Evaluation and treatment of female sexual disorders

Prevalence data suggest that more than 40% of women experience sexual problems and that 12% of these women are distressed by the problem. In the 1960s, Masters and Johnson introduced what is now considered the classic linear model of female sexual response based on a physiologic foundation. Recently, Rosemary Basson introduced a nonlinear interconnected model which emphasizes the importance of emotional intimacy and satisfaction as integral components of the female sexual response cycle. According to the Diagnostic and Statistical Manual (DSM-IV TR), there are six female sexual disorders: hypoactive sexual desire disorder, aversion disorder, sexual arousal disorder, female orgasmic disorder, vaginismus, and dyspareunia. Despite the high prevalence, few healthcare professionals take the time or feel adequately trained to assess and treat these sexual problems. Sexuality questionnaires play an integral role in the diagnosis and treatment of male and female sexual dysfunctions. They are used to (1) identify/diagnose individuals with a particular dysfunction, (2) assess the severity of the dysfunction, (3) measure improvement or satisfaction with treatment, (4) examine the impact of the dysfunction on the individual's quality of life (relationship satisfaction, mood, sexual confidence), and (5) study the impact of the dysfunction on the partner and his or her quality of life. Patient-reported outcomes (PRO) are increasingly important in both clinical practice and research settings. The instruments reviewed have played a significant role in furthering our understanding of the impact of female sexual function on the patient and partner and its treatment. It is important for the clinician and researcher to familiarize themselves with the best available measures for identifying specific dysfunctions, measuring distress due to the sexual dysfunction, assessing treatment efficacy, and objectively evaluating the quality of life issues of women with these dysfunctions. However, even the best PRO cannot replace the clinician-patient interview and the careful gathering of the patient's sexual history. PROs should always be interpreted and integrated with the woman's history.