Sex and the sixty year old

The February 14 issue of JAMA has an article on the sexual difficulties of a 60 year old woman, just in time for Valentine's Day, but I didn't see it until April 1. It seems that Ms. B has diabetes, hypertension, hyperlipidemia, and asthma now, and when she was younger she had endometriosis, bladder suspension surgery for incontinence and a hysterectomy for uterine fibroids. As might be expected, she takes a lot of medication, has back pain, and is allergic to some of her meds. She doesn't smoke or drink, and works as a psychologist. Oh yes, she didn't go through menopause until 58, so she dates her complaints to decreased desire and less stimulating sex to that. The author isn't specific, but says Ms. B. has some "body image" issues. One of the comments about obesity and sexual issue made me suspect that might be the problem.

I would be out of the mood just listing her health problems, so I can imagine trying to live with them. The article lists all sorts of reasons for sexual dysfunction and what life style or medical changes can be made. However, I found the very last paragraph quite instructive--almost humorous.

PHYSICIAN: How should I bill for a sexual health consultation in order to be reimbursed?
DR. POTTER: . . . Examples of reimbursable ICD-10 diagnoses include: lack or loss of sexual desire (F52.0), failure of genital response (F52.2), menopausal and female climacteric states (N95.1), postmenopausal atrophic vaginitis (N95.2), dyspareunia (N94.1), and orgasmic dysfunction (F52.3).

There are 122 references in the bibliography.