sexuality and modes of sexual expression

"I ask all my patients about their sexual health because it's an important part of overall health."

Ensure privacy first.

how to open a conversation about sexual health

Partners

Practices (vaginal, oral, anal)

Protection

Past STIs

Pregnancy intensions

what are the 5 Ps of sexual history?

Ask separately:

Sexual orientation: "How do you identify your sexual orientation?"

Gender identity: "What pronouns do you use?"

how to ask about sexual orientation and gender identity

desire

arousal

orgasm

resolution

what are the 4 phases of female sexual response

Reduced interest

Decreased lubrication

Reduced excitement

Lack of sexual thoughts

Duration ≥ 6 months, causing distress.

symptoms of female sexual interest/arousal disorder

SSRIs

Depression

Relationship issues

Hormonal changes

Menopause

common causes of female sexual interest/arousal disorder

Anxiety

Relationship problems

SSRI use

Lack of stimulation

common causes of female orgasmic disorder

Pain with penetration

Fear of pain

Pelvic floor tightening

symptoms genitopelvic pain/penetration disorder

Vaginal atrophy

Trauma history

Infection

Endometriosis

Pelvic floor dysfunction

main causes of genitopelvic pain disorder

topical estrogen

Postmenopausal dyspareunia → vaginal atrophy, treat with

medication side effect

Woman on SSRI with anorgasmia →