For a female patient presenting with sexual dysfunction, the initial assessment should begin with a comprehensive history taking that includes current and past symptoms related to pelvic floor dysfunction, sexual function, and any associated urinary or bowel symptoms. This history should explore potential contributing factors such as urinary incontinence, pelvic organ prolapse, chronic pelvic pain, neurological disease, medication side effects, diabetes, cancer, inflammatory conditions, and mobility or cognitive impairments NICE NG210.
A focused clinical examination may include inspection of the vulva and vagina for atrophy or other abnormalities, assessment for visible vaginal or rectal prolapse by asking the patient to bear down, and, if indicated, a rectal examination to check for impaction, especially in patients with cognitive impairment NICE NG210.
Use of validated symptom-specific questionnaires can aid in assessing the severity and impact of sexual dysfunction and related pelvic floor symptoms, helping to guide management and monitor treatment outcomes Clegg et al. 2012. Additionally, bladder diaries and quality-of-life assessments may be useful if urinary symptoms coexist NICE NG210[Clegg et al. 2012].
A medication review is important to identify drugs that may contribute to sexual dysfunction or pelvic floor symptoms NICE NG210. Depending on the clinical findings and patient preferences, further investigations such as urinalysis, bladder scanning to measure post-void residual volume, or referral for specialist assessment may be warranted NICE NG210,NICE NG123.
Overall, the assessment should be tailored to the woman’s age, understanding, and circumstances, with consideration of multidisciplinary input where appropriate NICE NG210.