Sexual Dysfunction in Multiple aspects of a woman’s circumstances can inﬂuence her sexual function, and one the Partner of the most important aspects is sexual dysfunction in a male partner (56). Successful treatment of a male partner’s erectile dysfunction can result in reversal of the woman’s sexual problems, including difficulties with sexual arousal, lubrication, orgasm satisfaction, and pain (45).
Infertility Infertility evaluation and assisted reproductive techniques can have negative effects on a woman’s body image and feelings of sexual self-worth. Infertility may cause her to feel hopeless and sexually undesirable. The loss of sexual spontaneity resulting from the goal-oriented approach to sex while trying to conceive with scheduled intercourse (coinciding with ovulation naturally or after hormonal stimulation) may lead to sexual dysfunction and is considered a major problem for many women (57). Erectile dysfunction may be a consequence, compounding the couple’s fertility difficulties and the woman’s sexual satisfaction (58). The stress of testing and waiting for results may disrupt emotional intimacy, causing further damage to sexual function. These changes do not always reverse with a successful pregnancy. Often there are unresolved feelings of guilt over personal responsibility for the infertility and feelings of resentment of the multiple procedures required for women compared with one semen analysis for men.
Drugs Prescription and nonprescription medications, including alcohol and illicit drugs, can alter the normal sexual response (Table 11.1). Adjustments in dosage or formulation of medication may be required. Theoretically, pharmacologic agents might improve or reverse the loss of arousal, desire, and orgasm commonly associated with serotonergic antidepressants (SSRIs). A Cochrane review could make no recommendations for women but did note that bupropion may be effective based on the results of one of two randomized controlled trials (43,59). In highly selective women on SSRIs, sildenafil may reverse orgasmic dysfunction (60).
Chronic Illness Chronic illness and living with a cancer diagnosis can affect sexual function in a number of ways (Table 11.2) (20).
Chronic Pelvic Chronic dyspareunia, remitting temporarily or not at all with surgical or medical therapy, Inﬂammatory Disease and typically is associated with loss of sexual motivation or interest. Although definitive therapy Endometriosis is the overall goal, encouragement of nonpenetrative sex is very important for preservation of the woman’s sexual enjoyment, sexual self-esteem, and relationship. GnRH therapy producing a
Table 11.1 Medications Affecting Sexual Response
Drugs with potential negative sexual effects
Antihypertensives: β-blockers, thiazides  Antidepressants: serotonergic antidepressants  Lithium  Antipsychotics Antihistamines  Narcotics  Benzodiazepines Oral contraceptives and oral estrogen therapy  Gonadotropin-releasing hormone (GnRH) agonists  Spironolactone Cocaine  Alcohol  Anticonvulsants
Drugs that appear to be potentially prosexual temporary medical menopause can add further difficulties with reduced arousability and vaginal discomfort from the low estrogen state.
There is no evidence that the higher androgen levels associated with polycystic ovarian syndrome (PCOS) afford protection from low sexual desire or low sexual arousability.
Some but not all studies of women with PCOS report reduced sexual satisfaction compared to controls. The limited data suggest that lower satisfaction is related to obesity and cosmetic androgen-related effects of hirsutism and acne. One small case study showed desire to increase in six women with antiandrogen treatment and to decrease in 13 women (61). Metformin may improve sexual function in women with PCOS (62).
Recurrent Herpes Fear of spreading an STD may reduce sexual motivation and arousability. Clear guidance regarding safer sexual practices is needed, along with a discussion of the causes of the woman’s
Table 11.2 Sex and Chronic Illness