Female orgasmic disorder
Signs and symptoms
The medical history should address the following:
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Chronic and acute medical conditions, including psychiatric conditions
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Current and, when relevant, past medications, over-the-counter drugs, and supplements
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Any patterns of substance abuse
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Sexual complaints
Many patients are reluctant to volunteer for sexual complaints. A good general strategy for gathering a sexual history might include the following steps:
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First, explain the rationale for inquiring about sexual topics, while sympathizing with the patient reluctance to discuss intimate topics
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Next, ask open-ended, general questions about the overall level of sexual interest and satisfaction
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Gradually introduce the topic of sexual issues
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As rapport improves, ask more specific, closed-ended questions that address the details of sexual activity Physical examination includes the following:
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General examination
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Cardiac, pelvic, and neurologic examinations to eliminate any coexisting medical conditions that might be contributing to the orgasmic dysfunction
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Mental status examination (usually normal in primary FOD; mild, anxious, or depressed mood or effect should be investigated)
Diagnosis
By definition, the diagnosis of FOD requires that the following criteria be met:
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Another disorder does not account for the orgasmic dysfunction better than FOD does
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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:
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Complete blood count (CBC)
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Chemistry panel
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Hormone panel
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Vitamin B-12 and folate levels
An informative hormone panel should include the following:
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Thyroid test (thyroid-stimulating hormone [TSH] and free T4)
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Estradiol
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Follicle-stimulating hormone (FSH) and luteinizing hormone (LH
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Prolactin
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Testosterone (total and free) only in monitoring testosterone therapy
