Sexual Hormone Therapy


Sex, Sexuality and Sexual Dysfunction

Good sexual health starts with having good general health, good self-esteem and a good attitude. Sexuality involves the ability to have erotic experiences. Healthy sexual behavior involves more than just intercourse. It ranges from pleasurable activities, such as holding hands to the most intimate of acts, oral sex, and more between consenting adults.

We have progressed from a sexually inhibited society to one that is inundated with sex. Yet despite the importance that sex plays in our lives, not everyone is sexually satisfied. According to a 1999 JAMA study, 43% of women reported having sexual dysfunction. Sexual dysfunction may be lifelong, acquired, situational or generalized.

According to the American Psychiatric Association, DSM 5, female sexual disorder includes: (1) female orgasmic disorder, (2) female sexual interest/arousal disorder as well as (3) genito-pelvic pain/penetration disorder.  Symptoms must be present for a minimum of six months and must not be explained by any other nonsexual, medication or medical condition.

Female Orgasmic Disorder

  • Requires the presence of either of the following on all or almost all (75% to 100%) occasion of sexual activity.
    • Marked delay in, marked infrequency of, or absence of orgasm.
    • Markedly reduced intensity of orgasmic sensations.
  • Orgasm has many purposes. It serves to:
    • Reconnect you with your partner.
    • Revive your energy.
    • Improve your mood.
    • Release oxytocin which improves your sleep.
  • 33 to 50% of women have infrequent orgasms.
  • 10% of women have never experienced an orgasm (Kinsey, Sexual Behavior in the Human Female, 1953).

Sexual Interest/Arousal Disorder

  • Is the lack of, or significantly reduced, sexual interest/arousal as manifested by three of the following:
    • Absent/reduced interest in sexual activity.
    • Absent/reduced sexual/erotic thoughts or fantasies.
    • No/reduced initiation of sexual activity and unreceptive to partner’s attempt to initiate.
    • Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (75% to 100%) sexual encounters.
    • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (written, verbal, visual).
    • Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (75% to 100%) sexual encounters.

Female Genito-Pelvic Pain/Penetration Disorder

  • Involves the persistent or recurrent difficulties with one or more of the following:
    • Vaginal penetration during intercourse.
    • Marked vulvovaginal or pelvic pain during intercourse or penetration attempts.
    • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
    • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

There is also a rare sexual dysfunction known as persistent genital arousal disorder.  It involves excessive genital arousal and engorgement in the absence of sexual interest.  It may lead to compulsive masturbation in which one masturbates not because one likes it but because one cannot help it.  Usually the arousal does not resolve with orgasm.

What Should You Expect During Your First Consultation?

  • A thorough history and physical examination, including pelvic examination.
  • Possible need for blood work to check your sex hormone levels.
  • Possible vaginal and/or cervical cultures to evaluate for infection.
  • Counseling as indicated.
  • Follow up appointment(s).
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