המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-31 9:09:41 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – Addressing only the physical component of female sexual dysfunction is likely to fail if psychosocial aspects are not dealt with at the same time.
A woman's sexual arousal involves much more than genital vasocongestion, Dr. Rosemary Basson of the University of British Columbia, in Vancouver, notes in the August issue of Obstetrics and Gynecology. Sexual stimulation does not guarantee arousal, she explained. In fact, many women with sexual arousal disorder may have perfectly normal genital blood flow.
"For men, their sexual enjoyment and sense of being aroused and wanting to continue the experience is influenced directly by awareness of their genital congestion," Dr. Basson pointed out. "Women have much less of that direct feedback."
She noted that if a women has sustained damage to the nerves supplying tissue in the vulva, she may have only a partial sexual response. "When the area is massaged, it does not feel very good because it's not filling with blood. So certainly we would expect Viagra-like compounds to help women in this situation," Dr. Basson said.
Other possible biologic factors that may be responsible, such as depression, medication side effects, lack of ovarian androgen, hypothyroidism, or hyperprolactinemia, could also interfere with arousal.
However, Dr. Basson writes, "Past negative experiences, low sexual self-image, lack of safety (re, birth control, sexually transmitted disease, or emotional safety), feelings of naivety, or negative emotions in response to physical arousal (sometimes related to past abuse) may be relevant."
Even if the initial problem is biological, she pointed out in the interview, "it doesn't just stay like that." The experience becomes negative as the woman loses confidence in herself or becomes avoidant of stimuli she needs to get excited.
"If there's no happy conclusion to her experience, she doesn't feel closer to her partner. She might even feel used by her partner if it wasn't rewarding for her."
"So by the time she seeks help, it's not just a medical entity anymore. There have been repercussions, so just giving a little bit of hormone or drug that enhances the neurotransmitter won't be enough. That's because her experience is so composite, and it's so important that what is going on in her mind is enjoyable as well as what is happening physically. "
Dr. Basson's advises physicians to explain to the female patient with sexual dysfunction that "it's important to strike up the context again that used to be enjoyable, since the recent memories are marred and not positive."
Obstet Gynecol 2001;98:350-353.
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