Review

Sexual dysfunction in women: Can we talk about it?

Stephanie S. Faubion, MD and Sharon J. Parish, MD
Cleveland Clinic Journal of Medicine May 2017, 84 (5) 367-376; DOI: https://doi.org/10.3949/ccjm.84a.16021

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    The intimacy-based female sexual response model suggests that while a woman may experience spontaneous sexual desire, a desire for emotional closeness or intimacy may also predispose her to engage in sexual activity. Biological, psychological, and sociocultural factors may adversely affect female sexual response.

    Adapted with permission from Basson R. Human sex-response cycles. J Sex Marital Ther 2001; 27:33–43.

Tables

  • TABLE 1

    Sexual function screening and assessment

    Are you currently sexually active? With men, women, or both?
    Do you have any sexual problems?
    How do you describe the problem(s)?
    Were there any triggering events? Are there exacerbating or alleviating factors?
    Is the problem specific to one situation or partner, or is it present in all situations and all partners?
    Are you experiencing any emotional problems that may affect your sexual function, such as stress, anxiety, depression, resentment, and guilt?
    Are you experiencing any physical problems that may affect your sexual function, such as pain, fatigue, and medical illness?
    Do you have any concerns about your relationship with your partner?
    Does your partner have any sexual problems?
    Specifically, do you have any distress related to:
     Your level of sexual desire or interest?
     Your ability to become or stay sexually aroused (vaginal lubrication, warmth or tingling feelings in genitals)?
     Your ability to experience, or the intensity of, orgasm?
    Are you experiencing any genital pain, specifically:
     Vaginal dryness or burning?
     Painful sexual activity (insertional or deeper pain)?
     Genital pain not associated with sexual activity?
    What treatments have you tried? How effective have they been?

    • Adapted with permission from Faubion S. Sexual dysfunction in women: a practical approach. Am Fam Physician 2015; 92: 281–288; and from Kingsberg S. Hypoactive sexual desire in women. Menopause 2013; 20:1284–1300.

  • TABLE 2

    A screening question for sexual dysfunction

    In the past 12 months, has there ever been a period of 3 months or more when you had any of the following problems or concerns? Check all that apply.
    You wanted to feel more interest in sexual activity
    You had difficulty with erections (penis getting hard or staying hard) (men only)
    Your vagina felt too dry (women only)
    You had pain during or after sexual activity
    You had difficulty having an orgasm
    You felt anxious about sexual activity
    You did not enjoy sexual activity
    Some other sexual problem or concern
    No sexual problems or concerns

    • Flynn KE, Lindau ST, Lin L, et al. Development and validation of a single-item screener for self-reporting of sexual problems in U.S. adults. J Gen Intern Med 2015; 30:1468–1475. Reproduced with permission of Springer.

  • TABLE 3

    Factors that can contribute to female sexual dysfunction

    Biological factors
    Medications, hormonal status, neurobiology, physical health, aging
    Psychological factors
    Depression, anxiety, self image, substance abuse, history of sexual abuse or trauma
    Sociocultural factors
    Upbringing, cultural norms and expectations, religious influences
    Interpersonal factors
    Relationship status and quality, partner sexual function, life stressors

    • Based on information in Althof SE, Leiblum SR, Chevret-Measson M, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med 2005; 26:793–800 and Rosen RC, Barsky JL. Normal sexual response in women. Obstet Gynecol Clin North Am 2006; 33:515–526.

  • TABLE 4

    Talking about sex: The PLISSIT model

    Permission: Give patient permission to speak about sexual health and validate her sexual choices and preferences (eg, legitimize her decision to participate in sexual activity on her own terms).
    Limited information: Provide basic sex education regarding anatomy, physiology, and normal sexual response; offer educational resources (eg, literature, videos, and erotica).
    Specific suggestions: Provide concrete suggestions to improve/enhance sexual function (eg, lubricant, vibrator or dilator use, self-stimulation, technical advice about sexual positioning, ways to increase emotional intimacy and communication).
    Intensive therapy: Validate patient’s sexual health concerns and refer to specialist (eg, individual, couples, or sex therapy).

    • PLISSIT = Permission, Limited Information, Specific Suggestions, and Intensive Therapy

    • Based on information in Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Educ Ther 1976; 2:1–15; Kingsberg S. Hypoactive sexual desire in women. Menopause 2013; 20:1284–1300; Faubion S. Sexual dysfunction in women: a practical approach. Am Fam Physician 2015; 92:281–288.

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