Phillips N A
Wellington School of Medicine, University of Otago, New Zealand.
Am Fam Physician. 2000 Jul 1;62(1):127-36, 141-2.
Sexual dysfunction includes desire, arousal, orgasmic and sex pain disorders (dyspareunia and vaginismus). Primary care physicians must assume a proactive role in the diagnosis and treatment of these disorders. Long-term medical diseases, minor ailments, medications and psychosocial difficulties, including prior physical or sexual abuse, are etiologic factors. Gynecologic maladies and cancers (including breast cancer) are also frequent sources of sexual dysfunction. Patient education and reassurance, with early diagnosis and intervention, are essential for effective treatment. Patient history and physical examination techniques, normal sexual responses and the factors that influence these responses, and the application of medical and gynecologic treatments to sexual issues are discussed. Basic treatment strategies, which may be successfully provided by primary care physicians for most sexual dysfunctions, are outlined. Referral can be reserved for patients who do not respond to therapy.
性功能障碍包括性欲、性唤起、性高潮及性交疼痛障碍（性交困难和阴道痉挛）。基层医疗医生必须在这些障碍的诊断和治疗中发挥积极作用。长期内科疾病、小病、药物以及心理社会问题，包括既往身体或性虐待，均为病因。妇科疾病和癌症（包括乳腺癌）也是性功能障碍的常见原因。患者教育及安抚，以及早期诊断和干预，对于有效治疗至关重要。文中讨论了患者病史及体格检查技巧、正常性反应及影响这些反应的因素，以及将内科和妇科治疗应用于性问题。概述了基层医疗医生可为大多数性功能障碍成功提供的基本治疗策略。对于治疗无反应的患者可安排转诊。
