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In one study,11 74 percent of patients who underwent surgery for gynecologic malignancy reported decreased desire, and 40 percent reported dyspareunia.In another study12 of patients who had undergone hysterectomy for benign disease, a decrease in sexual responsiveness of up to 30 percent was noted.

For example, treatment of a patient with recurrent cystitis as a cause of dyspareunia should include the use of lubricants and distraction techniques at first intercourse to assure adequate lubrication and relaxation, respectively.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.For example, a patient complaining about decreased desire might have a primary orgasmic disorder from insufficient stimulation, with decreased desire developing secondarily as a result of unsatisfying sexual encounters .8 Thus, treating the orgasmic disorder would indirectly enhance desire; whereas, treating a desire disorder would be unsuccessful and perhaps add to patient frustration and perpetuate the cycle of dysfunction. She may reveal fear of redeveloping an abnormal Papanicolaou smear from penile penetration, or she may admit that she is not attracted to her partner.Obtaining this information early in the evaluation process will expedite diagnosis and initiation of treatment.

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