Causes
Sexual dysfunction in females can have biopsychosocial roots:
- Biological:
- Hormonal changes (menopause, pregnancy, thyroid disorders).
- Chronic illnesses (diabetes, cardiovascular disease, CKD).
- Medications (antidepressants, antihypertensives).
- Pelvic conditions (endometriosis, pelvic floor dysfunction, vaginal atrophy).
- Psychological:
- Stress, anxiety, depression.
- History of trauma or abuse.
- Body image concerns.
- Social:
- Relationship issues (communication, conflicts).
- Sociocultural factors (stigma, cultural beliefs).
Diagnosis
- Comprehensive History:
- Focus on onset, duration, specific symptoms (e.g., low libido, pain, arousal issues).
- Evaluate relationship dynamics and psychological factors.
- Identify any medication or chronic disease impact.
- Physical Examination:
- Assess for signs of atrophy, infections, or pelvic floor issues.
- Rule out structural anomalies.
- Psychosocial Assessment:
- Screen for mental health conditions or relational challenges.
- Use tools like the Female Sexual Function Index (FSFI).
Differential Diagnosis
- Hypoactive Sexual Desire Disorder (HSDD).
- Arousal Disorders (e.g., vaginal dryness due to oestrogen deficiency).
- Orgasmic Disorders.
- Genito-Pelvic Pain/Penetration Disorder:
- Includes dyspareunia and vaginismus.
- Sexual aversion disorder (often linked with trauma).
Investigations
- Laboratory Tests:
- Hormonal panels (oestradiol, FSH, testosterone).
- Thyroid function tests.
- Glucose and HbA1c for diabetes screening.
- Imaging:
- Pelvic ultrasound if anatomical issues are suspected.
- Psychological Tools:
- Depression and anxiety scales (e.g., DASS-21, GAD-7).
5. Management (Rx and Mx)
- Lifestyle and Education:
- Promote healthy diet, exercise, and stress management.
- Educate about normal sexual changes with aging.
- Medical Treatment:
- Vaginal Oestrogens: For atrophic symptoms.
- Lubricants and Moisturizers: Address dryness.
- Medications: Consider hormonal therapy for HSDD
- Psychological Therapies:
- Cognitive-behavioural therapy (CBT) or sex therapy.
- Address trauma through appropriate counselling.
- Relationship Interventions:
- Couple’s therapy.
- Enhance communication and intimacy.
- Referrals:
- Specialist (gynaecologist, endocrinologist, or psychiatrist) for complex cases.
6. Preventive and Supportive Care
- Normalize discussions about sexual health during consultations.
- Screen for associated psychosocial issues and encourage open dialogue.
- Promote early intervention for related chronic conditions like diabetes or depression.
This holistic approach to diagnosis and management ensures both physical and emotional aspects are addressed, enhancing patient care in general practice.