Human Sexuality

An estimated 35% to 45% of women perceive they A have some type of sexual problem—most com-monly low sexual desire. Illness, medical and sur-gical treatment, lack of knowledge to manage this life experience, and emotional and physical stresses contribute to the frequency and severity of sexual problems. Physicians should be able to identify sexual disorders and know whether to offer treatment or refer patients to a specialist.

Determinants of healthy sexuality are complex and multifactorial. Intrapersonal factors include the sense of one’s self as a sexual being, one’s overall health status, a general perception of well-being, and the quality of an individual’s previous sexual experiences. For partnered individuals, this same list applies to the partner. Inter-personal aspects include the duration and overall quality of the relationship, communication styles, and the number and type of ongoing life events and stressors. Examples of generally “positive” life events which nevertheless can contribute to sexual dysfunctions include the birth of a child and retirement.

Sexuality involves a broad range of expressions of inti-macy and is fundamental to self-identification, with strong cultural, biologic, and psychological components. The obstetrician-gynecologist has an important role in assess-ing sexual function, because many women view their sex-uality as an important quality-of-life issue. Moreover, gynecologic disease processes and therapeutic interventions have the potential to affect sexual response. The clinician should not make assumptions or judgments about the woman’s behavior and, when counseling patients, should keep in mind the possibility of cultural and personal vari-ation in sexual practices.