Evaluation and Management of Female Sexual Dysfunction
Patients often fail to bring it up, and clinicians may be reluctant to discuss it, but ignoring sexual dysfunction can disrupt a woman’s most intimate relationships.
EFFECTIVE TREATMENT INCLUDES MULTIPLE OPTIONS
Lifestyle modifications can help
Lifestyle changes may help improve sexual function. These modifications include physical activity, healthy diet, nutrition counseling, and adequate sleep.23,24
Identifying medical conditions such as depression and anxiety will help delineate differential diagnoses of sexual dysfunction. Cardiovascular diseases may contribute to arousal disorder as a result of atherosclerosis of the vessels supplying the vagina and clitoris. Neurologic diseases such as multiple sclerosis and diabetes can affect sexual dysfunction by impairing arousal and orgasm.
Identification of concurrent comorbidities and implementation of lifestyle changes will help improve overall health and may improve sexual function.25
,In addition, Herati et al found food sensitivities to grapefruit juice, spicy foods, alcohol, and caffeine were more prevalent in patients with interstitial cystitis and chronic pelvic pain.26 Avoiding irritants such as soap and other detergents in the perineal region may help decrease dysfunction.27 Finally, foods high in oxalate and other acidic items may cause bladder pain and worsening symptoms of vulvodynia.28
Topical therapies worth considering
Lubricants and moisturizers may help women with dyspareunia or symptoms of vaginal atrophy. For instance
Zestra, which contains a patented blend of botanical oils and extracts and is applied to the vulva prior to sexual activity, has been proven more effective than placebo for improving desire and arousal.29
Neogyn, a nonhormonal cream containing cutaneous lysate, has been shown to improve vulvar pain in women with vulvodynia. A double-blind placebo-controlled randomized crossover trial followed 30 patients for three months and found a significant reduction in pain during sexual activity and a significant reduction in erythema.30
Alprostadil, a prostaglandin E1 analogue that increases genital vasodilation when applied topically, is currently undergoing investigational trials.31,32
Patients can also choose from many OTC lubricants that contain water-based, oil-based, or silicone-based ingredients.
Continue to: Don't overlook physical therapy
