Acknowledgements: The program (click the picture above) and this coverage would not have been possible without the outstanding contribution of the Boston University School of Medicine Office of Continuing Medical Education; we owe lots of thanks for them.

The research work done by Drs Irwin Goldstein and Jennifer Berman are integral to this course and to the entire field of female sexual dysfunction.

Psychologic and Sexual History Taking

Ellan Laan, a psychologist from the Netherlands, and one of the few pioneers in female sexual dysfunction has been working on a basic problem - what does a woman feel during sex? They have looked at the lack of agreement between what women report, the sexual arousal feelings they report, and what you can measure in the body.

Ellan Laan believed that part of this mismatch is due to a social difference between men and women, how most of them feel about being sexual. It's not easy to measure, but she monitored healthy women's physical response whilst they watched two types of sexually stimulating films - one made by a man and one by a woman, one which might make the woman feel uncomfortable about being sexual and one which she liked.

Blood flow response in women is somewhat involuntary, automatic. Once there's a strong sexual stimulus - an erotic film is a good sexual stimulus in the lab - genital blood flow occurs without you being aware of it, without you wanting it.

Medical History, Physical Examination, and Laboratory Tests

The same disease processes that cause erection problems in men cause sexual dysfunction in women. This is high blood pressure, diabetes, high cholesterol levels, heart disease, prior pelvic surgery, all those things can infect sexual function in women.

A thorough physical examination can reveal any anatomic abnormalities which can lead or be associated with the FSD.

The patients' hormonal profile should be evaluated to make sure whether hormonal replacement therapy might be warranted.

Oxygenation-temperature Method and Vasculogenic Vaginal Plethysmography

This paper reviewed reliability, specificity, and practical applicability of one of the most promising and widely used methods for measuring blood flow within the vagina: the vaginal photoplethysmography. It was concluded that the vaginal pulse amplitude as measured by the photoplethysmograph is a specific indicator of physiological sexual arousal. Although vaginal pulse amplitude seems to be the method of choice for measuring vaginal vasocongestion up to orgasm, and the oxygenation-temperature method for measuring orgasm, these measures should not be used in isolation. It is argued that women's sexual function should be evaluated using vaginal vasocongestion measures in conjunction with subjective indices. Finally, the field is in need of studies comparing physiological and subjective sexual responses in clinical and non-clinical groups.

Vaginometry, Vaginal Ph, Duplex Ultrasonography, and Vaginal Resistance

One day we will have ultrasound studies to record blood flow to the clitoris and vagina, which is under development now. pH and other aspects of the physiology of the vagina are recorded.