The Sex Talk…cuvailobgyn.com/assets/images/2020/03-isaacs-sexual-dysfunction-… · Female Sexual...
Transcript of The Sex Talk…cuvailobgyn.com/assets/images/2020/03-isaacs-sexual-dysfunction-… · Female Sexual...
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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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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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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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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• 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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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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DSM 52013
Reflects the constant evolution and thinking of the time…
1st edition (1952) listed diagnosis of “impotence” and “frigidity”
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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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Part 2…stay tuned…
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