Questioning the patQuestioning the patient about what she thinks is causing the problem may add insight. She may reveal fear of redeveloping an abnormal Papanicolaou smear from penile penetration, or she may admit that she is not attracted to her partner.
Medical conditions are a frequent source of direct or indirect sexual difficulties. Vascular disease associated with diabetes might preclude adequate arousal; cardiovascular disease may inhibit intercourse secondary to dyspnea (Table 1)"1Arthritis or urinary incontinence may cause discomfort or embarrassment, leading to dysfunction or decreased sexual activity.2Aggressive treatment of long-term disease and minor ailments, with attention to their sexual implications, will help enhance sexuality.
Prescription and over-the-counter medications, illicit drugs and alcohol abuse contribute to sexual dysfunction9,10 (Table 2).10Med10Medication changes, drug discontinuation, or dosage or schedule alterations may provide relief. Cigarette smoking, known to cause erectile dysfunction in men, may have a similar negative effect on arousal in women.
Gynecologic conditions contribute physically to sexual difficulties (Table 3)nd treatment must and treatment must address both of these issues. For example, treatment of a patient with recurrent cystitis as a cause of dyspareunia should include the use of lubricants and distraction techniques at first intercourse to assure adequate lubrication and relaxation, respectively. For patients with a female partner, details concerning sexual habits and objects of penetration, if any, are necessary. In these instances, hygienic use of vibrators may result in fewer episodes of cystitis.
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