vaginismus. Sexual dysfunctions are much more easily treated, either by oneself or by a therapist, when they are of short duration than after years of problems where physical causes and psychological overlay are so entwined that it is difficult to disentangle the various threads of the situation.
Last Modified: September 5, 2006
