202b Precipitating factors contributing to female in .NET

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Table 202b Precipitating factors contributing to female
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Table 202a Predisposing factors contributing to female
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sexual dysfunction
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Biologic Endocrine disorders (hypo androgenism, hypoestrogenism, hyperprolactinemia, adrenal dysfunction, thyroid dysfunction, diabetes) Recurrent vulvovaginitis and/or cystitis Pelvic oor disorders: lifelong or acquired Drug treatments affecting biovailability of sex steroids or neurotransmitter levels Chronic diseases (cardiovascular, neurologic or psychiatric diseases, and so on) Benign diseases (eg endometriosis) predisposing to iatrogenic menopause and dyspareunia Persistent residual conditions (eg dyspareunia/chronic pain associated with endometriosis) Psychosexual Inadequate/delayed psychosexual development Borderline personality traits Previous negative sexual experiences: sexual coercion, violence, or abuse Body image issues/concerns Affective disorders (dysthymia, depression, mania) and anxiety disorders Inadequate coping strategies Inadequate sexual education Contextual Ethnic/religious/cultural messages, expectations, and constraints regarding sexuality Social ambivalence towards sexual activity, when separated from reproduction or marriage Negative social attitudes towards female contraception Low socioeconomic status/reduced access to medical care and facilities Support network Modi ed from Graziottin (2005) [75]
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sexual disorder
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Biologic Negative reproductive events (unwanted pregnancies, abortion, traumatic delivery with damage of the pelvic oor, child problems, infertility) Postpartum depression Vulvovaginitis/sexually transmitted diseases Sexual pain disorders Age at menopause Premature ovarian failure (POF) menopause before age 40 Premature menopause menopause between age 40 and 45 Biologic vs surgical menopause (especially for premature menopause) Surgical menopause Androgen (besides estrogen) loss Associated disorder/disease Extent and severity of menopausal symptoms and impact on well-being Current disorders Current pharmacologic treatment Substance abuse (mainly alcohol and opiates) Psychosexual Loss of loving feelings toward partner Unpleasant/humiliating sexual encounters or experiences Affective and anxiety disorders Relationship of fertility loss to ful llment of life goals Contextual Relationship discord Life-stage stressors (eg child s diseases, divorce, separation, partner in delity) Loss or death of close friends or family members Lack of access to medical/psychosocial treatment and facilities Economic dif culties Modi ed from Graziottin (2005) [75]
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Sexual distress should be distinguished from nonsexual distress and from depression The degree of reported distress may have implications for the woman s motivation for therapy and for prognosis
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Physical Examination
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An accurate physical examination in any FSD complaint is important The appropriate evaluation of
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potential medical factors, endocrinologic, vascular, dysmetabolic, neurologic, neuroimmunologic or iatrogenic factors, as well as the neglected role of pelvic oor disorders in contributing to and maintaining FSD, is essential to avoid both a systematic medical omission and a gender bias [1 7,12,17,72 76] What to look for while examining the patient and the key potential ndings and associated co-morbidities
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Classi cation, Etiology, and Key Issues in Female Sexual Disorders
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Table 202c Maintaining factors contributing to female
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Biologic Diagnostic omissions: unaddressed predisposing/precipitating biologic etiologies Untreated or inadequately treated co-morbidities: Physical: pelvic oor disorders Urologic: incontinence, lower urinary tract symptoms, urogenital prolapse Proctologic: constipation, rhagades Metabolic: diabetes Psychiatric: depression, anxiety, phobias Pharmacologic treatments Substance abuse Multisystemic changes associated with chronic disease or secondary to menopause Hormonal Vascular Muscular Neurologic Immunologic Contraindications to hormone therapy (HT) Inadequacy of HT in ameliorating menopause-associated biologic symptoms Psychosexual Low or loss of sexual self-con dence Performance anxiety Distress (personal, emotional, occupational, sexual) Diminished affection for, or attraction to, partner Unaddressed affective disorders (depression and/or anxiety) Negative perception of menopause-associated changes Body image concerns and increased body changes (wrinkles, body shape/weight, muscle tone) Contextual Omission of FSD investigation from provider s diagnostic and therapeutic approach Lack of access to adequate care Partner s general health or sexual problems or concerns Ongoing interpersonal con ict (with partner or others) Environmental constraints (lack of privacy, lack of time) Modi ed from Graziottin (2005) [75]
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will be detailed in each subchapter related to women s sexual problems In addition, there is information concerning addressing FSD in both s 26 and 27
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Key point
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An interdisciplinary team is a valuable resource for a patient-centered approach, both for diagnostic accuracy and tailored treatment Disciplines that may take part in such a team of professional gures, or be available for referral, include medical sexologist, gynecologist, urologist, psychiatrist, endocrinologist, psychologist, anethesiologist, neurologist, proctologist, dermatologist, psychotherapist (individual and couple), sex therapist, and physical therapist This latter professional is emerging as a key resource in addressing pelvic oor disorders Clearly not all are needed in any team or for a particular consultation
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