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Stanley EE, Pfoh E, Lipold L, Martinez K. Gap in Sexual Dysfunction Management Between Male and Female Patients Seen in Primary Care: An Observational Study. J Gen Intern Med 2024:10.1007/s11606-024-09004-1. [PMID: 39231849 DOI: 10.1007/s11606-024-09004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Female sexual dysfunction (FSD), defined as clinically distressing problems with desire, arousal, orgasm, or pain, affects 12% of US women. Despite availability of medications for FSD, primary care physicians (PCPs) report feeling underprepared to manage it. In contrast, erectile dysfunction (ED) is frequently treated in primary care. OBJECTIVE To describe differences in patterns of FSD and ED diagnosis and management in primary care patients. DESIGN Retrospective observational study. SUBJECTS Primary care patients with an incident diagnosis of FSD or ED seen at a large, integrated health system between 2016 and 2022. MAIN MEASURES Sexual dysfunction management (referral or prescription of a guideline-concordant medication within 3 days of diagnosis), patient characteristics (age, race, insurance type, marital status), and specialty of physician who diagnosed sexual dysfunction. We estimated the odds of FSD and ED management using mixed effects logistic regression in separate models. KEY RESULTS The sample included 6540 female patients newly diagnosed with FSD and 16,591 male patients newly diagnosed with ED. Twenty-two percent of FSD diagnoses were made by PCPs, and 38% by OB/GYNs. Forty percent of ED diagnoses were made by PCPs and 20% by urologists. Patients with FSD were managed less frequently (33%) than ED patients (41%). The majority of FSD and ED patients who were managed received a medication (96% and 97%, respectively). In the multivariable models, compared to diagnosis by a specialist, diagnosis by a PCP was associated with lower odds of management for FSD patients (aOR, 0.59; 95% CI, 0.51-0.69) and higher odds of management (aOR, 1.52; 95% CI, 1.36-1.64) for ED patients. CONCLUSIONS Primary care patients with FSD are less likely to receive management if they are diagnosed by a PCP than by an OB/GYN. The opposite was true of ED patients, exposing a gap in the quality of care female patients receive.
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Affiliation(s)
| | - Elizabeth Pfoh
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA
| | - Laura Lipold
- Department of Family Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kathryn Martinez
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA
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Goddard B, Brucker B. Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students. Sex Med 2023; 11:qfad049. [PMID: 37692127 PMCID: PMC10484727 DOI: 10.1093/sexmed/qfad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic. Aim The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments. Methods We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD. Outcomes Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments. Results A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006). Clinical Implications There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD. Strengths and Limitations This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method. Conclusion Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.
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Affiliation(s)
- Brian Goddard
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - Benjamin Brucker
- Department of Urology, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States
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Azar M, Azar N, Kroll T, Bradbury-Jones C. Should I Seek Help for Sexual Difficulties? Middle-Aged Lebanese Women's Views. JOURNAL OF SEX & MARITAL THERAPY 2021; 47:635-655. [PMID: 34154514 DOI: 10.1080/0092623x.2021.1934208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This qualitative study explored the way middle-aged Lebanese women address their sexual difficulties. Data analysis revealed three overarching themes and subthemes. From these we developed a help-seeking behavior framework for sexual difficulties. The framework focuses on: the perception of the problem, the beliefs about help-seeking and the sources of help. This framework can be used to facilitate access to personalized sexuality-related care based on a better understanding of the complex interplay of personal, socio-cultural and service-related factors that influence help-seeking behavior for sexual problems.
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Affiliation(s)
- Mathilde Azar
- Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
| | - Nagham Azar
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Kingsberg SA, Nambiar S, Karkare S, Hadker N, Lim-Watson M, Williams LA, Krop J. Hypoactive sexual desire disorder (HSDD) is not "female erectile dysfunction (ED)": challenges with the characterization of HSDD in women based on a systematic literature review. Curr Med Res Opin 2020; 36:1069-1080. [PMID: 32301355 DOI: 10.1080/03007995.2020.1754181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Hypoactive sexual desire disorder (HSDD) in women has been viewed inaccurately by some in the medical and payer community as analogous to erectile dysfunction (ED) in men. This literature review aims to highlight the distinctions between HSDD and ED.Methods: Two systematic literature searches were conducted on the epidemiology, symptomatology and biopsychosocial outcomes of HSDD and ED. Studies published since 2007 were considered for HSDD; studies published since 2012 were considered for ED.Results: HSDD in women is primarily a central nervous system condition related to neuroendocrine factors, whereby neural pathways that regulate sexual excitation and/or inhibition appear to be involved. A combination of organic and psychogenic factors often contributes to ED. HSDD and ED are associated with similar psychological and interpersonal consequences, but affect different phases of the sexual response model (desire versus arousal) and have different pathophysiologies, therefore requiring different treatment and outcome paradigms. ED is measured by objective, physiological responses (erection and sexual function), but quantitative assessments for HSDD are more difficult because loss of desire with associated distress has to be assessed. Outcome measures used to assess ED, such as the number of satisfying sexual events, are far less informative as an endpoint for randomized clinical trials of treatments for HSDD.Conclusions: HSDD and ED are distinct conditions affecting different phases of the sexual response model, and thus require clear and unique clinical characterization and adequate communication between the health care professional and patient for appropriate diagnosis, management and treatment.
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Affiliation(s)
- Sheryl A Kingsberg
- Department of Obstetrics/Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, MA, USA
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Gurney K, Hobbs LJ, Adams NJ, Bailey JV. The Sextherapylondon interactive website for sexual difficulties: content, design and rationale. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2019.1703929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Gurney
- Clinical Psychologist and Psychosexologist, Chelsea and Westminster NHS Trust, Sexual Health Service, London, UK
| | - Lorna J. Hobbs
- Clinical Psychologist, e-Health Unit, University College London, Royal Free Hospital, London, UK
| | - Naomi J. Adams
- Consultant Clinical Psychologist, Central and North West London NHS Trust, Sexual Health Services, Mortimer Market Centre, London, UK
| | - Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
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6
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Muhamad R, Horey D, Liamputtong P, Low WY. Managing Women with Sexual Dysfunction: Difficulties Experienced by Malaysian Family Physicians. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:949-960. [PMID: 30238183 DOI: 10.1007/s10508-018-1236-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Recognizing barriers to managing sexual issues makes it more likely that effective ways to overcome them will be found. In Malaysia, where discussion of sexual issues is taboo, sociocultural factors may influence how physicians manage patients with these types of problems. This article focuses on the challenges encountered by 21 Malay family physicians when women experiencing sexual problems and female sexual dysfunction (FSD) attended their clinics, an uncommon occurrence in Malaysia, despite their high prevalence. This qualitative study employed a phenomenological framework and conducted face-to-face in-depth interviews. Three main barriers to managing women with sexual problems were identified that can hinder assessment and treatment: insufficient knowledge and training; unfavorable clinic environments; and personal embarrassment. Some barriers were associated with physician characteristics but many were systemic. These were further evaluated using social cognitive theory. Professional attitudes appear important as those physicians with an interest in managing women's health seemed to make greater effort to explore issues further and work to gain trust. Physicians who appeared indifferent to the impact of FSD showed greater reluctance to find solutions. Systemic issues included unfavorable clinical settings, lack of training, and lack of local evidence. Any strategy to address FSD needs to be underpinned by appropriate policies and resources.
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Affiliation(s)
- Rosediani Muhamad
- Family Medicine Department, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
- Department of Public Health, College of Science, Health and Engineering, Melbourne Campus, La Trobe University, Bundoora, VIC, Australia.
| | - Dell Horey
- Department of Public Health, College of Science, Health and Engineering, Melbourne Campus, La Trobe University, Bundoora, VIC, Australia
| | - Pranee Liamputtong
- School of Science and Health, School of Medicine, Western Sydney University, Campbelltown, Penrith, NSW, Australia
| | - Wah Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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7
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Brotto LA, Basson R, Chivers ML, Graham CA, Pollock P, Stephenson KR. Challenges in Designing Psychological Treatment Studies for Sexual Dysfunction. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:191-200. [PMID: 27414090 DOI: 10.1080/0092623x.2016.1212294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Lori A Brotto
- a Department of Obstetrics and Gynaecology , University of British Columbia , Vancouver , Canada
| | - Rosemary Basson
- b Department of Psychiatry , University of British Columbia , Vancouver , Canada
| | | | - Cynthia A Graham
- d Department of Psychology , University of Southampton , Southampton , UK
| | - Phil Pollock
- e Vancouver Prostate Centre , Vancouver , Canada
| | - Kyle R Stephenson
- f Department of Psychology , Willamette University , Salem , Oregon , USA
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Wallwiener CW, Wallwiener LM, Seeger H, Schönfisch B, Mueck AO, Bitzer J, Zipfel S, Brucker SY, Wallwiener S, Taran FA, Wallwiener M. Sexual Function, Contraception, Relationship, and Lifestyle in Female Medical Students. J Womens Health (Larchmt) 2017; 26:169-177. [DOI: 10.1089/jwh.2015.5731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Christian W. Wallwiener
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - Lisa-Maria Wallwiener
- Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Harald Seeger
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - Birgitt Schönfisch
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - Alfred O. Mueck
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - Johannes Bitzer
- Department of Obstetrics and Gynecology, University of Basel, Basel, Switzerland
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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9
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Lodise NM. Hypoactive sexual desire disorder in women: treatment options beyond testosterone and approaches to communicating with patients on sexual health. Pharmacotherapy 2014; 33:411-21. [PMID: 23553810 DOI: 10.1002/phar.1209] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hypoactive sexual desire disorder (HSDD) affects nearly 1 in 10 women. Thus, it is essential for pharmacists and other health care providers to be comfortable when discussing a patient's sexual health to ensure appropriate triage so that the specific causes of HSDD can be identified and potential recommendations provided. HSDD is defined as the absence or deficiency of sexual interest and/or desire, leading to significant distress and interpersonal difficulties. As health care providers, pharmacists have a critical role in assessing the presence of HSDD and providing education on available treatment options. This article will review the potential causes of HSDD and low sexual desire, the screening tools available, and the significant role of health care professionals in communicating with patients about their sexual health. An overview of the importance of behavioral modifications, the current pharmacologic options being investigated, and the use of complementary and alternative therapies will also be explored. Currently, buproprion is the primary pharmacologic agent that has shown positive results in treating patients with HSDD. The use of testosterone therapy will not be addressed in this article, as this therapy is described in greater detail elsewhere.
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Affiliation(s)
- Nicole M Lodise
- Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA.
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10
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Ribeiro S, Alarcão V, Simões R, Miranda FL, Carreira M, Galvão‐Teles A. General Practitioners' Procedures for Sexual History Taking and Treating Sexual Dysfunction in Primary Care. J Sex Med 2014; 11:386-93. [DOI: 10.1111/jsm.12395] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard Operating Procedures for Taking a Sexual History. J Sex Med 2013; 10:26-35. [DOI: 10.1111/j.1743-6109.2012.02823.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Alarcão V, Ribeiro S, Miranda FL, Carreira M, Dias T, Garcia e Costa J, Galvão‐Teles A. General Practitioners' Knowledge, Attitudes, Beliefs, and Practices in the Management of Sexual Dysfunction—Results of the Portuguese SEXOS Study. J Sex Med 2012; 9:2508-15. [DOI: 10.1111/j.1743-6109.2012.02870.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Maclaran K, Panay N. Managing Low Sexual Desire in Women. WOMENS HEALTH 2011; 7:571-81; quiz 582-3. [DOI: 10.2217/whe.11.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Low sexual desire is a prevalent symptom, but not one frequently volunteered by women. When accompanied by distress, loss of libido is known as hypoactive sexual desire disorder, which can have a significant impact on a woman's wellbeing. The etiology of hypoactive sexual desire disorder is multifactorial and its management requires a combination of psychosocial and pharmacological interventions. This article outlines the assessment of patients presenting with the symptom of low sexual desire and discusses the evidence for pharmacological management.
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Affiliation(s)
- Kate Maclaran
- Queen Charlotte's & Chelsea, & Chelsea & Westminster Hospitals, West London Menopause & PMS Centre, Du Cane Road, London, W12 0HS, UK
- Imperial College London, London, UK
| | - Nick Panay
- Queen Charlotte's & Chelsea, & Chelsea & Westminster Hospitals, West London Menopause & PMS Centre, Du Cane Road, London, W12 0HS, UK
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Richards TA, Bertolotti PA, Doss D, McCullagh EJ. Sexual dysfunction in multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs 2011; 15 Suppl:53-65. [PMID: 21816710 DOI: 10.1188/11.cjon.s1.53-65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The World Health Organization describes sexuality as a "central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors." Currently, no research has been conducted regarding sexual dysfunction in patients with multiple myeloma; therefore, information related to the assessment and evaluation of sexual dysfunction is gleaned from other malignancies and diseases. In this article, members of the International Myeloma Foundation's Nurse Leadership Board discuss the definition, presentation, and causes of sexual dysfunction; provide recommendations for sexual assessment practices; and promote discussion among patients with multiple myeloma, their healthcare providers, and their partners.
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Affiliation(s)
- Tiffany A Richards
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center in Houston, USA.
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Simon JA. Low sexual desire--is it all in her head? Pathophysiology, diagnosis, and treatment of hypoactive sexual desire disorder. Postgrad Med 2011; 122:128-36. [PMID: 21084789 DOI: 10.3810/pgm.2010.11.2230] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hypoactive sexual desire disorder (HSDD) is thought to be the most prevalent form of female sexual dysfunction (FSD), affecting up to 1 in 10 US women. Hypoactive sexual desire disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) as persistent or recurrent deficiency or absence of sexual fantasies and thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress or interpersonal difficulties and is not caused by a medical condition or drug. This definition has recently received criticism and recommendations for changes encompass the inclusion of duration, intensity, and frequency, and the elimination of distress as a diagnostic criterion. More recently, it has been suggested that arousal and desire be combined into one disorder for the upcoming DSM-V. Causes of low desire include chronic medical conditions, medications, surgeries, and psychosocial factors, but not necessarily increased age; both pre- and postmenopausal women can have HSDD, although the frequency appears to vary by age. Sexual function requires the complex interaction of multiple neurotransmitters and hormones, both centrally and peripherally, and sexual desire is considered the result of a complex balance between inhibitory and excitatory pathways in the brain. For example, dopamine, estrogen, progesterone, and testosterone play an excitatory role, whereas serotonin and prolactin are inhibitory. Thus, decreased sexual desire could be due to a reduced level of excitatory activity, an increased level of inhibitory activity, or both. A number of validated self-report and clinician-administered instruments are available for assessing female sexual function; however, most have been used primarily in clinical research trials. The Decreased Sexual Desire Screener (DSDS) was developed for practicing clinicians who are neither trained nor specialized in FSD to assist in making an accurate diagnosis of generalized acquired HSDD. As our understanding of the pathophysiology of HSDD increases, it may become easier for physicians to identify and treat women with low sexual desire.
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Affiliation(s)
- James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20036, USA.
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[Hypoactive sexual desire disorder, HSDD]. ACTA ACUST UNITED AC 2010; 39:28-31. [PMID: 21186133 DOI: 10.1016/j.gyobfe.2010.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/25/2010] [Indexed: 01/23/2023]
Abstract
Hypoactive Sexual Desire Disorder (HSDD) is the most common Female Sexual Dysfunction (FSD) affecting adult women of any age, including postmenopausal women. HSDD may have significant effects on the relationships and emotional balance of women and constitutes the most common form of FSD observed in clinical practice. HSDD is characterised by a deficiency or lack of sexual fantasies and desire for sexual activity, causing serious distress or interpersonal difficulties, and it is not exclusively caused by the effects of another psychiatric disorder, pathology or substance (such as medication). HSDD pathophysiology is not yet well understood, but it is thought to involve an imbalance between factors controlling inhibition and excitation of sexual desire in the brain. Many physicians are reluctant to discuss sexual desire problems with their patients for various reasons, such as insufficient knowledge of the field, an absence of efficient treatments and time constraints. Even though current treatment options are limited, a better understanding of the physiopathology behind HSDD may help develop new therapies.
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Wylie K, Rees M, Hackett G, Anderson R, Bouloux PM, Cust M, Goldmeier D, Kell P, Terry T, Trinick T, Wu F. Androgens, health and sexuality in women and men. HUM FERTIL 2010; 13:277-97. [DOI: 10.3109/14647273.2010.530966] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Wylie K, Rees M, Hackett G, Anderson R, Bouloux PM, Cust M, Goldmeier D, Kell P, Terry T, Trinick T, Wu F. Androgens, health and sexuality in women and men. Maturitas 2010; 67:275-89. [DOI: 10.1016/j.maturitas.2010.07.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 07/20/2010] [Indexed: 01/23/2023]
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Parish SJ, Rubio-Aurioles E. Education in Sexual Medicine: Proceedings from the International Consultation in Sexual Medicine, 2009. J Sex Med 2010; 7:3305-14. [DOI: 10.1111/j.1743-6109.2010.02026.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clayton AH, Segraves RT, Bakish D, Goldmeier D, Tignol J, van Lunsen RHW, Nappi RE, Wunderlich G, Kimura T, Lewis-D'Agostino DJ, Pyke R. Cutoff score of the sexual interest and desire inventory-female for diagnosis of hypoactive sexual desire disorder. J Womens Health (Larchmt) 2010; 19:2191-5. [PMID: 20858040 DOI: 10.1089/jwh.2010.1995] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the most appropriate cutoff value for the Sexual Interest and Desire Inventory-Female (SIDI-F) score to discriminate between women with hypoactive sexual desire disorder (HSDD) and those with no female sexual dysfunction (FSD). The SIDI-F is a clinician-rated instrument consisting of 13 items designed to assess HSDD severity in women. The total score ranges from 0 to 51, with higher scores indicating better sexual function. METHODS Data from patients enrolled in a North American nontreatment study and a European nontreatment study were analyzed. Both studies were 4-week, prospective, multicenter trials designed to assess the reliability and validity of the SIDI-F. Only patients with HSDD or no FSD were included in this analysis. Receiver operating characteristics (ROC) analysis was used to determine the ability of the SIDI-F to differentiate between patients with HSDD and those with no FSD at baseline. RESULTS A total of 428 women were included in this analysis: 174 from North America (HSDD 113, no FSD 61) and 254 from Europe (HSDD 130, no FSD 124). In the North American study, a SIDI-F cutoff score of 33 minimized the difference between sensitivity (94.7%) and specificity (93.4%). In the European study, SIDI-F cutoff scores of both 33 and 34 minimized the difference between sensitivity (95.2%) and specificity (94.4%). CONCLUSIONS In appropriately screened women, a SIDI-F score of ≤33 indicates the presence of HSDD.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia 22903, USA.
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Clayton AH, Dennerstein L, Pyke R, Sand M. Flibanserin: A Potential Treatment for Hypoactive Sexual Desire Disorder in Premenopausal Women. WOMENS HEALTH 2010; 6:639-53. [DOI: 10.2217/whe.10.54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hypoactive Sexual Desire Disorder (HSDD) is defined as a persistent or recurrent deficiency of sexual fantasies and desire for sexual activity, which causes marked personal distress or interpersonal difficulty, and is not better accounted for by another psychiatric disorder or the direct physiological effects of a substance (e.g., a medication) or medical condition. HSDD is believed to be the most common form of Female Sexual Dysfunction and is associated with emotional distress and relationship problems. No pharmacologic therapy is approved for the treatment of HSDD in premenopausal or naturally postmenopausal women. Flibanserin is a 5-HT1A agonist/5-HT2A antagonist that is under investigation as a treatment for HSDD in women. The aim of this article is to present an overview of the pharmacology, clinical efficacy and safety of flibanserin. Flibanserin is an investigational drug that is not licensed for any indication in any country.
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Affiliation(s)
- AH Clayton
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, 2955 Ivy Road, Northridge Charlottesville, VA 22903, USA
| | - L Dennerstein
- Office for Gender & Health, Department of Psychiatry, National Ageing Research Institute, University of Melbourne, Parkville, Vic 3050 Australia
| | - R Pyke
- Boehringer Ingelheim Pharmaceuticals Inc, 900 Ridgebury Road, Ridgefield, CT 06877, USA
| | - M Sand
- Boehringer Ingelheim Pharmaceuticals Inc, 900 Ridgebury Road, Ridgefield, CT 06877, USA
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Clayton AH. The pathophysiology of hypoactive sexual desire disorder in women. Int J Gynaecol Obstet 2010; 110:7-11. [DOI: 10.1016/j.ijgo.2010.02.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 02/23/2010] [Accepted: 03/16/2010] [Indexed: 01/23/2023]
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Wallwiener CW, Wallwiener LM, Seeger H, Mück AO, Bitzer J, Wallwiener M. Prevalence of Sexual Dysfunction and Impact of Contraception in Female German Medical Students. J Sex Med 2010; 7:2139-2148. [DOI: 10.1111/j.1743-6109.2010.01742.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abdolrasulnia M, Shewchuk RM, Roepke N, Granstaff US, Dean J, Foster JA, Goldstein AT, Casebeer L. Management of female sexual problems: perceived barriers, practice patterns, and confidence among primary care physicians and gynecologists. J Sex Med 2010; 7:2499-508. [PMID: 20524976 DOI: 10.1111/j.1743-6109.2010.01857.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although approximately 40% of women report female sexual problems--and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians. AIM To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S. practicing primary care physicians (PCPs) and obstetrician/gynecologists (OB/GYNs). METHODS A random sample of practicing U.S. PCPs and OB/GYNs were sent a case-vignette survey by e-mail and fax. Response to the survey was considered consent. A regression model was analyzed to assess predictors of confidence. MAIN OUTCOME MEASURE Frequency and variability in diagnostic tests ordered and treatment recommendations provided for a patient with diminished sexual desire. Percent of physicians who reported they were confident in treating hypoactive sexual desire disorder (HSDD) and percent who reported significant barriers to initiating a dialogue about sexual health with female patients. RESULTS A total of 505 responses were analyzed (8.8% response rate). Of respondents, 21% of OB/GYNs and 38% of PCPs stated they were not at all confident in treating HSDD. The majority of physicians would order a thyroid panel (PCP = 63%, OB/GYN = 53%) to assess a patient's diminished desire and recommended counseling and stress management to treat a patient with sexual complaints (PCP = 48%, OB/GYN = 54%). Regression results identified time constraints, the perceived lack of effective therapies, perceptions regarding patient-physician gender discordance, years in practice, number of patients seen per week, and perceptions regarding continuing medical education and practice experience as significant and independent predictors of confidence in treating HSDD patients.
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Foley K, Foley D, Johnson BH. Healthcare resource utilization and expenditures of women diagnosed with hypoactive sexual desire disorder. J Med Econ 2010; 13:583-90. [PMID: 20831458 DOI: 10.3111/13696998.2010.518114] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe healthcare utilization and costs among commercially insured women with a diagnosis of hypoactive sexual desire disorder (HSDD) in the US and to compare them with an age-matched control cohort. METHODS The Thomson Reuters MarketScan * Commercial Database was used to identify women aged 18-64 with an ICD-9-CM coded diagnosis of HSDD from 1/1/1998 to 9/30/2006. A control group of women with no diagnosis of any sexual dysfunction was matched 3:1 to cases based on age, health plan, and enrolment period. Healthcare utilization and costs were examined in the year prior to (pre-period) and following (post-period) index. Multivariate analyses were used to determine the adjusted difference in cost between women with and without HSDD in the post-period. RESULTS In both the pre- and post-periods, women with HSDD had more outpatient office visits, radiology services, prescription medication use, and medical visits (e.g., laboratory and outpatient surgeries) relative to controls. In the 12-month post-period, women with HSDD had significantly higher total costs relative to controls ($5,504 ± 11,132 vs. $4,606 ± 12,601, p < 0.001). After adjusting for clinical characteristics, women with HSDD had total healthcare expenditures that were 16.8% higher than controls (p < 0.001). LIMITATIONS There is a potential for selection bias among the women who actually received a diagnosis of HSDD from a clinician. Women who received a diagnosis may be different from women without a diagnosis in ways that cannot be measured in this study. Additionally, it is possible that some women in the control group had HSDD but were undiagnosed. To the extent that the control group included women who did have HSDD, the study estimates of differences between the two groups would be underestimated. CONCLUSIONS Women diagnosed with HSDD use significantly more healthcare services than women without diagnosed sexual dysfunction. These higher costs are driven by a greater use of outpatient services and prescription medications.
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Trastorno del deseo sexual hipoactivo: comparación de 2 cuestionarios (breve perfil de la función sexual de la mujer y salud y disfunción sexual femenina en atención primaria) en 2 grupos de mujeres (ovariectomizadas e histerectomizadas, y normales). CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2010. [DOI: 10.1016/j.gine.2009.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Rosen RC, Shifren JL, Monz BU, Odom DM, Russo PA, Johannes CB. ORIGINAL RESEARCH—EPIDEMIOLOGY: Correlates of Sexually Related Personal Distress in Women with Low Sexual Desire. J Sex Med 2009; 6:1549-1560. [DOI: 10.1111/j.1743-6109.2009.01252.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Graziottin A, Serafini A, Palacios S. Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction. Maturitas 2009; 63:128-34. [DOI: 10.1016/j.maturitas.2009.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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