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Female sexual dysfunction in midlife and beyond

DEFINITION
Female sexual dysfunction (FSD) is a prevalent problem, afflicting approximately 40% of women and there are few treatment options. FSD is more typical as women age and is a progressive and widespread condition.
1. To measure the importance of psychological & biological factors in relation to women’s sexual response.
2. To understand women’s sexual dysfunction
3. To recognize the complexities of sexual difficulties & choose therapies.

ASSESSMENT OF SEXUAL PROBLEMS
Sexual assessment includes medical, gynecological assessment plus sexual history. Discuss sexual difficulties & identify medical / psychological problems. Speak to both partners at together and separately. Feed backs to both partners should be given regarding possible contributing factors.

FEMALE SEXUAL DYSFUNCTION – TYPES AND MANAGEMENT
Female Sexual function declines with Menopause transition. When Dysfunction causes distress, it is called Female sexual dysfunction. 
A. Hypoactive sexual desire disorder (HSDD)- is the persistent or recurrent absence of sexual fantasies/thoughts and/or desire for sexual activity leading to personal distress [1]. 
B. Female sexual arousal disorders (FASD)- can be defined as a recurrent inability to attain, or maintain  arousal until completion, sexual activity. 
C. Orgasmic disorders- are described as
the persistent or recurrent difficulty, delay in, or absence of, attaining orgasm following sufficient sexual stimulation and arousal that leads to personal distress.
D. Sexual pain disorders can be  coital sexual pain disorders like dyspareunia and vaginismus and noncoital sexual pain disorder, the recurrent or persistent genital pain induced by non coital sexual stimulation.

MANAGEMENT

Life style changes, improving communication between partners and providing sexual counseling is often helpful. Above all a caring relationship is the key to success.

HRT can customized according to need. Addition of Androgens to ET is especially helpful in premature menopause. Drugs like gabapentine, 5%lidocaine are effective for provoked vestibulodynia & allodynia. Non-hormonal lubricants like soya-isoflavene gel, hyaluronic acid gel can be used for longer time without any systemic adverse effect. Newer drugs has been approved by FDA premenopausal women with difficulties with female sexual arousal. Last but not the least are the energy based (laser and radiofrequency) devices used for vulvovaginal atrophy.

CONCLUSION
Due to the complexity of FSD, a multifaceted approach, addressing neurobiological, vasoactive, hormonal as well as psychosocial/cultural aspects is required