Female Sexual Health Evaluation
Women’s sexual health is an often under-addressed area
of concern by physicians; and female patients don’t often
share their questions or problems with their doctor.
Whether it be from a lack of interest, insight or ability to help,
sexuality is often ignored, even though it is the most personal
aspect of one’s life.
Talking about Sexual Health
Women often don’t talk about their sexual concerns or needs
with their partners, and sometimes aren’t even sure what brings themselves the most sexual satisfaction. Historically, women with problems related to sexual desire, intimacy, climax and orgasm, have been told that the problem is “in their head” or psychological. However, it is our psychology colleagues who have done much of the ground-breaking research to show that it is not all psychological or emotional, but physiologic and physical.
Problem in female sexuality are extremely common, and are underreported. Women can have problems with lubrication, feelings of attractiveness, problems achieving intimacy, lack of sexual desire, inability to become aroused, inability to achieve an orgasm or an orgasm as intense as one would like, and suffer from pain which affects sexual pleasure.
Sexual Health Evaluation
The sexual health evaluation begins with a detailed medical, surgical, social and psychologic history. In an attempt to uncover possible biological problems causing or contributing to sexual dysfunction, Dr. Boyle will evaluate each patient for high blood pressure, elevated cholesterol, diabetes, thyroid dysfunction, hormonal abnormalities including menopause, and identify risk factors like tobacco use, drug use, alcohol use, medications which may contribute. She will perform a physical examination and perform laboratory testing for diagnostic purposes.
Dr. Boyle encourages partner involvement in the evaluation, diagnostic and treatment processes. She often performs couples based evaluations, and conducts basic couples counseling.
Treatment of Women's Sexual Health
The treatment of women’s sexual health concerns begins with the identification and correction of possible reversible causes, and then continues to include first-line and second-line treatments. Modification of reversible causes may include couples counseling, sex therapy, physical therapy with biofeedback, changes in lifestyle such as diet, smoking cessation, exercise, changing or discontinuing certain prescription medications, evaluation and treatment of any sexual dysfunction in one’s partner.
First-line therapies may include hormone therapy with testosterone, estrogen, progesterone; dopamine agonists, oral phosphodiesterase-5 inhibitors, and clitoral vacuum device treatment. Second –line treatments are only considered when first-line have failed and may include surgical procedures such as vestibulectomy.
Below are a listing of the definitions used to classify female sexual dysfunction.
Hypoactive Sexual Desire Disorder (HSDD)
Persistent or recurrent deficiency and/or absence of sexual fantasies/thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress.
Sexual Aversion Disorder
Persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress.
Sexual Arousal Disorder (FSAD)
Persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress. It may be expressed as a lack of subjective excitement, or a lack of genital lubrication, or swelling, or other somatic responses.
Persistent Genital Arousal Disorder / Persistent Sexual Arousal Syndrome
A sub classification of female sexual arousal disorder, PGAD or PSAS is defined as feelings of spontaneous, persistent and intense genital arousal with or without orgasm, with or without genital engorgement, in the absence of sexual desire.
Orgasmic Disorder
Persistent or recurrent difficulty, delay in or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress.
Sexual Pain Disorders
Dyspareunia: Recurrent or consistent genital pain associated with genital intercourse.
Vaginismus: Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration which causes personal distress.
Coital Sexual Pain Disorder: Recurrent of persistent genital pain induced by non-coital sexual stimulation.
Female Androgen Insufficiency Syndrome
A pattern of clinical symptoms in the presence of decreased bioavailable testosterone and normal estrogen status. Free testosterone values should be at or below the lowest quartile of the normal range. Clinical symptoms include:
diminished sense of well-being or dysphoric mood persistent, unexplained fatigue sexual function changes including decreased libido, sexual receptivity and pleasure, bone loss, decreased muscle strength and
changes in cognition or memory.
Definitions of Female Sexual Dysfunction (FSD) are from the American Foundation for Urologic Disease (AFUD) International Consensus Panel, Boston, USA 1998.
Karen Elizabeth Boyle, M.D.
Reproductive Medicine & Surgery, Sexuality and Aesthetics
Contact Us
Karen E. Boyle, M.D.
Phone: 410-825-5454
Fax: 410-825-5811
Chesapeake Urology Associates at Greater Baltimore Medical Center (GBMC)
Physicians Pavilion North
6535 North Charles Street, Suite 625
Baltimore, MD 21204
