Female sexuality and sexual counseling

Sexual problems are among the most common problems reported to physicians and mental health professionals. It has been estimated that 50% of all sexually active couples will have some type of sexual problem. Although sexual problems are common, medical training in the area of human sexuality has been lacking. The purpose of this article is to increase the gynecologist's awareness of female sexuality and sexual disorders and to facilitate doctor-patient discussions of sexual health issues. After a brief review of the study of sexuality, the paper describes the development of female sexuality, including the physiologic and psychological components. It examines the clinical research regarding the four stages of the female sexual response cycle, in addition to a review of the literature on female sexual satisfaction. After a discussion of normal female sexuality, a description and review of the literature of five female sexual disorders are provided. These disorders are hypoactive desire disorder, female sexual arousal disorder, inhibited female orgasm, vaginismus, and dyspareunia. A brief summary of treatment modalities is described. The second part of the paper is devoted to sexual counseling for the physician. This includes sections on overcoming the obstacles to sexual counseling, the prerequisites for sexual counseling, a case example, and a discussion of clinical ethics. Last, a bibliography of suggested patient education materials is provided.