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Sexual Dysfunction in Women, “Let’s Talk About Sex“


Historically, this three letter word, S-E-X, has been either avoided or frowned-upon in most household and relationship conversations. Let’s face the facts: the generation before us “shushed it”, our generation scoffs about it, and when our children’s generation brings it up most of us run in the other direction! Dr. Lord Tomas says worry about the other bad four letter words and embrace discussions, accurate and relevant ones, about sex. She means within our households and amongst our children, when appropriate, and especially in our relationships. Knowledge of one’s anatomy and understanding of certain feelings creates empowerment and truly helps with self-esteem and mutual respect amongst the sexes. This starts in the early teen, or “tween”, years and continues throughout our lives.
Developing this accurate and comfortable education can help the next generation decrease the unnecessary tension, neglect and even abuse between males and females.
Dr Lord Tomas’ specialty deals with women ranging from age 12-90 typically, and these issues exist more frequently than one may think. Most studies incorporate women in the range of 18 years of age and older relating to sexual problems, which is why her focus herein. A recent study showed that 10% of women experience personal distress associated with their sexual desire problems. In her practice, this means she addresses this issue with 2-3 patients every day. Personal distress may be determined by a woman’s self-rating of her feelings of distress about her sex life in terms of guilt, frustration, stress, worry, anger, embarrassment and unhappiness.

There are 4 categories of Female Sexual Dysfunction(FSD) and 6 overall Disorder Subtypes. Now, any of us are allowed a short dry spell, but these are extremes, ok?! In order for a patient to be accurately diagnosed with FSD, three criteria must be met:
1)must be persistent or recurrent, 2) must cause marked personal distress or interpersonal difficulty, 3) must NOT be caused by another disorder, general medical condition or side effect of medication or substance abuse. The 6 FSDs (which include the 4 general categories and the 2 subtypes) are as follows: 1) Hypoactive Sexual Desire Disorder (HSDD): a deficiency of absence in the desire for sexual activity or occurrence of sexual fantasies, 2) Sexual Aversion Disorder: an aversion to and avoidance of genital sexual contact with a sexual partner, 3) Female Sexual Arousal Disorder: the inability to attain or maintain an adequate lubrication-swelling response until completion of sexual activity, 4) Female Orgasmic Disorder: a delay or absence of orgasm following a normal sexual excitement phase, 5) Dyspareunia: genital pain, ranging from mild discomfort to sharp pain, associated with sexual intercourse, 6) Vaginismus: involuntary contraction of the muscles surrounding the outer third of the vagina on attempted vaginal penetration. HSDD and Sexual Aversion Disorder are subtypes of the category Sexual Desire Disorders. Dyspareunia and Vaginismus are subtypes of the category Pelvic Pain Disorders. Sexual Desire Disorders ranks at about 10% of prevalence of distressing sexual problems in adult women. It is a well-known fact that sexual tension/problems ranks right up there with money and family problems as causes for divorce or separations and household discontent. Occasionally, there are historical factors in one’s past which make solving sexual problems next to impossible. Other causal factors must be ruled out as well, which is why the third criteria as stated must be met in diagnosing true FSD.

Accurately assessing a patient, as in any medical or surgical condition, is necessary in order to work towards a solution. Dr. Lord Tomas believes, as do many other clinicians, that just by acknowledging one’s sexual health concern can offer a patient comfort and validation. She goes from there and strives for continued improvement. Thorough history-taking and detailed physical exam are both parts of one’s assessment, and can lead to other related diagnoses needing medical or surgical work-up.
Let’s be honest, as with many of our interpersonal issues and self-improvement issues, working with FSD often proves to be a continued work-in-progress. There is definitely no room for emotional, intellectual or physical laziness here. You don’t want to prolong the “dry spell” too long, all involved suffer and that’s a shame for something that can be properly assessed and hopefully treated. A patient surely deserves attention and solutions.
Making a dialogue about sexual health needs to be a routine part of a patient’s visit, especially during her annual exam – if it isn’t, it should. You can ask any questions you may have via our Ask the Doctor’s link on Dr. Lord Tomas’ web site,


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