Female Sexual Dysfunction: Facts & Fiction 1/24/20

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FEMALE SEXUAL DYSFUNCTION… FACTS & FICTION

Christine Isaacs, MDProfessor

Department of Obstetrics & Gynecology

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The Sex Talk…

CONFLICTS: NONE

Objectives:

1. Review the prevalence of sexual

dysfunction disorders in women

2. Identify barriers that exist in

identifying disorders

3. Understand the current model of the Sexual response cycle

Part 1

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1,769 miles

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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44-57% OF MIDDLE-AGED AND POSTMENOPAUSAL WOMEN EXPERIENCE

SOME INVOLUNTARY URINE LOSS

ACOG Practice Bulletin No. 155

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15% OF COUPLES ARE AFFECTED BY INFERTILITY

ACOG Committee Opinion, No. 781

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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43% OF AMERICAN WOMEN REPORT EXPERIENCING A SEXUAL PROBLEM

ACOG Practice Bulletin No. 213

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WHAT IS NORMAL?

(A misleading concept…Sexually speaking)

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MODELS OF “NORMAL”…

Masters & Johnson, 1966

“Linear Model”Kaplan & Leif, 1979

Modified to Include Desire

(Kingsberg and Woodard, Obstet Gynecol 2015)

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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COMPONENTS OF DESIRE…

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DESIRE…• Biologic drive

• Spontaneous sexual interest• Not fully understood• Declines with aging in men and

women

• Cognition• Expectations, beliefs and values

about sex

• Motivation• Willingness

Linear based model…relies on spontaneous sexual desire

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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COULD ANOTHER MODEL EXIST?

• One that incorporates the importance of…

• Intimacy

• Sexual stimuli

• Relationship satisfaction

Acknowledging the complexity of women’s sexual functioning

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BASSON’S NONLINEAR MODEL

Desires can be SPONTANEOUS or STIMULATED

(Kingsberg and Woodard, Obstet Gynecol 2015)

(Basson, Obstet & Gyn 2001)

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BASSON’S NONLINEAR MODEL

• Women can begin from a

point of sexual neutrality

• Desire can result from

arousal in the context of a loving relationship

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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DYSFUNCTION…WHEN SOMETHING GOES WRONG

• Desire disorder

• Arousal disorder

• Orgasmic disorder

• Pain disorder

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SEXUAL DYSFUNCTION

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HOW COMMON IS THIS?

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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• 43% of American women report a sexual problem

• 12% report that it leads to

personal distress

• Problems increase with advancing age

(Prevalence of Fem ale Sexual Problem s Associated with Distress and

Determ inants of Treatm ent Seeking-PRESIDE Study, 2008)

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• Distressing problems PEAK in women in midlife

• Cross-sectional population-based survey of female adults in the US

• n=31,581

(Prevalence of Female Sexual Problems Associated with

Distress and Determinants of treatment Seeking (PRESIDE), 2008)

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WE HAVE A SMALL PROBLEM….

• International Survey of 27,500 men and

women age 40-80

• ~50% had experienced at least 1 sexual

problem

• Only 9% had been asked about their sexual health during a routine visit

during the past 3 years

(Moreira et al, Int J Clin Pract 2005;59:6-16)

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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2004 SURVEY ANNUAL MEETINGS OF FOUR MAJOR SPECIALTY SOCIETIES…

• ACOG ACM

• Endocrine Society

• NAMS

• American Society for Reproductive Medicine

(Bachmann G. J Sex Med 2006;3:639)

Biggest obstacles to discussing sexual health with patients?

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ANSWER?

• #1…Limited time!

• Embarrassment

• Lack of effective treatment options

• Limited training on female sexual function

• Reliance on patients to initiate the discussion

• 60% of respondents rated their knowledge and comfort level with FSD

as only fair to poor

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3,807 WOMEN ASKED WHY THEY DID NOT SEEK HELP FOR SEXUAL PROBLEMS…

• Embarrassed

• Fear of provider embarrassment

• Fear they could not get help/no treatment

• It didn’t occur to seek help from a doctor

(Parish, Sex Med Rev 2016; 4:103-120)

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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DSM 52013

Reflects the constant evolution and thinking of the time…

1st edition (1952) listed diagnosis of “impotence” and “frigidity”

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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SEXUAL DISORDERS…DSM-5

• Must be associated with PERSONAL DISTRESS

• Requires a minimum duration of 6 months

• Must experience the disorder 75-100% of the time

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DSM IV DSM VLINEAR model (5 dysfunctions)

1. Desire

2. Arousal

3. Orgasm

4. Dyspareunia

5. Vaginismus

Complex model (3 dysfunctions)

1. Female Sexual Interest/Arousal Disorder

2. Orgasm

3. Genitopelvic Pain/Penetration Disorder

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SUMMARY OF WHAT WE NOW KNOW…

1. Female Sexual Dysfunction is very common in your patients

2. Newer “circular” models illustrate the complexity of the female sexual response cycle…perhaps a good thing!

3. There are LOTS of barriers to discussing/helping patients

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WHAT IS THE CLINICIAN TO DO?

How can you fix things?

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Female Sexual Dysfunction: Facts & Fiction 1/24/20

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Part 2…stay tuned…

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