Intensive Therapy. Patients with childhood sexual abuse probably require intensive therapy. Vaginismus may require intensive therapy.
Case reports of patients helped by therapy
- 47 yo woman married to a physician for 23 years. No intercourse for 20 years, and no communication outside the bedroom about their sexual relationship. She is very angry. Her last gynecologist said she should get a good divorce attorney.
- 50 yo woman complains of no desire and lack of lubrication. Married for 20 years. She has insulin-dependent diabetes. Her last gynecologist told her to use KY jelly. She became very angry saying KY jelly was “too clinical.”
- 30 yo woman referred for severe dyspareunia and pelvic pain. Prior workup including IVP, ultrasound, and laparoscopy found no organic cause. She describes severe inhibited sexual desire and had not attempted intercourse in 4 months.
- 34 yo married woman complains of anorgasmia since starting fluoxetine (Prozac) 2 years ago. She had orgasm prior to that. After changing to bupropion (Wellbutrin), her anorgasmia continued.
Summary
Many gynecologists are concerned about lack of time or skills to deal with sexual problems. However, it often takes less time to deal with the problem than to ignore it. If a problem is uncovered during a scheduled brief visit, the patient can be given a follow-up appointment to ensure adequate time.
Dr. Carey is a member of the Female Sexual Dysfunction CME Steering Committee, sponsored by the University of Medicine and Dentistry of New Jersey, through a grant from Proctor and Gamble.