This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology.
The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Sexual health guidelines ukm updates to this document can be found on www. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person.
Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred
Sexual health guidelines ukm connection with this publication or reliance on the information presented.
Sexuality involves a broad range of expressions of intimacy and is fundamental to self-dentification, with strong cultural, biologic, and psychologic components. Obstetrician—gynecologists often are consulted by patients about sexual health and are in a unique position to open a dialogue on sexual health issues.
However, data on reproductive and sexual health morbidity suggest sexual health is an important health care issue. Each year, an estimated 45, new cases of human immunodeficiency virus HIV and approximately 20 million sexually transmitted infections occur, 3 million women experience unintended pregnancies, and 1 million women are sexually assaulted.
Openly discussing sexual health has the potential to prevent these unnecessary sexual health-related outcomes.
Clinical conversations should acknowledge the contributions of sexuality, relationships, and sexual behavior to overall health. Obstetrician—gynecologists also can support policies that broaden the coalition for effective prevention of sexually transmitted infections and promote healthy sexuality, with the ultimate goal of improving health outcomes and public health.
The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:. This Committee Opinion also will do the following: Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination, and violence.
Multilayered socioeconomic and educational Sexual health guidelines ukm, such as poverty and community violence, may contribute Sexual health guidelines ukm poor sexual health and should be considered during treatment and counseling 2.
Sexuality involves a broad range of expressions of intimacy and is fundamental to self-identification, with strong cultural, biologic, and psychologic components. The obstetrician—gynecologist has an important role in assessing sexual function because many women view their sexuality as an important quality-of-life issue that frequently is affected by reproductive events.
Additionally, obstetrician—gynecologists should be aware that some medical conditions and medications can affect sexual function and overall sexual health. Use of antidepressants, particularly selective serotonin reuptake inhibitors, oral contraceptives, and corticosteroids can be associated with hypoactive sexual desire disorder 4. Each year, an estimated 45, new cases of human immunodeficiency virus HIV 6 and approximately 20 million sexually transmitted infections STIs occur 73 million women experience unintended pregnancies, and 1 million women are sexually assaulted 8.
In the United States, was the second year in a row in which increases were seen in cases of chlamydial infection, gonorrhea, and syphilis 9.
Openly discussing sexual health has the potential to address these unnecessary sexual health-related outcomes Clinical conversations should acknowledge the contributions of sexuality, relationships, and sexual behavior to overall health Decreasing the stigmatization of sexual health in public opinion is a challenge. During the past decade, sexual health promotion has become less stigmatized, and the focus has shifted toward a more holistic view that promotes sexual health as a right for all women and men.
This broader perspective recognizes that even factors such as living in a safe community can contribute Sexual health guidelines ukm a woman being able to make healthy sexual choices for herself 8. Understanding the reproductive lifespan, and the treatment of sexual issues from adolescence through menopause and beyond, may improve the well-being and happiness of the patient. Discussions of sexual health and aging within the framework of well-woman care should include the evolution of sexual health issues across a lifespan.
Continued high-quality clinical care through perimenopause and beyond is essential. Hypoactive sexual desire disorder reaches a peak in women aged 40—60 years and in individuals who have undergone surgical menopause 4. Obstetrician—gynecologists should continue to screen based on risk factors and counsel patients in this age group for STIs and sexual abuse.
In addition, menopause affects sexual health significantly, mostly through vulvovaginal atrophy and, in part, through often detrimental changes in mood and sleep.
Obstetrician—gynecologists should be familiar with comprehensive pharmaceutical and nonpharmaceutical options for the management Sexual health guidelines ukm menopausal symptoms Obstetrician—gynecologists are encouraged to update their questionnaires and in-office interview questions for relevance to the experiences and concerns of patients of all ages.
Incorporating comprehensive sexual health into practice involves first taking a comprehensive sexual history see Box 1.
Asking questions will help lay the groundwork for creating an open dialogue with the patient. Obstetrician—gynecologists should focus on the positive aspects of sexuality, not only disease processes, giving examples of positive and respectful relationships American College of Obstetricians and Gynecologists. Retrieved March 21, and Care Sexual health guidelines ukm transgender adolescents.
Retrieved March 21, Addressing intimate partner violence, reproductive and sexual coercion: Futures Without Violence; Retrieved March 21, and Reproductive and sexual coercion. See Routine human immunodeficiency virus screening. Data from Centers for Disease Control and Prevention. A guide to taking a sexual history.
The use of broad, open-ended questions in a routine history gathering can disclose issues that may require further exploration. The following are examples of basic questions posed in a Sexual health guidelines ukm fashion:.
Deliberate inquiries should be made to assess the quality of the interpersonal relationship between a patient and her partner, including mutual satisfaction with their sexual relationship. After asking general questions, it may be helpful to ask additional questions, such as the following:.
Difficulties with prior sexual experience, insufficient foreplay, and attitudes about sexual pleasure can be elicited with careful history taking. For example, difficulties reaching orgasm or markedly reduced intensity of orgasmic sensations may not be a problem unless the patient or partner perceives it to be 3.
When discussing female sexual response, obstetrician—gynecologists should emphasize the wide range of complex normal experiences. Historically, female sexual response was described as linear, as noted in the Masters and Johnson model in Over time, other models have been developed that encompass a variety of sequences of the original four stages of female sexual response and the inclusion of others see Fig.
A discussion of sexual responsiveness with a patient can include the importance of not only "Sexual health guidelines ukm" stimuli, but also factors such as emotional intimacy and relationship satisfaction.