Differentials
Sexual aversion
SIGNS / SYMPTOMS
The thought of sexual activity, as well as any sexual experience, is highly distressing and the person reacts with phobic anxiety.
INVESTIGATIONS
There is no test available to differentiate sexual aversion from sexual desire/interest disorder. Rather, a careful clinical assessment confirming phobic-like anxiety and extreme avoidance of any sexual stimuli would be characteristic of sexual aversion and not of sexual desire/interest disorder.
Interpersonal factors (e.g., relationship discord, intimate partner violence, other significant stressors)
SIGNS / SYMPTOMS
Lack of response and desire is logical and normal when there is insufficient emotional closeness, or presence of distress or fear.
Response alone or to erotica is normal unless depression is comorbid.
INVESTIGATIONS
Relationship discord can be the main etiology of a woman's sexual dysfunction. Only after addressing the discord can any remaining sexual dysfunction be confirmed.
Self-report questionnaires (e.g., the Dyadic Adjustment Scale) may provide a cursory overview of the degree of relationship dissatisfaction.
Nonsexual mental disorders (e.g., depression)
SIGNS / SYMPTOMS
Screen for accompanying symptoms of the primary mental health diagnosis, particularly symptoms not associated with sexual dysfunction, (e.g., generalized guilt, hopelessness, appetite changes, psychomotor retardation, suicidal ideation) and temporal relationship to sexual symptoms.
INVESTIGATIONS
Clinical interview and/or validated questionnaires (i.e., Patient Health Questionnaire-9 [PHQ-9] or Hamilton Depression Rating Scale [HAM-D]).
Substance and/or medication use
SIGNS / SYMPTOMS
Onset of sexual dysfunction coincides with onset of medication or substance use, worsens with dose increase, and dissipates with dose reduction/discontinuation.
INVESTIGATIONS
Evaluate whether substance/medication has known impact on sexual function.
Consider dose adjustment, discontinuation, or switch to evaluate causality.
Another medical condition
SIGNS / SYMPTOMS
Onset of sexual symptoms may coincide with onset or progression of other medical condition (e.g., diabetes, thyroid dysfunction, neurological disease), and may improve with treatment.
INVESTIGATIONS
Signs, symptoms, primary diagnostic testing for other medical conditions per associated guidelines.
Inadequate or absent sexual stimuli
SIGNS / SYMPTOMS
Introduction of adequate/appropriate stimuli leads to resolution of symptoms.
INVESTIGATIONS
Clinical history taking into account type of stimulus, sexual communication, and context of sexual experiences.
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