Evaluating Sexual Dysfunction in Women

Sexual dysfunctions are common in women. However, they are detected rarely by their gynecologists in part because the patient, health care provider, or both may be reticent to raise the topic. This article attempts to provide diagnosis and treatment information about sexual function and dysfunction patterns for the purpose of providing more thorough patient care. Although the epidemiologic data about the incidence and prevalence of sexual dysfunction are sparse, there are several notable findings. Sexual dysfunctions are reported by women across the life span. Table 1 summarizes the data from a random probability sample of more than 1,600 women (age range, 18-59) of different racial and ethnic backgrounds (75% white, 12% black, 7% to 9% Hispanic, with a residual of 3%), educational, and economic levels. These data report "problems within the last year," with lack of sexual desire reported by nearly one third of the sample and orgasmic difficulties reported by nearly 25% of the sample.1 In a clinic-based sample of 329 healthy women (age range, 18-73) at an outpatient gynecologic clinic, 28% (figures rounded) were no longer sexually active. Overall, 38% of the women reported anxiety or inhibition during sex; 18% of the women reported frequent intercourse pain; and 58% of the women reported significant orgasm difficulties.2TABLE 1: Prevalence of Female Sexual Dysfunction by Age (N = 1,622) Another reported finding is that sexual relationship satisfaction is not exclusively determined by sexual functioning. In the study just mentioned, 68% of the women reported being somewhat to very satisfied with the overall sexual relationship despite their reported sexual difficulties.2 Similarly, happily married women have reported a rather high rate of sexual dysfunction (63% in one study).3 Women may tolerate a certain level of sexual dysfunction before calling it a problem or reporting marital dissatisfaction.