The challenge of sexual medicine for women: overcoming cultural and educational limits and gender biases.

Women's sexuality is multifactorial, rooted in biological, psychosexual and context-related factors, correlated not only to the couple concerned, but also to family and socio-cultural issues. Female sexual identity, sexual function and sexual relationship interact to give female sexual health its full meaning or, on the contrary, its problematic profile. Women's sexuality is discontinuous throughout the life cycle and is dependent on personal, current contextual and relationship variables as well as historical factors. Female sexual dysfunctions (FSD) occur along a continuum from dissatisfaction (with or without significant distress) to complete dysfunction (with or without significant distress). Sexual problems reported by women are not discrete and often co-occur, co-morbidity being one of the leading characteristics of female sexual dysfunctions. Socio-cultural factors may modulate the expression and complaining modality, i.e. wording of a sexual disorder. The meaning of sexual intimacy is to be understood, as it is indeed a strong modulator of the sexual response and of the quality of satisfaction the woman experiences, besides being the simple adequacy of the sexual function. Quality of feelings for the partner and the partner's health and sexual problems may further contribute to FSD. To improve women's sexual health, physicians should receive a formal training in sexual medicine both in the general medical training and in the speciality course; should become competent in the first level medical diagnosis of FSD; have an interdisciplinary approach and acknowledge the socio-cultural and context-dependent differences in FSD etiology and wording.