21-Year-Old Female with PCOS Presenting with Sexual Dysfunction and Decreased Genital Sensitivity

Case at a Glance

A 21-year-old female with a history of polycystic ovary syndrome (PCOS) presents with complaints of decreased sexual sensation, anorgasmia, and reduced genital sensitivity during intimate activities.

Patient's Story

The patient reports a long-standing history of reduced sexual pleasure and difficulty achieving orgasm. She describes minimal sensation during vaginal penetration and reports never experiencing a complete orgasm. The patient has noted some clitoral sensitivity during direct stimulation, which can produce intense sensations and physical responses including tremor-like movements. She also reports decreased sensitivity in other erogenous zones, minimal response to tactile stimulation in typically sensitive areas such as the neck, and absence of normal tickle responses. Breast/nipple sensitivity appears preserved. The patient reports minimal arousal response to visual sexual stimuli.

Initial Assessment

Patient presents with symptoms consistent with female sexual arousal disorder and anorgasmia in the setting of known PCOS. Physical examination and hormonal evaluation indicated to rule out organic causes.

The Diagnostic Journey

Given the patient's history of PCOS, initial workup should focus on hormonal evaluation including testosterone, estrogen, progesterone, and glucose metabolism studies. Comprehensive gynecological examination to assess for anatomical abnormalities, nerve function, and vascular integrity. Psychological assessment to evaluate for anxiety, depression, or relationship factors that may contribute to sexual dysfunction.

Final Diagnosis

Female sexual arousal disorder, likely multifactorial etiology involving hormonal imbalances secondary to PCOS, possible neurological component affecting peripheral sensation, and psychosocial factors requiring further evaluation.

Treatment Plan

1. Endocrinological consultation for PCOS management and hormonal optimization 2. Referral to certified sex therapist for comprehensive sexual health evaluation 3. Gynecological examination to rule out anatomical causes 4. Consideration of glucose tolerance testing given PCOS association with insulin resistance 5. Patient education regarding normal variations in sexual response and realistic expectations 6. Couple's counseling if relationship dynamics are contributing factors

Outcome and Follow-up

Patient and partner educated on the multifactorial nature of female sexual dysfunction and the importance of addressing both medical and psychological components. Follow-up scheduled with endocrinology for PCOS management and with certified sex therapist for specialized evaluation. Emphasis placed on communication, realistic expectations, and comprehensive approach to sexual health rather than focusing solely on perceived deficits.