Diagnosis of FSD
A modified process of care approach is used for the management of women with sexual health problems in our sexual health clinic.
We start with “identification” of the sexual problem through history (sexual, medical, gynecologic, psychosocial), physical examination, laboratory blood tests, psychologic interview and specialized genital sensory, pelvic floor and blood flow testing.
We follow with “education”, specifically about the role of androgens and estrogens in sexual function.
We subsequently discuss “modification” and the role of hormonal replacement especially if blood tests are low.
During “identification” of the sexual problem genital function testing has revealed that abnormal genital sensation was found in more than half of the women. In addition, approximately 75% of these patients also showed abnormal genital blood flow (abnormal duplex Doppler ultrasound) before and after sexual stimulation. Most significantly, when we evaluated hormone levels, we found that approximately two thirds of these women had low levels of dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione, dihydrotestosterone, free testosterone and total testosterone. We concluded that sexual dysfunction in these otherwise young and healthy patients had a significant organic component. How could this be explained?
Basic research shows that following sexual stimulation, the most effective genital smooth muscle relaxation and arousal response occurs in the presence of adequate androgen levels. In the absence of androgens, poor genital smooth muscle relaxation and poor arousal follows sexual stimulation. In addition to their effects on smooth muscle relaxation, androgens also appear to maintain the integrity of sensory receptors in the labia, clitoris, and vagina. We have always known that androgens affect desire. Therefore, it can now be further researched that androgen deficiency adversely impacts all three components of the female sexual response, that is, desire arousal, and orgasm.
Thus, we now have good evidence that there are substantial physiologic issues underlying female sexual dysfunction. The basis, in part, for many women with female sexual dysfunction is not vascular disease—as it appears in the majority of men with ED––but an underlying hormonal abnormality affecting the zona reticularis of the adrenal gland. Much research is underway to better understand the nature of the suspected hormonal insufficiency.