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Women s sexuality is multifactorial, rooted in biologic, psychosexual, and context-related factors [1,3,4,7 16] The latter include couple dynamics, family and sociocultural issues and developmental factors, including sexual abuse [17 19] Sexuality is also multisystemic: in men and women, a physiologic response requires the integrity of the hormonal, vascular, nervous, muscular, connective, and immune systems a fact too often overlooked in women, until recently [7,15,16,20 25] Three major dimensions female sexual identity, sexual function and sexual relationship interact to de ne women s sexual health [7,15,22] Women s sexuality varies over the life cycle and is dependent on biologic (reproductive events) as well as personal, current contextual, and relationship variables [13,26] Female sexual problems are age related, progressive, and highly prevalent, affecting up to 43% of women [27 31] More importantly, a third to half of women who were de ned as having a prob-

467 471 471

lem regarded the problem as distressing [30,32] These sexual problems appear to increase with both menopause and with age [33 37] Sexual disorder, among both men and women, has been associated with poor quality of life, lower perception of wellbeing, lower self-esteem, poor self-image, poor relationship quality, and depression and anxiety [38 40] Female sexual problems may occur along a continuum from dissatisfaction (with potential integrity of the physiologic response but emotional/affective frustration), to dysfunction (with or without pathological modi cations), to severe pathology, biologically rooted [26,41] Pelvic oor disorders are among the most important and yet neglected medical contributors to women s sexual disorders [42 44] Sexual dissatisfaction, disinterest and even dysfunction may occur in conjunction with male sexual disorders or in the context of an abusive relationship Female sexual problems should not all be labelled per se as diseases or dysfunctions requiring medical treatment [30] Low levels of female sexual function may occur with or without signi cant personal (and interpersonal) distress [9,30,45] For example, although female sexual function declines with age and incrementally with menopause [46], women become less distressed about low sexual function with age [47] Sociocultural factors may further modulate the perception, expression, and complaining modality that is, the wording of a sexual disorder The meaning of sexual intimacy is a strong modulator of sexual response and of the quality of satisfaction the

The broadest form of partnership is a joint venture, which allows both individuals and corporations to combine their skills as well as capital, land, and other assets in investments or development projects Typically focused on one project, it can take any of the following forms Consult both a lawyer and an accountant to determine which one is right for you and your partners

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20 included in the broader manual of psychiatric disorders [61,62] The rst and second consensus conferences on FSD [3,13] set out to de ne women s sexual disorders, with special attention given to bringing together the current level of evidence with de nitions tting women s wording and experiences The latest classi cation is reported in Table 201

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woman experiences, in addition to physical response [4,19,48 50] The quality of feelings for the partner, change in relationship status, and length of the relationship, also signi cantly affect female sexual function [9,51] Sexual problems reported by women are not discrete and often co-occur, co-morbidity being one of the leading characteristics of female sexual disorders [13,26] Co-morbidity between female sexual disorder and medical conditions urologic, gynecologic, proctologic, dysmetabolic, cardiovascular and nervous diseases, to mention a few is beginning to be recognized [15,22,44,52,53] For example, latent classes analysis of sexual dysfunctions by risk factors in women indicate that urinary tract symptoms have a RR = 402 (275 589) of being associated with arousal disorders, and a RR = 761 (406 1426) of being associated with sexual pain disorders, according to the epidemiologic survey of Laumann and colleagues [27] The attention dedicated to FSD-related co-morbidities both between FSD subtypes and between FSD and medical conditions in this document re ects the clinical relevance of this association, especially in the urogynecologic and proctologic domains Psychiatric co-morbidity impacts sexual function to different degrees in each individual, with past sexual trauma, eating disorders, or histrionic personality disorder [54 58] having some impact on sexual function As many as 70% of patients with depression report a decline in libido [59] The greater prevalence of anxiety disorders (305% to 192%) and depressive disorders (21% to 13%) in women in comparison to men increases the importance of evaluating and treating psychiatric comorbidity [60]