A 42-year-old G1P1 has recently started dating again after her divorce 3 years ago. She has been seeing the same man for the last 3 months. They have had several sexual encounters, but she reports a lack of interest in having sex. She reports a normal sexual desire when she was younger and wonders if hormonal changes are causing her lack of interest. She has a history of hypertension which is well controlled with metoprolol. She says she is not depressed, but she has been taking fluoxetine since her divorce to help her cope with the stresses of her life change.
For the clinical scenario, select the most appropriate sexual dysfunction disorder.
A. DyspareuniaFemale sexual dysfunction disorders are characterized by painful intercourse or disturbances in desire, arousal, orgasm or resolution that causes marked distress or interpersonal difficulty. Sexual dysfunction is not better accounted for by another psychiatric disorder, and is not due exclusively to a substance or medical condition. Hypoactive sexual desire disorder is the persistent or recurrent absence of sexual fantasies or desire for sexual activity. Alcohol and drugs may interfere with sexual desire. Medications such as antihypertensives, anticholinergics, antidepressants, narcotics, sedatives, and others may decrease arousal and inhibit sexual interest. Sexual aversion disorder is a persistent or recurrent extreme aversion to or avoidance of sexual genital contact. Sexual prompts or advances by a partner are dismissed. It may be acquired following sexual or physical abuse or trauma, and may be life-long. When presented with a sexual opportunity, the individual may experience panic attacks or extreme anxiety. Sexual arousal disorder is the persistent inability to attain or maintain until completion of sexual activity an adequate lubrication-swelling response of sexual excitement. The inability to become aroused also may be related to anxiety or inadequate stimulation. Vaginismus is the recurrent involuntary spasm of the musculature of the lower third of the vagina that interferes with sexual intercourse and penetration. Usually at the root of vaginismus is a combination of physical or nonphysical triggers that cause the body to anticipate pain. Reacting to the anticipation of pain, the body automatically tightens the vaginal muscles, and sex becomes painful. Penile entry may be more difficult or impossible depending on the severity muscle contraction. Dyspareunia is recurrent or persistent genital/pelvic pain associated with sexual intercourse (not caused by vaginismus or lack of lubrication).