It may not allow total visualization of the vaginal vault and cervix, but it will again reinforce to the patient that you will not be harming her during the pelvic examination. The size of the speculum can gradually be increased as the patient becomes more comfortable with the pelvic examination. Often, patients do not feel comfortable discussing sexual problems the first time the physician attempts to obtain a sexual history. However, I have found that many patients remember that their practitioner is open to discussing their problem. Therefore, do not hesitate to obtain a brief sexual history even if few patients respond positively at first.
Some literature supports the cause and effect of androgens and sex drive motivational activities.
Much of the work of Sherwin and Gelfand 5,6 has clearly shown that androgen replacement improves sexual desire, fantasy and arousal. Patients who are beginning estrogen replacement therapy do not need a serum estrogen level and follicle-stimulating hormone level initially drawn, because it is expensive and it is not helpful in the management of the patient. Additionally, more ambulatory practice time is added because the medical office has to follow up on and report laboratory test results to the patient. Although we often equate the increasing prevalence of sexual dysfunction in menopausal and postmenopausal women with the loss of gonadal hormones, we must not ignore the fact that a large number of younger women may also experience a decline in sexual interest. Therefore, an age limit should not be placed on obtaining a sexual history.