Компоненти статевого анамнезу для оцінки жіночої сексуальної дисфункції

Medical history (past and current)

General health (including medical history, endocrinologic conditions, physical energy, level of stress and anxiety, psychiatric history, and mood), medications, substance misuse, gynecologic and obstetric history (eg, procedures, pregnancies, STIs), pelvic trauma, and sexual trauma

Relationship with partner

Sexual orientation, emotional intimacy, trust, respect, attraction, communication, fidelity, anger, hostility, resentment, history of intimate partner violence

Current sexual context

Sexual function of partner, activities and behaviors during the hours before attempts at sexual activity, adequacy of sexual stimulation, adequacy of sexual communication, timing (eg, too late at night, too hurried), degree of privacy

Triggers of desire and arousal

Setting; visual, written and spoken sexual cues; activities (eg, showering together, dancing, listening to music); types of stimulation (nonphysical, physical nongenital, nonpenetrative genital)

Inhibitors of arousal

Fatigue, stress, anxiety, depression, negative past sexual experiences, fears about outcome (including loss of control, pain, unwanted pregnancy, and infertility), day-to-day distractions, sleep deprivation

Orgasms

Presence or absence, response to absence (whether the woman is distressed or not), differences in responses with partner and with self-stimulation

Outcome

Emotional and physical satisfaction or dissatisfaction

Quality and location of pain in dyspareunia

Burning, tearing, rubbing, stretching, or dull

Superficial (introital), intravaginal, or deeper in pelvis

Timing of pain in dyspareunia

During partial or full entry, deep thrusting, penile movement, or the man’s ejaculation; immediately after penetration; or during urination after vaginal penetration

Self-image

Self-confidence; feelings about desirability, body, genitals, or sexual competence

Developmental history

Relationship with caregivers and siblings, traumas, loss of a loved one, abuse (emotional, physical, or sexual), consequences of expressing emotions as a child, cultural or religious restrictions

Past sexual experiences

Type (whether desired, coercive, abusive, or a combination), subjective experience (how rewarding, varied, and pleasing), outcomes (positive or negative—eg, unplanned pregnancy, STIs, parental or societal disapproval, guilt due to religious teachings)

Personality factors

Ability to trust, comfort level with being vulnerable, suppressed anger causing suppression of sexual emotions, need to feel in control, unreasonable expectations of self, hypervigilance to self-harm (ie, worry about pain, which inhibits enjoyment), obsessiveness, anxiety, depressive tendencies

Medications

Specific medications (including over-the-counter medications) and the timing of their use with sexual dysfunction