여성 성기능 장애의 최신지견

Female sexuality is important women’s health issue. Female sexual dysfunction, estimated to afflict 30 - 50% of women in the United States, is chronic, progressive, age-related and adversely affects quality of life and interpersonal relationships. Although age, menopause, hysterectomy and vascular risk factor exposure have been linked to female sexual dysfunctions (disorders of desire, arousal, orgasm or pain), prevailing clinical management is primarily psychologically-based, with limited attention to physiologically-based conditions. There have been limited anatomic and physiologic investigations of the female sexual arousal response. There is a need to broaden understanding of the pathophysiological mechanisms of female sexual dysfunction to improve clinical management. Although the general or routine diagnostic procedure is not broadly accepted, some diagnostic modalities are being suggested at present. History and physical examination is the base to reveal the patient characteristics, personal problems, and physical condition of the genitalia Female Sexual Dysfunction Index, a questionnaire composed of 6 domains including desire, arousal, lubrication, orgasm, pain and satisfaction, reflects clinical situation of the patient. For objective measurement of physiologic sexual response, measuring blood flow and neural integrity with vaginal photoplethysmography, clitoral Doppler ultrasonography and Genital sensory analyzer can be used. In laboratory test fasting blood sugar, liver and renal function test, lipid profile and sex hormones including testosterone should be checked. Management of female sexual dysfunction is very complicated for satisfactory results. Education of the patients and her partner and changing reversible factors should be tried. And then hormonal therapy, corrective surgery or pharmacotherapy including vasoactive drugs such as phosphodiesterase 5 inhibitors or Prostaglandin E I can be applied if it is indicated. In conclusion, female sexual function is a complex process, which requires integration of signals from various neurotransmitters and vasoactive agent. In addition, other important factors such as endocrine hormones, balance in tissues structural components and the health of the vascular system are important to this physiological process. Although some management is effective, there is no definite treatment for female sexual dysfunction but various treatment modalities may be applied for better results.