Treating patients with sexual dysfunction. (Sexual Arousal Disorder, Dyspareunia).

VAIL, COLO. -- It's a scenario familiar to every ob.gyn.: Just as an office visit draws to a close, the patient says, "Oh, by the way ..." and suddenly the real purpose of her visit becomes apparent.

She has a sexual complaint.

Ob.gyns. can do much to help, but not right then. The first step is to have the patient schedule an appointment for a long visit at the end of a workday. A thorough, time-consuming history will need to be taken to determine which of the common specific dysfunctions is involved: hypoactive sexual desire disorder, female sexual arousal disorder, female orgasmic disorder, dyspareunia, or vaginismus, William D. Petok, Ph.D., explained at a conference on obstetrics and gynecology sponsored by the University of Colorado.

The most common form of sexual dysfunction in women is what the American Psychiatric Association's DSM-IV-TR calls hypoactive sexual desire disorder (HSDD). The patient complains she's not as interested in sex as she used to be. She doesn't have sexual fantasies or any desire for sexual activity.

Diagnostically useful questions include: How long have you been experiencing this problem? How often did you have sex in the past year? What's your lifestyle like? How is your relationship with your partner? Do you have the same problem with other partners, if any? And whom does this problem bother more: you, your partner, or both of you equally?

The problem is more likely to be HSDD if it bothers the patient more, said Dr. Petok, a clinical psychologist in Baltimore.

Another time-consuming part of this first office visit involves ruling out drug side effects, hormonal disorders, alcohol dependence, depression, extramarital affairs, and spousal abuse as potential causes of the patient's sexual apathy complaint.