Female Sexual Dysfunction: General Treatment Guidelines

Provide education

Provide information and education (e.g., about normal anatomy, sexual function, normal changes of aging, pregnancy, menopause). Provide booklets, encourage reading; discuss sexual issues when a medical condition is diagnosed, a new medication is started, and during pre- and postoperative periods; give permission for sexual experimentation.

Provide distraction techniques**

Encourage erotic or nonerotic fantasy; recommend pelvic muscle contraction and relaxation (similar to Kegel exercise) exercises with intercourse; recommend use of background music, videos or television.

Encourage noncoital behaviors***

Recommend sensual massage, sensate-focus exercises (sensual massage with no involvement of sexual areas, where one partner provides the massage and the receiving partner provides feedback as to what feels good; aimed to promote comfort and communication between partners); oral or noncoital stimulation, with or without orgasm.

Minimize dyspareunia "painful sexual intercourse"

Superficial: female astride for control of penetration, topical lidocaine, warm baths before intercourse, biofeedback.

Vaginal: same as for superficial dyspareunia but with the addition of lubricants.

Deep: position changes so that force is away from pain and deep thrusts are minimized, nonsteroidal anti-inflammatory drugs before intercourse.