Essentials of Female Sexual Dysfunction from a Sex Therapy Perspective

Linda E. Ohl, MSW, CSW, ACH


Urol Nurs. 2007;27(1):57-63. 

In This Article

Obtaining a Sexual History

When obtaining a sexual history, depending on the environment and time constraints, it is important to collect relevant information in a timely manner. If the patient has seen a clinician prior to the appointment, and the clinician seems concerned about the patient's sexual wellness, has a professional demeanor, and seems comfortable and understanding, it will make the sexual interview much more relaxing, honest, and helpful.

Make sure the patient is in a comfortable position (for example, is not disrobed for an examination), relaxed, face-to-face to the clinician, and in a private setting. There should be no desk between patient and clinician, as this may create a feeling of a boundary to the discussion. The practitioner should feel comfortable using sexual terminology, and be ready to listen actively. The use of eye contact is vital in gaining the woman's trust and confidence. The interview environment is crucial in making a comfortable exchange of information, as the patient is being asked the most intimate, detailed questions of private life.

While speaking, it is best to mirror the patient's sexual vocabulary so she can relate and understand the discussion. If possible, let the patient set the pace and the tone of conversation. Often, a question may need to be asked several times, in different ways, to get an accurate answer.

It is important to ask the patient if she would like to speak with the clinician about these issues. For some women this is not a concern, and for others it is a major life event. Giving the patient permission to discuss the issues is the first step in problem solving.

Some general leading questions may be necessary to initiate the conversation, such as:

  • "Are you having any sexual difficulties at this time?"

  • "Are you having difficulties with desire for sex?"

  • "Do you feel a sense of arousal when engaging in sexual behavior or when thinking about sexual matters?"

  • "Do you have difficulties with lubrication, either be coming wet or staying wet?"

  • "Do you have difficulties achieving orgasms?"

  • "Do you have pain during or after sex?"

  • "Do you have problems when your partner attempts penetration?"

  • "It is not uncommon for women with hypertension, diabetes, or heart disease to experience difficulty with sexual functioning. Is this a problem for you?"

More specific questions can follow, once the conversation is initiated.

For professionals working in a clinical environment, time is of the essence. There may not be time to practically include sexual function in a clinical encounter. To help with the time issue, some clinicians use validated research instruments designed to define the degree of sexual dysfunction. One such vehicle is the Female Sexual Function Index (FSFI), a five-page questionnaire asking about sexual feelings and responses (Rosen et. al., 2000). The use of screening surveys may assist in finding individuals in whom further questioning is necessary.


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