Women want sex Carey

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This is a corrected version of the article that appeared in print. Sexual dysfunction in women is a common and often distressing problem that has a negative impact on quality of life and medication compliance. The problem is often multifactorial, necessitating a multidisciplinary evaluation and treatment approach that addresses biological, psychological, sociocultural, and relational factors. Lifelong anorgasmia may suggest the patient is unfamiliar or uncomfortable with self-stimulation or sexual communication with her partner.

Delayed or less intense orgasms may be a natural process of aging due to decreased genital blood flow and dulled genital sensations. Treatment depends on the etiology. Estrogen is effective for the treatment of dyspareunia associated with genitourinary syndrome of menopause. Testosterone, with and without concomitant use of estrogen, is associated with improvements in sexual functioning in naturally and surgically menopausal women, although data on long-term risks and benefits are lacking.

Bupropion has been shown to improve the adverse sexual effects associated with antidepressant use; however, data are limited. Psychotherapy or sex therapy is useful for management of the psychological, relational, and sociocultural factors impacting a woman's sexual function. Clinicians can address many of these issues in addition to providing education and validating women's sexual health concerns. These sexual health concerns are not considered dysfunctions unless they cause distress. Enlarge Print.

Bupropion Wellbutrin in higher dosages mg twice daily has been shown to be effective as an adjunct for antidepressant-induced sexual dysfunction in women. Sildenafil Viagra may benefit women with sexual dysfunction induced by selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor use. Female genital sexual pain disorders are complex and most effectively managed with a comprehensive, multidisciplinary approach that addresses contributing biopsychosocial factors. Group cognitive behavior therapy has been shown to effectively treat low sexual desire.

Mindfulness-based interventions have been shown to effectively treat low sexual desire and arousal, and acquired anorgasmia. A [ corrected ]. Local vaginal estrogen therapy is recommended and preferred over systemic estrogen therapy for treatment of genitourinary syndrome of menopause and related dyspareunia when vaginal dryness is the primary concern. Because of potential adverse effects, the use of estrogens, especially systemic estrogens, should be limited to the shortest duration compatible with treatment goals.

Transdermal testosterone, with or without concomitant estrogen therapy, has been shown to be effective for short-term treatment of low sexual desire or arousal in natural and surgically induced menopause. The etiology of female sexual dysfunction is multifactorial, encompassing biological, psychological, relational, and sociocultural factors. Some chronic illnesses, such as vascular disease, diabetes mellitus, neurologic disease, and malignancy, can directly or indirectly impact sexual function Table 1.

Dermatologic conditions e. Gynecologic conditions e. Impact of hypertension or treatment is unclear; one study found an association with low desire. Increased problems with lubrication and orgasm. Malignancy and treatment e. Sexual function may be directly or indirectly impacted by cancer diagnosis and treatment; factors include cancer diagnosis, disease itself, treatment surgery, radiation, chemotherapyand body image.

Direct impact on sexual response; indirect effect on desire may be mediated by arousal disorders or pain. Desire may be increased or decreased. Dialysis is associated with sexual dysfunction; no data on which type of sexual dysfunction is affected. Information from references 3 and 4. Hormonal changes occurring in midlife may impact a woman's sexual function. Menopause is marked by a decline in ovarian hormone levels, which occurs gradually in natural menopause but may be sudden if menopause occurs because of surgery, radiation, or chemotherapy. Decreased vaginal lubrication and dyspareunia are associated with low estradiol levels; however, the association between low sexual desire and lower estradiol levels has been inconsistent.

Testosterone levels do not correlate with female sexual function or overall well-being, possibly because of the difficulty in accurately measuring free and total testosterone levels at the lower end of the female range. Serotonin-enhancing medications have an inhibitory effect on sexual function. Cardiovascular and antihypertensive medications. Beta blockers. Hormonal preparations. Gonadotropin-releasing hormone agonists.

Gonadotropin-releasing hormone analogues. Hormonal contraceptives. Ultra-low-potency contraceptives. Monoamine oxidase inhibitors. Selective serotonin reuptake inhibitors. Tricyclic antidepressants. Aromatase inhibitors. Chemotherapeutic agents.

Women want sex Carey

Histamine H 2 blockers and promotility agents. Phenytoin Dilantin. Adapted with permission from Buster JE. Managing female sexual dysfunction. Fertil Steril. The most common psychological factors impacting female sexual function are depression, anxiety, distraction, negative body image, sexual abuse, and emotional neglect. Common contextual or sociocultural factors that cause or maintain sexual dysfunction include relationship discord, partner sexual dysfunction e. Assessment of female sexual dysfunction is best approached using a biopsychosocial model eFigure Aand should include a sexual history and physical examination.

Laboratory testing is usually not needed to identify causes of sexual dysfunction. Biopsychosocial model of female sexual dysfunction. Various factors from different realms can promote or hinder normal sexual function. Sexual desire and hypoactive sexual desire disorder in women. Introduction and overview. Standard operating procedure SOP Part 1.

Women want sex Carey

J Sex Med. Standard operating procedures for female genital sexual pain. Arriving at the diagnosis of female sexual dysfunction. Your ability to experience or reach the desired intensity of an orgasm? Vaginal dryness or burning? Pain with sexual activity insertional or deeper pain?

Assess for genitourinary syndrome of menopause and pelvic floor muscle dysfunction. Information from reference 8. Women commonly report experiencing these as part of the same process. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. The symptoms in Criterion A cause clinically ificant distress in the individual.

The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress e. Lifelong : The disturbance has been present since the individual became sexually active. Acquired : The disturbance began after a period of relatively normal sexual function. Generalized : Not limited to certain types of stimulation, situations, or partners. Situational : Only occurs with certain types of stimulation, situations, or partners. Mild : Evidence of mild distress over the symptoms in Criterion A. Moderate : Evidence of moderate distress over the symptoms in Criterion A.

Severe : Evidence of severe or extreme distress over the symptoms in Criterion A. Reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.

Women want sex Carey

Arlington, Va. It is important to determine whether the patient's problem with desire or arousal is a dysfunction or a normal variation of sexual response. The following examples are not considered sexual dysfunction: a patient reports little or no spontaneous desire but continues to experience responsive desire; a patient maintains spontaneous or responsive desire but reports a desire discrepancy between herself and her partner; a patient has reduced physiologic sexual arousal e.

About one-half of women who do not consistently reach orgasm during sexual activity do not report distress. Does this difficulty occur during self-stimulation, partnered sexual activity, or both? Does this difficulty occur across different sexual activities e. Orgasmic difficulties may be lifelong present since sexual debut or acquired starting after a period of no dysfunction.

Lifelong anorgasmia may suggest the patient is unfamiliar or uncomfortable with self-stimulation or sexual communication with her partner, or lacks adequate sex education. These examples are not considered sexual dysfunction. The clinician should determine whether orgasmic difficulties occur only with certain types of stimulation, Women want sex Carey, or partners. If the patient reports difficulty during partnered sexual activity but not with self-stimulation, it may be the result of inadequate sexual stimulation.

This disorder of sexual pain is defined as fear or anxiety, marked tightening or tensing of the abdominal and pelvic muscles, or actual pain with vaginal penetration that is persistent or recurrent for at least six months. This may be lifelong or acquired after a period of no dysfunction. Although female sexual dysfunction often requires multidisciplinary treatment, even the initial visit can be beneficial. Table 5 summarizes the PLISSIT permission, limited information, specific suggestions, intensive therapy model for addressing sexual health with patients. Permission: Give patient permission to speak about her sexual health and to do what she is already doing sexually or may want to do.

Thank you for sharing. Many postmenopausal women report a decrease in sexual desire. Limited information: Provide basic accurate sex education e. After menopause you may experience more responsive desire than spontaneous desire. Specific suggestions: Provide simple suggestions to increase sexual function e.

Talk with your partner about how to be more intentional sexually. Intensive therapy: Validate the patient's concerns and refer her to a subspecialist see eTable A for resources. I'd like to refer you to someone with expertise in sexual health. Information from reference The unique predisposing, precipitating, and maintaining factors for a woman's sexual dysfunction will determine the treatment plan.

This pain may be described as a deeper pelvic pain associated with penetrative sexual activity, pain that radiates to the low back or inner thigh, or pain that persists for some time after vaginal penetration. Consistent painless sexual activity and sexual stimulation with the therapeutic use of a vibrator may also help maintain vaginal health. Psychotherapy or sex therapy is useful for women who have relational or sociocultural factors contributing to their pain, and for those who experience anxiety in conjunction with their pain.

Sexual pain during initial vaginal penetration may suggest inadequate sexual arousal before penetration, genitourinary syndrome of menopause formerly termed vulvovaginal atrophy24 or provoked vestibulodynia. Group cognitive behavior therapy may be effective for low sexual desire. Sexual health concerns are common in natural or surgically induced menopause, particularly sexual pain related to genitourinary syndrome of menopause. A Cochrane review showed that hormone therapy estrogen alone or in combination with a progestogen was associated with a small to moderate improvement in sexual function, especially pain, in symptomatic or early menopausal women.

The route of administration of estrogen can impact sexual function. Oral estrogens increase sex hormone—binding globulin, which reduces available free testosterone and may thereby adversely impact sexual function, whereas transdermal estrogens have no such effect.

Women with genitourinary syndrome of menopause and sexual pain may have dysfunctional pelvic floor muscles, which may become tense or tight as a result of ongoing vaginal dryness and discomfort or pain with sexual activity. Randomized controlled trials involving naturally or surgically menopausal women with low sexual desire or arousal have shown improvements in sexual function with transdermal testosterone therapy with or without concomitant estrogen therapy.

However, because of the lack of long-term data on safety and effectiveness, it does not recommend routine testosterone treatment for women with low androgen levels related to hypopituitarism, bilateral oophorectomy, or adrenal insufficiency. If therapy is initiated, clinical evaluation and laboratory monitoring of testosterone levels are suggested to evaluate for overuse and s of hyperandrogenism e. If a patient reports distress but does not meet criteria for sexual dysfunction, intervention is still needed.

Women who report low desire or arousal, difficulty with orgasm, or inadequate sexual stimulation may benefit from normalization, sexual health education, and referral to a sex therapist. The female sexual response cycle eFigure B is an important educational tool that clinicians can use when counseling women with sexual concerns. Women enter this cycle of sexual response with spontaneous sexual drive i.

Women want sex Carey

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