Sexual dysfunction.

Sexual dysfunction may adversely affect a woman's self-esteem and her overall sense of well-being. The obstetrician-gynecologist can play an important role by asking the patient about any problems with sexual function. Physiologic changes, disease, surgery, or medical therapy may result in sexual dysfunction. The physician should recognize the potential effects of these conditions on a patient's sexuality and provide the patient with appropriate education and counseling. Patients should also be advised about alternatives for sexual expression, particularly after pelvic surgery. Specific support groups of others facing similar conditions may also be helpful. If, after taking a history of the patient's psychologic status, relationship, and a sexual history, the physician does not see an obvious cause and course of treatment, the best choice may be referral to a marriage or relationship counselor or a sexual therapist, particularly if the problem is of a psychologic nature or of long duration. Counseling or referral can be helpful and rewarding for the patient, her partner, and the physician.