Exploring female sexual dysfunction

In this episode of The Good GP, Dr Krystyna de Lange is joined by Anisa Varasteh, a clinical sexologist, psychotherapist, and former president of the Society of Australian Sexologists, to discuss the topic of female sexual dysfunction and its management in general practice.

Anisa Varasteh provides a thorough overview of the multifaceted nature of female sexual dysfunction, emphasising the complex interplay between biological, psychological, relational, and social factors. Highlighting the impact of chronic stress, nervous system overload, and the relational context on sexual function. Psychological factors such as anxiety, depression, trauma, and body image concerns are explored, as well as the influence of cultural myths and social conditioning on female sexuality across the lifespan.

Anisa identifies everyday factors influencing desire and arousal, including sleep deprivation, mental load, lack of pleasure outside of sex, unresolved grief, and body image issues. She shares practical strategies for GPs when supporting patients, such as normalising fluctuations in desire, exploring the biopsychosocial context, shifting the focus towards pleasure and connection, and promoting nervous system regulation. Early referral to sexologists or related professionals is suggested, as is the value of providing patients with language and frameworks to have open conversations with their partners.

The episode concludes with strategies for empowering patients to discuss their sexual wellbeing without shame or guilt and the benefits of reframing intimacy outside the goal of intercourse.

Potential questions to use in assessment of sexual function:

1. What is the concern, and what does it mean to the patient?
2. Is there distress around it?
3. How long has it been present?
4. What is the impact on their life or relationship?
5. In what contexts is it not present?
6. Have they sought help before?
7. How is their general health and mental wellbeing?
8. How do they feel in their relationship?
9. Why is this a concern now?

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