Assessment

Assessment of female arousal disorders begins with separating out problems of desire and orgasm that disguise themselves as arousal difficulties. Relationship satisfaction is assessed, and queries about current life stressors are posed. The clinician enquires about what forms of sexual activity the woman finds arousing, both in fantasy and behaviour, by herself and with a partner. As with men who have erectile dysfunction, the patient is asked to judge her subjective arousal employing a rating scale of zero to 10 (with 10 being the most aroused) to a wide range of conventional stimuli such as undressing, being touched, touching the partner, kissing, breast stimulation, manual genital stimulation, oral genital stimulation, intercourse in various positions, etc. The course of the disorder's development and the phenomenology of the problem in the women are assessed. It is essential to establish that the woman is receiving adequate cognitive and physical sexual stimulation. Too often hurried attempts at intercourse without adequate preparation and foreplay result in symptoms of an arousal disorder. The clinician should explore whether cultural, social, or religious ideas may be interfering with the development of arousal. The symptom may be a reflection of relationship dissatisfaction, sexual orientation incongruity, preoccupation with other life tasks (childbearing), fatigue, or depression. It is always worthwhile asking about the patient and partner's attribution concerning the onset and maintenance of the problem, and what forms of self-help they have attempted. Finally, enquiries regarding treatment expectations are posed, unrealistic expectations are challenged, and sensible goals negotiated.

An integrated medical-psychological approach is essential in assessing sexual arousal disorders in women. This is best accomplished through the conjoint efforts of a gynaecologist and mental health clinician. Gynaecological aspects of assessment can be found in other texts and are beyond the scope of this chapter.

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