Female orgasmic disorder

Signs and symptoms
The medical history should address the following:

•    Chronic and acute medical conditions, including psychiatric conditions
•    Current and, when relevant, past medications, over-the-counter drugs, and supplements
•    Any patterns of substance abuse
•    Sexual complaints

Many patients are reluctant to volunteer sexual complaints. A good general strategy for gathering a sexual history might include the following steps:

•    First, explain the rationale for inquiring about sexual topics, while sympathizing with the patient reluctance to discuss intimate topics
•    Next, ask open-ended, general questions about the overall level of sexual interest and satisfaction
•    Gradually introduce the topic of sexual issues
•    As rapport improves, ask more specific, closed-ended questions that address the details of sexual activity Physical examination includes the following:
•    General examination
•    Cardiac, pelvic, and neurologic examinations to eliminate any coexisting medical conditions that might be contributing to the orgasmic dysfunction
•    Mental status examination (usually normal in primary FOD; mild, anxious, or depressed mood or affect should be investigated)

Diagnosis

By definition, the diagnosis of FOD requires that the following criteria be met:

•    Another disorder does not account for the orgasmic dysfunction better than FOD does
•    The dysfunction is not exclusively due to a direct physiologic effect of a substance (eg, a drug of abuse or medication) or a general medical condition

Laboratory workup should include the following:

•    Complete blood count (CBC)
•    Chemistry panel
•    Hormone panel
•    Vitamin B-12 and folate levels

An informative hormone panel should include the following:

•    Thyroid test (thyroid-stimulating hormone [TSH] and free T4)
•    Estradiol
•    Follicle-stimulating hormone (FSH) and luteinizing hormone (LH
•    Prolactin
•    Testosterone (total and free) only in monitoring testosterone therapy