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
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