Female orgasmic disorder

Female orgasmic disorder

Signs and symptoms

The medical history should address the following:

  • Chronic and acute medical conditions, including psychiatric conditions
  • Current and, when relevant, past medications, over-the-counter drugs, and supplements
  • Any patterns of substance abuse
  • Sexual complaints

Many patients are reluctant to volunteer sexual complaints. A good general strategy for gathering a sexual history might include the following steps:

  • First, explain the rationale for inquiring about sexual topics, while sympathizing with the patient reluctance to discuss intimate topics
  • Next, ask open-ended, general questions about the overall level of sexual interest and satisfaction
  • Gradually introduce the topic of sexual issues
  • As rapport improves, ask more specific, closed-ended questions that address the details of sexual activity Physical examination includes the following:
  • General examination
  • Cardiac, pelvic, and neurologic examinations to eliminate any coexisting medical conditions that might be contributing to the orgasmic dysfunction
  • Mental status examination (usually normal in primary FOD; mild, anxious, or depressed mood or affect should be investigated)

Diagnosis

By definition, the diagnosis of FOD requires that the following criteria be met:

  • Another disorder does not account for the orgasmic dysfunction better than FOD does
  • The dysfunction is not exclusively due to a direct physiologic effect of a substance (eg, a drug of abuse or medication) or a general medical condition

Laboratory workup should include the following:

  • Complete blood count (CBC)
  • Chemistry panel
  • Hormone panel
  • Vitamin B-12 and folate levels

An informative hormone panel should include the following:

  • Thyroid test (thyroid-stimulating hormone [TSH] and free T4)
  • Estradiol
  • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH
  • Prolactin
  • Testosterone (total and free) only in monitoring testosterone therapy
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