Approximately 40% of women will experience. Female Sexual Dysfunction Focus on Low Desire. Clinical Expert Series

Size: px
Start display at page:

Download "Approximately 40% of women will experience. Female Sexual Dysfunction Focus on Low Desire. Clinical Expert Series"

Transcription

1 Clinical Expert Series Female Sexual Dysfunction Focus on Low Desire Sheryl A. Kingsberg, PhD, and Terri Woodard, MD Low or absent sexual desire is the most common sexual dysfunction in women, and its prevalence peaks during midlife. Its etiology is complex and may include biologic, psychologic, and social elements. Major risk factors for its development include poor health status, depression, certain medications, dissatisfaction with partner relationship, and history of physical abuse, sexual abuse, or both. Diagnosis is based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) and requires that a woman experience personal distress. Clinical evaluation should include medical history, sexual history, and, sometimes, a physical examination. Laboratory data are of limited value, except when warranted by history or physical examination. Treatment options include nonpharmacologic interventions such as education, office-based counseling, and psychotherapy. Although there are no U.S. Food and Drug Administration (FDA) approved treatments for low desire, pharmacologic agents have been used off-label for this purpose. Bupropion is an antidepressant that has been shown to improve desire in some women with and without depression. Systemic estrogen therapy is not recommended in the absence of vasomotor symptoms and is not directly associated with desire. However, vaginal estrogen is useful in patients presenting with concomitant vaginal atrophy and dyspareunia. Ospemifene is a selective estrogen receptor modulator that can be used as an alternative to vaginal estrogen. Exogenous testosterone has demonstrated efficacy in treating loss of desire in postmenopausal women. However, patients should be counseled that it is not FDA-approved for this purpose and there are limited published long-term safety data. Several agents for the treatment of low desire are currently in development. Gynecologists are in a unique position to address concerns about sexual desire in women. (Obstet Gynecol 2015;125:477 86) DOI: /AOG Approximately 40% of women will experience some type of sexual problem over the course of their lifetimes. 1,2 A sexual complaint is diagnosed as a dysfunction when the criteria from the American From the Case Western Reserve University School of Medicine, Cleveland, Ohio; and the University of Texas MD Anderson Cancer Center and Baylor College of Medicine, Houston, Texas. Continuing medical education for this article is available at com/aog/a594. Corresponding author: Sheryl A. Kingsberg, PhD, Case Western Reserve University, Mailstop 5034, Euclid Avenue, Cleveland, OH 44106; sheryl.kingsberg@uhhospitals.org. Financial Disclosure Dr. Kingsberg is a paid consultant for the following pharmaceutical companies: Apricus, Emotional Brain, Teva, Pfizer, Shionogi, Trimel, Sprout, NovoNordisk, Palatin, and Metagenics. The other author did not report any potential conflicts of interest by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: /15 Psychiatric Association s Diagnostic and Statistical Manual (DSM) for sexual dysfunctions are met and it results in personal distress. 3 Although sexual complaints among women are common, the largest and most recent epidemiologic survey places the prevalence of diagnosable sexual disorders at approximately 12%. 2 The most prevalent sexual dysfunction in women across all ages is a lack of sexual desire, previously referred to as hypoactive sexual desire disorder in the DSM 4th Edition, Text Revision 4 (DSM-IV-TR) and female sexual interest and arousal disorder in the DSM 5th Edition (DSM-5). 3 Women with hypoactive sexual desire disorder may report little or no interest in sex, an inability to respond to sexual stimuli, or feeling numbness despite having a good relationship with her partner. Absent or low sexual desire represents an important problem that has major implications for women s quality of life, sense of well-being, and interpersonal VOL. 125, NO. 2, FEBRUARY 2015 OBSTETRICS & GYNECOLOGY 477

2 relationships. 5 The Women s International Study of Health and Sexuality trial, a large national survey of more than 2,000 U.S. women, revealed that those with hypoactive sexual desire disorder had statistically significant decrements in health status, especially in domains that measured aspects of mental health. 6 It has also been shown that postmenopausal women with hypoactive sexual desire disorder experience more health burdens, including more comorbid medical conditions, and are nearly twice as likely to report fatigue, depression, memory problems, back pain, and a lower quality of life. 7 In addition, they are more likely than women with normal desire to agree with statements expressing negative emotional or psychological states, including feelings of frustration, hopelessness, anger, loss of femininity, and decreased self-esteem. 7 Gynecologists are in a unique position to address these concerns and help women lead the healthy sex lives that they deserve. We review and discuss the diagnosis and treatment of low sexual desire in women with an emphasis on promoting efficient office-based assessment and treatment and referral. NORMAL SEXUAL FUNCTION AND MODELS OF SEXUAL RESPONSE Normal sexual function is a misleading concept, because there is not an objective measure to define it. Normal is often defined by statistical norms, cultural norms, or both. Furthermore, normal function may vary between women and within the same woman over the course of her lifetime. Multiple models have been developed to describe a healthy sexual response. In 1966, Masters and Johnson proposed a linear model of sexual response based on their observations of the physiologic changes that occurred in men and women in a laboratory setting. Their model consisted of four stages: excitement, plateau, orgasm, and resolution (Fig. 1). Subsequently, Kaplan and Leif independently modified this model to include the concept of desire, which reflects the psychological, emotional, and cognitive components of sexual response. This revised linear model encompassed three phases: desire, excitement, and orgasm (Fig. 2). Based on observations that women s sexual responses often do not follow a linear trajectory, Basson introduced an intimacy-based circular model to help explain the multifactorial nature of women s sexual response. 8 Her model acknowledges the intricate interplay of emotional intimacy, sexual stimuli, psychological factors, and relationship satisfaction that determine sexual response (Fig. 3). It also introduces the concept of sexual neutrality and responsive desire (the idea that women may not be motivated by Sexual response Orgasm Plateau Excitement Time Resolution Fig. 1. The Masters and Johnson model of sexual response. This linear response model was proposed in 1966 and is composed of four stages: excitement, plateau, orgasm, and resolution based on physiologic findings of men and women in the laboratory. Women may experience different variations of this response. Modified from Masters WH, Johnson VE. Human sexual response. Boston (MA): Little, Brown; Kingsberg. Female Sexual Dysfunction. Obstet Gynecol spontaneous desire and that desire results from arousal in the context of a loving relationship) and forms the basis for the DSM-5 criteria of Female Sexual Interest and Arousal Disorder. 3 DISORDERS OF SEXUAL DESIRE: DIAGNOSIS Definition According to the DSM-IV-TR, hypoactive sexual desire disorder was defined as persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. 4 To qualify as a disorder, it should not be better accounted for by another mental disorder, drug, or other medical condition. Diagnosis Sexual response Desire Excitement Orgasm Time Resolution Fig. 2. The Kaplan Triphasic model of sexual response. This model adds the concept of desire and condenses the sexual response into three phases: desire, excitement, and orgasm. The physiological events that take place in Kaplan s threestage model are the same as Masters and Johnson s fourstage model. Data from Kaplan HS. Disorders of sexual desire and other new concepts and techniques in sex therapy. New York (NY): Brunner/Hazel Publications; Kingsberg. Female Sexual Dysfunction. Obstet Gynecol Kingsberg and Woodard Female Sexual Dysfunction OBSTETRICS & GYNECOLOGY

3 Emotional intimacy Seeking out and being receptive to Fig. 3. Basson s nonlinear model of female sexual response. This model acknowledges the complexity of women s sexual functioning and incorporates the importance of intimacy, sexual stimuli, and relationship satisfaction. It also acknowledges that women may begin from a point of sexual neutrality. Modified from Basson R. Female sexual response: the role of drugs in the management of sexual dysfunction [published erratum appears in Obstet Gynecol 2001;98:522]. Obstet Gynecol 2001;98: Kingsberg. Female Sexual Dysfunction. Obstet Gynecol Emotional and physical satisfaction Arousal and sexual desire Spontaneous sexual drive Sexual arousal Sexual stimuli Biologic Physiological should take into account the normal fluctuation seen with relationships over time, age, personal health, and life circumstances. In the newly released DSM-5, 3 hypoactive sexual desire disorder and female sexual arousal disorders have been combined into one disorder, now called female sexual interest/arousal disorder, based on data suggesting that sexual response is not always a linear, uniform process and that the distinction between certain phases (particularly desire and arousal) may be artificial (Table 1). 9,10 As implied by Basson s circular model, desire and arousal are difficult to separate and normal desire includes a responsive component. 8 To increase objectivity and precision and to avoid overdiagnosis of transient sexual difficulties, diagnosis now requires a minimum duration of approximately 6 months and more precise severity criteria. Also, the DSM-5 requires that woman presenting with loss of desire experience personal distress rather than her partner or their relationship. Prevalence Two of the most recent epidemiologic surveys of low sexual desire include The Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking (PRESIDE) study 2 and a survey by West et al. 11 The PRESIDE survey included 31,581 U.S. women aged 18 years or older and used validated questionnaires to evaluate sexual function and measure distress. 2 In this study, 8.9% of women aged years, 12.3% of women aged years, and 7.4% of women older than 65 years exhibited low desire and distress, showing that distressing sexual problems peak during middle age. Using similar methods, West et al 11 conducted a cross-sectional study of 2,207 U.S. women aged years and found that the overall prevalence of hypoactive sexual desire disorder was 8.3%. Other studies have shown similar trends. 6,12 Pathophysiology The pathophysiology of low sexual desire is complex and should be considered in the context of the biopsychosocial approach. The biopsychosocial approach emphasizes the importance of understanding human health and illness in their fullest contexts by systematically considering biological, psychological, and social factors and their complex interactions on health and illness. 13 Biological factors may contribute to decreased desire by direct or indirect mechanisms. Common medical conditions (such as hypertension and diabetes mellitus) 14 and their treatment (including antihypertensives such as calcium channel blockers and angiotensinconverting enzyme inhibitors) 15 have been associated with decreased sexual desire. Frequently, sexual problems overlap such as the presence of dyspareunia being an underlying cause of low desire. Aging can also affect sexual desire. Previous studies have shown that middle-aged women have the highest prevalence of decreased desire with distress. 6,12 The intensity of sexual desire a woman experiences may decline as a result of neuroendocrine changes (declining testosterone, changes in neurochemistry, and indirect changes from loss of estrogen). Genital sensation may change, requiring stronger and longer stimulation to achieve arousal. Low estrogen levels may cause vulvovaginal atrophy and dyspareunia, which is associated with decreased desire. 16 These factors, along with unique psychosocial factors that VOL. 125, NO. 2, FEBRUARY 2015 Kingsberg and Woodard Female Sexual Dysfunction 479

4 Table 1. Classification of Female Sexual Dysfunction: Diagnostic and Statistical Manual of Mental Disorders (4th Edition, Text Revision) Compared With the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) DSM-IV-TR* DSM-5 Sexual desire disorders Hypoactive sexual desire disorder Deficiency or absence of sexual fantasies and desire for sexual activity Sexual aversion disorder Aversion to and active avoidance of genital sexual contact with a sexual partner Sexual arousal disorders Female sexual arousal disorder Persistent or recurrent inability to attain or to maintain until completion of the sexual activity, an adequate lubrication swelling response or sexual excitement Orgasmic disorders Female orgasmic disorder Persistent or recurrent delay in, or absence of, orgasm after normal sexual excitement Sexual pain disorders Dyspareunia Genital pain that is associated with sexual intercourse Vaginismus Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted Female sexual interest or arousal disorder Lack of or significantly reduced sexual interest or arousal as manifested by three of the following: 1. Absent or reduced interest in sexual activity 2. Absent or reduced sexual or erotic thoughts or fantasies 3. No or reduced initiation of sexual activity and unreceptive to partner s attempts to initiate 4. Absent or reduced sexual excitement or pleasure during sexual activity in almost all or all (75 100%) sexual encounters 5. Absent or reduced sexual interest or arousal in response to any internal or external sexual or erotic cues (written, verbal, or visual) 6. Absent or reduced genital or nongenital sensations during sexual activity in almost all or all (75 100%) sexual encounters Female orgasmic disorder Presence of either of the following on all or almost all (75 100%) occasions of sexual activity: 1. Marked delay in, marked infrequency of, or absence of orgasm 2. Markedly reduced intensity of orgasmic sensations Genitopelvic pain or penetration disorder Persistent or recurrent difficulties with one or more of the following: 1. Vaginal penetration during intercourse 2. Marked vulvovaginal or pelvic pain during intercourse or penetration attempts 3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or because of vaginal penetration 4. Marked tensing or tightening of pelvic floor muscles during attempted vaginal penetration DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders (4th Edition, Text Revision); DSM-5, Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Data from the American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition, revised. Arlington (VA): American Psychiatric Association; 2000, and American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Association; * Disturbance must cause marked distress or interpersonal difficulty. The sexual dysfunction must not be better accounted for by another disorder and is not attributed to the direct physiologic effects of a substance or medication or general medical conditions. Symptoms persist for a minimum of 6 months, are not better explained by a nonsexual mental disorder or a consequence of severe relationship distress or other significant stressors, and are not attributed to the effects of a substance or medication or other medical conditions. present during this life phase, influence sexual function during the menopausal transition. 17 Psychological factors play a significant role in sexual desire and may even sometimes override biologic factors. Psychiatric conditions (such as depression and anxiety) and their treatment (medications including selective serotonin reuptake inhibitors and anxiolytics) are associated with decreased 480 Kingsberg and Woodard Female Sexual Dysfunction OBSTETRICS & GYNECOLOGY

5 sexual desire. Sexual abuse and trauma in childhood and puberty, perceived stress, distraction, self-focused attention or anxiety, personality disorders, and body image or self-consciousness have all been shown to negatively affect desire. 18 The affect of social factors on sexual desire should also be considered. Cultural, social, and religious values and mores can negatively influence women s sexual desire, especially in women raised in highly restrictive cultures or religions. 5 Relationship factors such as conflict or a partner s sexual dysfunction (eg, erectile dysfunction and premature ejaculation in a male partner), 19 stressors such as financial hardship, career-related pressures, and familial obligations can also contribute to decreased sexual desire. To gain a better understanding of the etiology of hypoactive sexual desire disorder, the HSDD Registry for Women was designed to characterize a large (1,500 women) cross-section of women with hypoactive sexual desire disorder and to prospectively investigate several biopsychosocial factors associated with the disorder. 20 Initial findings from the registry confirm the multifactorial nature of hypoactive sexual desire disorder with the majority of premenopausal women identifying multiple factors (such as stress or fatigue, dissatisfaction with physical appearance and other sexual difficulties) that contribute to their decreased desire. 20 Screening Sexual concerns should be addressed routinely as part of all comprehensive women s health visits. Only onethird of women with seriously distressing sexual problems seek help. 21 Although some women are hesitant to initiate discussions, many still want their health care provider to open the dialogue about sex. 22 When a health care provider initiates this dialogue, he or she acknowledges and prioritizes the role that sexual health plays in overall well-being. Furthermore, the woman is given the opportunity to discuss issues and concerns that she may otherwise not disclose for fear of embarrassment or perception that it is not important. Gynecologists are often the first health care provider a woman turns to when seeking help for sexual problems. It is important to provide a safe and nonjudgmental environment that facilitates discussion of these issues. Placing patient-friendly educational materials in waiting and examination rooms and training staff to be knowledgeable and comfortable with sexual topics can create an atmosphere that is conducive to discussing sexual issues. Intake forms can be modified to include questions about sexual health, which provide additional opportunities for patients to disclose their sexual concerns. Women should be reassured that discussions will remain confidential. When women perceive that a health care provider is uncomfortable, disinterested, or reluctant, communication about sexual health can be hindered. 23,24 There are a variety of screening instruments thatcanbeusedtohelpidentifywomenwhosuffer from low desire. In particular, the Decreased Sexual Desire Screener 25 ( fsd/dsds_pocketcard.pdf) is a validated five-question, self-administered survey that helps practitioners identify generalized acquired hypoactive sexual desire disorder in both premenopausal and postmenopausal women in a timely and practical manner. 25 This screener is a useful adjunct to the patient history and physical examination in the diagnosis of hypoactive sexual desire disorder. Because the new DSM-5 diagnostic category of Female Sexual Interest/Arousal Disorder combines the prior DSM-IV-TR disorders of hypoactive sexual desire disorder and Female Sexual Arousal Disorder, screening and assessment should also include inquiry of difficulties with genital and nongenital excitement and arousal. Although time is limited in the clinical setting, it is important to ask questions that help determine the true nature of problem. When the patient presents with low desire, a detailed description of her problem, including the onset, duration, and severity of her symptoms, should be obtained. Her level of distress should be determined. Open-ended questions allow the patient to provide information essential for accurate diagnosis andthedevelopmentofanappropriatetreatmentplan. If there is not enough time to have a complete discussion, a return visit should be scheduled to specifically focus on her sexual concerns. History A complete medical history can identify conditions that contribute to low sexual desire. Psychiatric conditions should also be identified, because many such as depression and anxiety are associated with low desire. Medications should be reviewed, because some (such as selective serotonin reuptake inhibitors and antihypertensives) are linked to low desire (Box 1). Oral contraceptive use has been associated with low desire, 26,27 although other studies have not found this association. 28,29 Although most women will likely not be affected, the possible sexual consequences should be considered with patients during discussions of contraception options. VOL. 125, NO. 2, FEBRUARY 2015 Kingsberg and Woodard Female Sexual Dysfunction 481

6 Box 1. Medications Associated With Low Sexual Desire Anticonvulsants Carbamazepine Phenytoin Primidone Cardiovascular and antihypertensive agents Angiotensin-converting enzyme inhibitors Amiodarone Beta-blockers (atenolol, metoprolol, propranolol) Calcium channel blockers Clonidine Digoxin Diuretics (hydrochlorothiazide) Lipid-lowering agents Hormonal medications Antiandrogens (flutamide, spironolactone) Gonadotropin-releasing hormone agonists Oral contraceptive pills Other Histamine receptor blockers Pain relievers Nonsteroidal antiinflammatory drugs Opiates Psychotropic medications Antipsychotics Anxiolytics (alprazolam, diazepam) Serotonin norepinephrine reuptake inhibitors Serotonin selective receptor inhibitors Drugs of abuse Alcohol Amphetamines Cocaine Heroin Marijuana Gynecologic history can provide additional data about the cause of low desire. The presence of menstrual irregularities can indicate hormonal disorders (such as hyperprolactinemia and hypothyroidism) that interfere with sexual desire. A history of pelvic surgery may point to an anatomical source for sexual problems. Other gynecologic-related issues such as sexually transmitted infections and urinary incontinence can influence a woman s motivation and desire for sexual activity. Components of the sexual history should include direct questions about sexual behavior and safe sex practices. Sexual history-taking should always be conducted in a culturally sensitive manner, taking account of the individual s background and lifestyle and status of the partner relationship. 30 Physical Although many women with low desire will have normal findings, a physical examination may be warranted in some cases to identify possible contributors to low desire. The gynecologic examination can be particularly informative. The presence of vulvovaginal atrophy may result in dyspareunia, which can negatively affect sexual desire. Other important findings may include genital sensory changes (vulvodynia or neuropathy), pelvic floor muscle contraction (vaginismus), and pelvic floor prolapse, all of which can contribute to sexual dysfunction. Laboratory evaluation is rarely helpful in the diagnosis of low desire; however, it should be considered as warranted by history and physical examination. Women with physical findings suggestive of hyperprolactinemia or thyroid disease should have prolactin levels and thyroid function tests measured, respectively. Androgen levels alone are not meaningful, because levels have not been shown to correlate with sexual function. 31,32 Furthermore, the testosterone assays that are currently used are unreliable at the lower levels seen in women. 33,34 TREATMENT CONSIDERATIONS FOR LOW DESIRE Office-Based Counseling for the Obstetrician Gynecologist The complex etiology of low desire often dictates the need for a multifaceted intervention that uses a biopsychosocial approach. Before initiating treatment, it is important to set realistic goals and expectations. Women should be encouraged and empowered to take an active role in their treatment plan. The value of basic sex education should not be forgotten. Many women demonstrate a lack of knowledge about basic reproductive anatomy and physiology. Having anatomic diagrams and models can help patients gain a better understanding of their bodies and provide them with the vocabulary and knowledge to have effective and meaningful discussions about sex and sexual health. Women should be educated about the heterogeneity of normal sexual function. The popular media and society are often sources of misinformation and distorted ideas about sex. Health providers must be ready to identify and dispel myths about sex that can negatively influence sexual behavior. 482 Kingsberg and Woodard Female Sexual Dysfunction OBSTETRICS & GYNECOLOGY

7 Changes in lifestyle and behavior can help optimize sexual functioning. Gynecologists should not underestimate the effects of providing simple officebased suggestions. Reminding patients that leading a healthy lifestyle through diet, exercise, avoiding tobacco use, and minimizing stress can improve overall well-being and self-esteem, which may make women with low desire more receptive to sexual stimuli or activity. Circumventing boredom and routine by planning romantic encounters or incorporating erotica can foster an environment that optimizes sexual desire. Encourage patients to promote intimacy with one s partner through shared activities, date nights, and effective communication, which can also help rekindle sexual energy and interest. The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) model 35 is an incremental approach to office-based counseling for sexual problems that was designed to assist health care providers who wish to incorporate behavioral and psychological sex therapy techniques into their practice. In this model: Women are given permission to discuss their problems and emotions and to explore new solutions (Permission [P]); The health care provider gives some basic education specific for sexual function, provides educational resources such as literature, videos, and erotica, or both (Limited information [LI]); The health care provider offers specific directives or advice to address the presenting problem (Specific suggestions [SS]); and The health care provider gives referral for individual or couples therapy to address hypoactive sexual desire disorder that requires more intensive treatment than the office-based suggestions (Intensive therapy [IT]). Psychological Interventions Women who are refractory to office-based counseling should be referred to counselors or therapists with expertise in sexual problems. Psychological interventions include cognitive behavioral therapy, 36 sex therapy, 37 and mindfulness training. 38 Although there is insufficient evidence with regard to controlled trials studying the efficacy of psychological treatment in women with sexual dysfunction, the available evidence suggests significant improvements in sexual function after intervention with traditional sex therapy, cognitive behavioral therapy, 39 or both. Psychotherapy is typically favored when the low desire is acquired, situational, or both. In these cases, treatment focuses on modifying precipitating or contributing circumstances or behaviors. Sex therapy and cognitive behavioral therapy (individual, couples, or both) are the major treatment approaches represented in the empirical literature. Traditional sex therapy is a behavioral treatment that aims to improve an individual or couple seroticexperiences while reducing anxiety and self-consciousness about sexual activity. Cognitive behavioral sex therapy includes traditional behavioral sex therapy components but places a greater emphasis on modifying thought patterns or beliefs that interfere with intimacy and sexual pleasure. 40 Mindfulness-based cognitive behavioral treatments have also shown excellent promise for sexual desire problems. 41 In one of the few empirically tested outcome studies of psychotherapy, Brotto et al 41 demonstrated that a brief mindfulness-based cognitive behavioral intervention was successful in improving sexual desire and arousal problems in gynecologic cancer survivors. Pharmaceutical Interventions There are no U.S. Food and Drug Administration (FDA) approved interventions for the treatment of low desire in women. However, some agents are used off-label and several others are currently under clinical development. Conjugated estrogens and ospemifene are FDAapproved for the treatment of dyspareunia, which can contribute to low or absent desire. Although systemic estrogen has not been shown to improve sexual desire directly, vaginal estrogen significantly improves vaginal atrophy. Ospemifene is a novel selective estrogen receptor modulator with indication for the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women. A daily dose of 60 mg has been shown to be effective and safe with minimal side effects. 42,43 Both of these treatments can be useful in the treatment of women who have secondary hypoactive sexual desire disorder as a result of vaginal atrophy and dyspareunia. Testosterone production is critical for women, both as a major precursor for estradiol production and for its direct actions on androgen receptors throughout the body. 44 Although it is not FDAapproved for use in women, testosterone is widely prescribed off-label for postmenopausal women throughout the United States. 45 Substantial evidence suggests that testosterone therapy improves sexual well-being in postmenopausal women with decreased desire. 46 Improvements have been reported in the number of sexual events reported as satisfactory, sexual desire, pleasure, arousal, and frequency of orgasm as well as a reduction in personal distress. Benefits have been demonstrated in studies of testosterone implants, VOL. 125, NO. 2, FEBRUARY 2015 Kingsberg and Woodard Female Sexual Dysfunction 483

8 oral methyltestosterone, and transdermal testosterone. 47,48 Data on testosterone treatment in premenopausal women are lacking. U.S. Food and Drug Administration approval of testosterone use in women has not been achieved as a result of concerns about long-term safety and efficacy. Procter and Gamble submitted an application for a testosterone patch for women (Intrinsa) in 2004, but it was denied by the FDA because of concerns of long-term safety. BioSante Pharmaceuticals Inc. s testosterone gel for women (LibiGel) failed two large Phase III efficacy studies in The potential virilizing effects of exogenous testosterone include development of acne, hirsutism, deepening of the voice, and androgenic alopecia. 49 However, these effects are dose-related and can be avoided if hormone levels are kept in the female physiologic range. In a 4-year open-label extension safety summary of data of women receiving transdermal testosterone, the most common side effects were application site reactions and unwanted hair growth. 50 Other important concerns are whether testosterone therapy raises a woman s risk for cardiovascular disease and breast cancer. So far, there are no studies that have demonstrated a causal role. 51,52 Transdermal administration avoids first-pass liver effects, thereby avoiding alterations in lipid metabolism. 44,53 Analysis of data from the Nurses Health Study suggested that methyltestosterone users may be at increased risk of breast cancer, 54 whereas other studies of methyltestosterone use have not shown an increased risk. 53 APhase III long-term safety study showed that use of a testosterone transdermal gel did not increase cardiovascular events or breast cancer, even in high-risk women. 44,55 Testosterone therapy can be considered in perimenopausal and postmenopausal women for symptoms of decreased desire; however, it remains controversial and caution should be used. Oral formulations are not recommended as a result of its potential negative effects on lipids and liver function tests. The most common formulation used is a transdermal 1% testosterone cream (0.5 g cream55 mg testosterone daily) applied to skin of the arms, abdomen, or legs. Testosterone patches and gels formulated for men should be used with caution, because accurate dosing is difficult. Testosterone injections and implants are also available but may be subject to supraphysiologic dosing. Before prescribing testosterone, normal lipid levels and liver function should be documented. Women receiving testosterone therapy should be monitored for potential side effects and lipids and liver function should be reassessed. Free testosterone levels can be assessed to ensure that they remain in the physiologic range for premenopausal women. In all cases, patients must be informed about the lack of longterm published safety data. 49 Bupropion is a mild dopamine and norepinephrine reuptake inhibitor and nicotinic acetylcholine receptor antagonist that is used as an antidepressant and smoking cessation aid. In a single-blind study of 51 nondepressed women, 29% responded to treatment with bupropion SR. 56 A subsequent randomized, double-blind, placebo-controlled study of bupropion (150 mg/day) in 232 premenopausal women without depression also showed a significant increase in desire and decrease in distress in the treated group. 57 In addition to the treatment of nondepressed women with hypoactive sexual desire disorder, bupropion has been shown to be effective in reversing selective serotonin reuptake inhibitor-induced sexual dysfunction in premenopausal women. 58 Drugs in Development Although there are no FDA-approved pharmacologic treatments for hypoactive sexual desire disorder, several are currently in development. Flibanserin is a 5-HT1A receptor agonist and 5-HT2 receptor antagonist that has been studied in more than 11,000 women. Phase III trials have shown 100 mg flibanserin nightly to improve sexual desire, decrease distress, and increased the number of satisfying sexual events. A New Drug Application for treatment for hypoactive sexual desire disorder in premenopausal women was rejected by the FDA in October A subsequent appeal through a formal dispute resolution has led to additional safety studies currently underway and a resubmission is planned in the Spring of Other pharmaceutical agents in development include novel combination drugs that contain sublingual testosterone with a phosphodiesterase inhibitor (Lybrido) or a 5HT1A receptor agonist (Lybridos). Both are proposed to increase sexual motivation through testosterone; however, the addition of the phosphodiesterase inhibitor is thought to increase sexual physiological (vascular) sexual response, 59 whereas addition of a 5HT1A receptor agonist is thought to act centrally by decreasing sexual inhibition. 60 Bremelanotide, a melanocortin receptor 4 agonist, is another agent that is being investigated for the treatment of low desire and is also postulated to work through central nervous system mechanisms. 61 Complications of Treatment Although gynecologists can diagnose and treat many cases of low desire, there are some that require expert care. The identification of unresolved physical or sexual 484 Kingsberg and Woodard Female Sexual Dysfunction OBSTETRICS & GYNECOLOGY

9 trauma, abuse, and the presence of serious psychiatric issues should prompt immediate referral to a specialist. These issues need to be addressed before treating low desire. Women who have lifelong symptoms, psychiatric comorbidities, a partner with sexual dysfunction, or ongoing intrapersonal, interpersonal, and sociocultural issues that affect sexual function can also be particularly challenging and warrant referral to an expert in sexual medicine. Establishing a relationship with a network of health care providers trained in sexual health and medicine is helpful. Organizations such as the International Society for the Study of Women s Sexual Health ( the American Association of Sexuality Educators, Counselors and Therapists ( and the Society for Sex Therapy and Research ( have online tools that help people locate health care providers who specialize in sexual health issues. CONCLUSION Decreased sexual desire is common among women of all ages and can have negative effects on overall wellbeing. As frontline providers of women s health care, gynecologists are in a unique position to effectively diagnose and treat this condition. Sex education, office-based counseling, and medications (including bupropion and testosterone) are viable options in appropriate candidates. Difficult cases warrant referral to specialists in sexual health and medicine. Although there are not any FDA-approved medications for treatment of low sexual desire, several agents are in development. REFERENCES 1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281: Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008;112: American Psychiatric Association, American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association; American Psychiatric Association, American Psychiatric Association. Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; Kingsberg SA, Rezaee RL. Hypoactive sexual desire in women. Menopause 2013;20: Leiblum SR, Koochaki PE, Rodenberg CA, Barton IP, Rosen RC. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women s International Study of Health and Sexuality (WISHeS). Menopause 2006;13: Biddle AK, West SL, D Aloisio AA, Wheeler SB, Borisov NN, Thorp J. Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. Value Health 2009; 12: Basson R. Human sex-response cycles. J Sex Marital Ther 2001;27: Binik YM, Brotto LA, Graham CA, Segraves RT. Response of the DSM-V Sexual Dysfunctions subworkgroup to commentaries published in JSM. J Sex Med 2010;7: ter Kuile MM, Brauer M, Laan E. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): psychometric properties within a Dutch population. J Sex Marital Ther 2006;32: West SL, D Aloisio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med 2008;168: Rosen RC, Connor MK, Miyasato G, Link C, Shifren JL, Fisher WA, et al. Sexual desire problems in women seeking healthcare: a novel study design for ascertaining prevalence of hypoactive sexual desire disorder in clinic-based samples of U.S. women. J Womens Health (Larchmt) 2012;21: Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977;196: Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet 2007;369: Finger WW, Lund M, Slagle MA. Medications that may contribute to sexual disorders. A guide to assessment and treatment in family practice. J Fam Pract 1997;44: Levine KB, Williams RE, Hartmann KE. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause 2008;15: Dennerstein L, Lehert P, Burger H, Dudley E. Factors affecting sexual functioning of women in the mid-life years. Climacteric 1999;2: Brotto LA, Bitzer J, Laan E, Leiblum S, Luria M. Women s sexual desire and arousal disorders. J Sex Med 2010;7: Rubio-Aurioles E, Kim ED, Rosen RC, Porst H, Burns P, Zeigler H, et al. Impact on erectile function and sexual quality of life of couples: a double-blind, randomized, placebo-controlled trial of tadalafil taken once daily. J Sex Med 2009;6: Rosen RC, Connor MK, Maserejian NN. The HSDD registry for women: a novel patient registry for women with generalized acquired hypoactive sexual desire disorder. J Sex Med 2010;7: Shifren JL, Johannes CB, Monz BU, Russo PA, Bennett L, Rosen R. Help-seeking behavior of women with self-reported distressing sexual problems. J Womens Health (Larchmt) 2009; 18: Berman L, Berman J, Felder S, Pollets D, Chhabra S, Miles M, et al. Seeking help for sexual function complaints: what gynecologists need to know about the female patient s experience. Fertil Steril 2003;79: Buster JE. Managing female sexual dysfunction. Fertil Steril 2013;100: Hughes AK. Mid-to-late-life women and sexual health: communication with health care providers. Fam Med 2013;45: Clayton AH, Goldfischer ER, Goldstein I, Derogatis L, Lewis- D Agostino DJ, Pyke R. Validation of the decreased sexual desire screener (DSDS): a brief diagnostic instrument for generalized acquired female hypoactive sexual desire disorder (HSDD). J Sex Med 2009;6: Wallwiener CW, Wallwiener LM, Seeger H, Muck AO, Bitzer J, Wallwiener M. Prevalence of sexual dysfunction and impact of contraception in female German medical students. J Sex Med 2010;7: VOL. 125, NO. 2, FEBRUARY 2015 Kingsberg and Woodard Female Sexual Dysfunction 485

10 27. Bitzer J, Tschudin S, Meier-Burgoa J, Armbruster U, Schwendke A. Effects on the quality of life of a new oral contraceptive containing 30 mcg EE and 3 mg drospirenone (Yasmin) [in German]. Praxis (Bern 1994) 2003;92: Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med 2012;9: Pastor Z, Holla K, Chmel R. The influence of combined oral contraceptives on female sexual desire: a systematic review. Eur J Contracept Reprod Health Care 2013;18: Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard operating procedures for taking a sexual history. J Sex Med 2013;10: Davis SR, Davison SL, Donath S, Bell RJ. Circulating androgen levels and self-reported sexual function in women. JAMA 2005; 294: Santoro N, Torrens J, Crawford S, Allsworth JE, Finkelstein JS, Gold EB, et al. Correlates of circulating androgens in mid-life women: the study of women s health across the nation. J Clin Endocrinol Metab 2005;90: Guay AT, Jacobson J. Decreased free testosterone and dehydroepiandrosterone-sulfate (DHEA-S) levels in women with decreased libido. J Sex Marital Ther 2002;28(suppl 1): Talakoub L, Munarriz R, Hoag L, Gioia M, Flaherty E, Goldstein I. Epidemiological characteristics of 250 women with sexual dysfunction who presented for initial evaluation. J Sex Marital Ther 2002;28(suppl 1): Aanon JS. Behavioral treatment of sexual problems: brief therapy. Hagerstown (MD): Harper and Row; Trudela GMA, Ravartb M, Aubinb S, Turgeonb L, Fortierb P. The effect of a cognitive-behavioral group treatment program on hypoactive sexual desire in women. Sex Relat Ther 2001;16: Hawton K, Catalan J, Martin P, Fagg J. Long-term outcome of sex therapy. Behav Res Ther 1986;24: Brotto LA, Basson R, Luria M. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. J Sex Med 2008;5: Günzler C, Berner MM. Efficacy of psychosocial interventions in menandwomen withsexualdysfunctions a systematic review of controlled clinical trials: part 2 the efficacy of psychosocial interventions for female sexual dysfunction. J Sex Med 2012;9: Bradford A. Inhibited sexual desire in women. In: Grossman LR, Walfish S, editors. Translating psychological research into practice. New York (NY): Springer; 2013:p Brotto LA, Erskine Y, Carey M, Ehlen T, Finlayson S, Heywood M, et al. A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol 2012;125: Cui Y, Zong H, Yan H, Li N, Zhang Y. The efficacy and safety of ospemifene in treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy: a systematic review and meta-analysis. J Sex Med 2014;11: Goldstein SR, Bachmann GA, Koninckx PR, Lin VH, Portman DJ, Ylikorkala O, et al. Ospemifene 12-month safety and efficacy in postmenopausal women with vulvar and vaginal atrophy. Climacteric 2014;17: Davis SR, Braunstein GD. Efficacy and safety of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. J Sex Med 2012;9: Snabes MC, Simes SM. Approved hormonal treatments for HSDD: an unmet medical need. J Sex Med 2009;6: Somboonporn W, Davis S, Seif MW, Bell R. Testosterone for peri- and postmenopausal women. The Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD DOI: / CD pub Braunstein GD. Safety of testosterone treatment in postmenopausal women. Fertil Steril 2007;88: Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 2008;359: Female sexual dysfunction. Practice Bulletin No American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117: Nachtigall L, Casson P, Lucas J, Schofield V, Melson C, Simon JA. Safety and tolerability of testosterone patch therapy for up to 4 years in surgically menopausal women receiving oral or transdermal oestrogen. Gynecol Endocrinol 2011; 27: Brand JS, van der Schouw YT. Testosterone, SHBG and cardiovascular health in postmenopausal women. Int J Impot Res 2010;22: Laughlin GA, Goodell V, Barrett-Connor E. Extremes of endogenous testosterone are associated with increased risk of incident coronary events in older women. J Clin Endocrinol Metab 2010;95: Davis SR. Cardiovascular and cancer safety of testosterone in women. Curr Opin Endocrinol Diabetes Obes 2011;18: Ness RB, Albano JD, McTiernan A, Cauley JA. Influence of estrogen plus testosterone supplementation on breast cancer. Arch Intern Med 2009;169: White WB, Grady D, Giudice LC, Berry SM, Zborowski J, Snabes MC. A cardiovascular safety study of LibiGel (testosterone gel) in postmenopausal women with elevated cardiovascular risk and hypoactive sexual desire disorder. Am Heart J 2012;163: Segraves RT, Croft H, Kavoussi R, Ascher JA, Batey SR, Foster VJ, et al. Bupropion sustained release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women. J Sex Marital Ther 2001;27: Safarinejad MR, Hosseini SY, Asgari MA, Dadkhah F, Taghva A. A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women. BJU Int 2010; 106: Safarinejad MR. Reversal of SSRI-induced female sexual dysfunction by adjunctive bupropion in menstruating women: a double-blind, placebo-controlled and randomized study. J Psychopharmacol 2011;25: Poels S, Bloemers J, van Rooij K, Goldstein I, Gerritsen J, van Ham D, et al. Toward personalized sexual medicine (part 2): testosterone combined with a PDE5 inhibitor increases sexual satisfaction in women with HSDD and FSAD, and a low sensitive system for sexual cues. J Sex Med 2013;10: van Rooij K, Poels S, Bloemers J, Goldstein I, Gerritsen J, van Ham D, et al. Toward personalized sexual medicine (part 3): testosterone combined with a Serotonin1A receptor agonist increases sexual satisfaction in women with HSDD and FSAD, and dysfunctional activation of sexual inhibitory mechanisms. J Sex Med 2013;10: Portman DJ, Edelson J, Jordan R, Clayton A, Krychman ML. Bremelanotide for hypoactive sexual desire disorder: analyses from a phase 2B dose-ranging study. Obstet Gynecol 2014;123 (suppl 1):31S. 486 Kingsberg and Woodard Female Sexual Dysfunction OBSTETRICS & GYNECOLOGY

Female Sexuality Sheryl A. Kingsberg, Ph.D.

Female Sexuality Sheryl A. Kingsberg, Ph.D. Female Sexuality Sheryl A. Kingsberg, Ph.D. Professor of Reproductive Biology Case Western Reserve University School of Medicine Chief, Division of Behavioral Medicine Department of OB/GYN University Hospitals

More information

Low sexual desire: Appropriate use of testosterone in menopausal women

Low sexual desire: Appropriate use of testosterone in menopausal women Low sexual desire: Appropriate use of testosterone in menopausal women Low-dose testosterone treatment may be considered for HSDD in carefully selected menopausal women after standard therapies have been

More information

Nivedita Dhar M.D. Wayne State University April 25, 2013

Nivedita Dhar M.D. Wayne State University April 25, 2013 Female Sexual Dysfunction Nivedita Dhar M.D. Wayne State University April 25, 2013 Outline Define Sexual Health and Wellness and discuss how it is unique to each individual Discuss the current terminology

More information

Psykiatri PCK/Sexologisk Klinik Medication for Female Sexual Dysfunction - where are we?

Psykiatri PCK/Sexologisk Klinik Medication for Female Sexual Dysfunction - where are we? Medication for Female Sexual Dysfunction - where are we? Annamaria Giraldi, Professor, MD, PHD Sexological Clinic Copenhagen, Denmark Disclosures Eli Lilly - lecturer Boehringer advisory board Pfizer -

More information

Sexual dysfunction: Is it all about hormones?

Sexual dysfunction: Is it all about hormones? Sexual dysfunction: Is it all about hormones? Angelica Lindén Hirschberg, MD, PhD, Professor Department of Women s and Children s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm,

More information

Erin E. Stevens, MD Chair, Department of Gynecologic Oncology Billings Clinic Cancer Center January 18, 2017

Erin E. Stevens, MD Chair, Department of Gynecologic Oncology Billings Clinic Cancer Center January 18, 2017 Erin E. Stevens, MD Chair, Department of Gynecologic Oncology Billings Clinic Cancer Center January 18, 2017 Objectives Define what's normal Define female sexual dysfunction Identify the causes of female

More information

Sexuality. The Pharmacologic Treatment of Female Sexual Dysfunction: Future Reality or Wishful Thinking? Risks of Opening the Medicine Cabinet

Sexuality. The Pharmacologic Treatment of Female Sexual Dysfunction: Future Reality or Wishful Thinking? Risks of Opening the Medicine Cabinet 5 th Annual Meeting of the North American Menopause Society October 5, 4 Washington, DC Low Libido at Midlife: Will the Answer Ever Be in Our Medicine Cabinets? The Pharmacologic Treatment of Female Sexual

More information

Dr. Maliheh Keshvari

Dr. Maliheh Keshvari 1 Dr. Maliheh Keshvari Assistant professor of Urology Fellowship in Female Urology Mashhad University of Medical Sciences 2 Female Sexual Function and Dysfunction 3 It was not until recently that urologists

More information

Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)

Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis) COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Adult Men with Sexual Performance Problems Individual Planning: A Treatment Plan Overview for Adult Men with Sexual

More information

An Evidence-based Review of Clinical Trial Data

An Evidence-based Review of Clinical Trial Data An Evidence-based Review of Clinical Trial Data Karen K. Miller, MD Massachusetts General Hospital Harvard Medical School Boston, MA 1 Rationale for Investigating Androgen Administration in Women: Data

More information

Carmita Abdo, MD PhD. Medical School, University of São Paulo Program of Studies in Sexuality (ProSex)

Carmita Abdo, MD PhD. Medical School, University of São Paulo Program of Studies in Sexuality (ProSex) Carmita Abdo, MD PhD Medical School, University of São Paulo Program of Studies in Sexuality (ProSex) Carmita Abdo, MD PhD As per Rule 1595/2000 of the Federal Medical Council and Resolution RDC 102/2000

More information

Leslie R. Schover, PhD Department of Behavioral Science

Leslie R. Schover, PhD Department of Behavioral Science Causes and Treatments of Low Sexual Desire in Breast Cancer Survivors Leslie R. Schover, PhD Department of Behavioral Science IMPORTANCE OF SEX TO BREAST CANCER SURVIVORS Livestrong 2006 Post-Treatment

More information

Sexual difficulties in the menopause

Sexual difficulties in the menopause Sexual difficulties in the menopause Information Sheet Key points Sexual difficulties can be life-long or recently acquired, but they are a common presentation at menopause. Hormones are rarely the only

More information

Therapy and Sexual Health

Therapy and Sexual Health Menopausal hormone therapy and sexual health Earn 3 CPD Points online Menopausal Hormone Therapy and Sexual Health Key messages Dr Tobie De Villiers Consultant Gynaecologist Panorama MediClinic Department

More information

Resilient Intimacy. Richa Sood, M.D.

Resilient Intimacy. Richa Sood, M.D. Resilient Intimacy Richa Sood, M.D. Disclosures No financial conflicts My specialty is Female Sexual Dysfunction Common Questions What is normal sexuality, and how does it change with medical illness?

More information

PSYCHOLOGICAL TREATMENT FOR HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) IN MEN AND WOMEN

PSYCHOLOGICAL TREATMENT FOR HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) IN MEN AND WOMEN PSYCHOLOGICAL TREATMENT FOR HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) IN MEN AND WOMEN MARITA McCABE PhD FAPS DIRECTOR INSTITUTE FOR HEALTH AND AGEING SMSNA 207 Annual Scientific Meeting May 2, 207 Boston,

More information

Hypoactive Sexual Desire Disorder: Advances in Diagnosis and Treatment

Hypoactive Sexual Desire Disorder: Advances in Diagnosis and Treatment Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including

More information

Quick Study: Sex Therapy

Quick Study: Sex Therapy Quick Study: Sex Therapy Sexual Dysfunction: Difficulty experienced by an individual or couple during the stages of normal sexual activity including physical pleasure, desire, arousal, or orgasm. Assessing

More information

Sexual Dysfunction in Women: A Practical Approach. STEPHANIE S. FAUBION, MD, and JORDAN E. RULLO, PhD, Mayo Clinic, Rochester, Minnesota

Sexual Dysfunction in Women: A Practical Approach. STEPHANIE S. FAUBION, MD, and JORDAN E. RULLO, PhD, Mayo Clinic, Rochester, Minnesota : A Practical Approach STEPHANIE S. FAUBION, MD, and JORDAN E. RULLO, PhD, Mayo Clinic, Rochester, Minnesota Sexual dysfunction in women is a common and often distressing problem that has a negative impact

More information

The menopause is considerably more than just. Hormonal Changes in Menopause and Implications on Sexual Health

The menopause is considerably more than just. Hormonal Changes in Menopause and Implications on Sexual Health 220 Hormonal Changes in Menopause and Implications on Sexual Health Anneliese Schwenkhagen, MD Gynaekologicum Hamburg, Hamburg, Germany DOI: 10.1111/j.1743-6109.2007.00448.x ABSTRACT Introduction. The

More information

Female Sexual Dysfunction: Clinical approach

Female Sexual Dysfunction: Clinical approach Female Sexual Dysfunction: Clinical approach - What Nurses want to know - Alessandra Graziottin MD Director, Center of Gynecology and Medical Sexology H.San Raffaele Resnati, Milano, Italy Co-Director,

More information

9/30/2016. Data and Women s Preferences Should Inform the Treatment of Hypoactive Sexual Desire Disorder: The Case for Pharmacologic Agents

9/30/2016. Data and Women s Preferences Should Inform the Treatment of Hypoactive Sexual Desire Disorder: The Case for Pharmacologic Agents Data and Women s Preferences Should Inform the Treatment of Hypoactive Sexual Desire Disorder: The Case for Pharmacologic Agents Sources of Evidence for Physiological Mechanisms Modulating Sexual Desire

More information

Updating the Female Nomenclature: ICSM, ISSWSH, and ICD-11 Classification. Sharon J. Parish, MD, IF, NCMP 2017 Annual Scientific Program May 12, 2017

Updating the Female Nomenclature: ICSM, ISSWSH, and ICD-11 Classification. Sharon J. Parish, MD, IF, NCMP 2017 Annual Scientific Program May 12, 2017 Updating the Female Nomenclature: ICSM, ISSWSH, and ICD-11 Classification Sharon J. Parish, MD, IF, NCMP 2017 Annual Scientific Program May 12, 2017 Disclosures Advisory Board Palatin, Valeant Speaker

More information

Addyi (flibanserin) When Policy Topic is covered Coverage of Addyi is recommended in those who meet the following criteria:

Addyi (flibanserin) When Policy Topic is covered Coverage of Addyi is recommended in those who meet the following criteria: Addyi (flibanserin) Policy Number: 5.01.605 Last Review: 10/2018 Origination: 10/2015 Next Review: 10/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for Addyi when

More information

I have no disclosures to report. Addressing Female Sexual Needs. Sexual health. Objectives. WHO definition of sexual health:

I have no disclosures to report. Addressing Female Sexual Needs. Sexual health. Objectives. WHO definition of sexual health: Addressing Female Sexual Needs I have no disclosures to report Essentials of Women s Health Conference Big Island, Hawaii July 2016 Jennifer Kerns, MD, MS, MPH Assistant Professor, UCSF Department of Obstetrics,

More information

Female&sexual& dysfunction&and& Interstitial&cystitis& Urology Grand Rounds November 14, 2012 Momoe Hyakutake, Urogynecology Fellow.

Female&sexual& dysfunction&and& Interstitial&cystitis& Urology Grand Rounds November 14, 2012 Momoe Hyakutake, Urogynecology Fellow. Female&sexual& dysfunction&and& Interstitial&cystitis& Urology Grand Rounds November 14, 2012 Momoe Hyakutake, Urogynecology Fellow Objectives& 1) Overview of female sexual dysfunction 2) Explore the relationship

More information

Sexological aspects of genital pain

Sexological aspects of genital pain Sexological aspects of genital pain Annamaria Giraldi, professor, MD, PHD Sexological Clinic, Psychiatric Centre Copenhagen 1 Disclosures Speaker: Eli Lilly, Pfizer Consultant: Eli Lilly,Palatin 2 Agenda

More information

Sexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist

Sexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist Sexual dysfunction of chronic kidney disease Razieh salehian.md psychiatrist Disturbances in sexual function are a common feature of chronic renal failure. Sexual dysfunction is inversely associated with

More information

Bibliotherapy for Low Sexual Desire among Women: Evidence for Effectiveness. Laurie Mintz, Alexandra Balzer, & Hannah Bush. University of Missouri

Bibliotherapy for Low Sexual Desire among Women: Evidence for Effectiveness. Laurie Mintz, Alexandra Balzer, & Hannah Bush. University of Missouri Bibliotherapy for Low Sexual Desire among Women: Evidence for Effectiveness Laurie Mintz, Alexandra Balzer, & Hannah Bush University of Missouri Presented at the 118 th Convention of the American Psychological

More information

Sexual dysfunction in women with cancer: Navigating intimacy and intercourse between women and their partners

Sexual dysfunction in women with cancer: Navigating intimacy and intercourse between women and their partners Sexual dysfunction in women with cancer: Navigating intimacy and intercourse between women and their partners Don S. Dizon, MD, FACP Clinical Co-Director, Gynecologic Oncology Founder and Director, The

More information

GP Education Series Women s cancers. GP Education Day 11 July 2016

GP Education Series Women s cancers. GP Education Day 11 July 2016 GP Education Series Women s cancers GP Education Day 11 July 2016 Sexual Consequences of Treatment for Women s Cancers Dr Isabel White Clinical Research Fellow in Psychosexual Practice The Royal Marsden

More information

Learning Objectives. Peri menopause. Menopause Overview. Recommendation grading categories

Learning Objectives. Peri menopause. Menopause Overview. Recommendation grading categories Learning Objectives Identify common symptoms of the menopause transition Understand the risks and benefits of hormone replacement therapy (HRT) Be able to choose an appropriate hormone replacement regimen

More information

Male Sexual Dysfunction in Psychiatric Illnesses Sujit Kumar Kar 1, Saranya Dhanasekaran 1 Correspondence: gmail.

Male Sexual Dysfunction in Psychiatric Illnesses Sujit Kumar Kar 1, Saranya Dhanasekaran 1 Correspondence:  gmail. RESEARCH ARTICLE Open Access Male Sexual Dysfunction in Psychiatric Illnesses Sujit Kumar Kar 1, Saranya Dhanasekaran 1 Correspondence: drsujita@gmail.com; saranya296@ gmail.com Full list of author information

More information

Mayo Clin Proc, July 2002, Vol 77 Female Sexual Dysfunction Sexual pain disorder: the persistent or recurrent genital pain associated with non

Mayo Clin Proc, July 2002, Vol 77 Female Sexual Dysfunction Sexual pain disorder: the persistent or recurrent genital pain associated with non 698 Concise Review for Clinicians Female Sexual Dysfunction DEBORAH J. LIGHTNER, MD Female sexual dysfunction (FSD) was recently recognized as arising from multiple organic etiologies; it is not primarily

More information

Sexual Problems. Results of sexual problems

Sexual Problems. Results of sexual problems What leads to sexual problems? Side effects from certain medications Results of sexual problems Relationship difficulties What reduces sexual problems Medical treatment (if problem is biological) Medical

More information

Sexuality After the Diagnosis of Ovarian Cancer

Sexuality After the Diagnosis of Ovarian Cancer Sexuality After the Diagnosis of Ovarian Cancer June La Valleur, MD, FACOG, Sexual Health Counselor Associate Professor, Ret., University of Minnesota Medical School Sexual Health Consultant at Skyhill

More information

Sexuality and Sexual Dysfunction in Women

Sexuality and Sexual Dysfunction in Women Sexuality and Sexual Dysfunction in Women Denise M.S. Willers, MD Associate Professor of Obstetrics and Gynecology Washington University School of Medicine Disclosures No financial disclosures to make

More information

Assessment of female sexual dysfunction: review of validated methods

Assessment of female sexual dysfunction: review of validated methods FERTILITY AND STERILITY VOL. 77, NO. 4, SUPPL 4, APRIL 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Assessment

More information

Outline. Do Women Care about Sex? 3/22/2016. Aging and sexuality: More than just menopause. Sexual Health is. Definitions and Epidemiology

Outline. Do Women Care about Sex? 3/22/2016. Aging and sexuality: More than just menopause. Sexual Health is. Definitions and Epidemiology Outline Definitions and Epidemiology Aging and sexuality: More than just menopause Physiology, Definitions, Dysfunction Tami Rowen MD MS Assistant Professor UCSF Department of ObGyn&RS Physiology of Female

More information

Understanding the Spectrum of Female Sexual Dysfunction

Understanding the Spectrum of Female Sexual Dysfunction . Understanding the Spectrum of Female Sexual Dysfunction Bruce Kessel, MD Chair Jeanne Leventhal Alexander, MD; Sheila Bolour, MD; Mark Elliott, PhD; Lori Futterman, RN, PhD; Jannet Huang, MD; Lee Shulman,

More information

Women s sexuality, current debates

Women s sexuality, current debates Women s sexuality, current debates Denise Medico, M.Sc., M.A., Ph.D cand. Psychologist, Sexologist Training Course in Reproductive Health Research WHO Geneva 2008 (De)Constructing women s sexuality A dominant

More information

Sexual and Gender Identity Disorders

Sexual and Gender Identity Disorders Sexual and Gender Identity Disorders This section contains the Sexual Dysfunctions, the Paraphilias, and the Gender Identity Disorders. The Sexual Dysfunctions are characterized by disturbance in sexual

More information

THE BIG QUESTION NEW INSIGHTS INTO FEMALE SEXUAL DESIRE DISORDERS SEXUAL DESIRE DISORDERS - COMMON IN WOMEN

THE BIG QUESTION NEW INSIGHTS INTO FEMALE SEXUAL DESIRE DISORDERS SEXUAL DESIRE DISORDERS - COMMON IN WOMEN NEW INSIGHTS INTO FEMALE SEXUAL DESIRE DISORDERS DISCLOSURES - NIL Dr Rosie King MB BS FAChSHM OUTLINE Prevalence of desire disorders in women Libido and limerence Unrealistic Sexpectations impact of the

More information

Interventions to Address Sexual Problems in People with Cancer

Interventions to Address Sexual Problems in People with Cancer A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Interventions to Address Sexual Problems in People with Cancer L. Barbera, C. Zwaal, D. Elterman, K. McPherson,

More information

OBSTETRICS & GYNECOLOGY

OBSTETRICS & GYNECOLOGY JANUARY 2012 COMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING WWW.CPSRXS. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: Female Sexual Arousal

More information

Women s Sexual Interest/Desire Disorder : Implications of New Definition

Women s Sexual Interest/Desire Disorder : Implications of New Definition Women s Sexual Interest/Desire Disorder : Implications of New Definition Rosemary Basson MD FRCP(UK) Vancouver General Hospital University of British Columbia Vancouver, Canada 1 New Model of Sex Response

More information

CHAPTER 11: SEXUAL AND GENDER PROBLEMS KEY TERMS

CHAPTER 11: SEXUAL AND GENDER PROBLEMS KEY TERMS CHAPTER 11: SEXUAL AND GENDER PROBLEMS KEY TERMS Androgens The most important of the male hormones. Unusual sexual behaviour, such as impulsive sexual offending involving non-consenting others, may be

More information

Alphabetical Listing of DSM-IV Sexual and Gender Identity Disorders Reviewed

Alphabetical Listing of DSM-IV Sexual and Gender Identity Disorders Reviewed Alphabetical Listing of DSM-IV Sexual and Gender Identity Disorders Reviewed Handbook of Sexual and Gender Identity Disorders Edited by David L. Rowland and Luca Incrocci Copyright 2008 John Wiley & Sons,

More information

Sexual problems- some basic information

Sexual problems- some basic information Sexual Problems 1 Soheil A. Hanjani, MD, FACOG, FACS Obstetrics & Gynecology 830 Oak Street Brockton, MA 02301 (508) 583-4961 Fax (508) 583-4732 Soheil.Hanjani@Steward.org www.hanjanimd.com Sexual problems-

More information

The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction

The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction Original Article Ewha Med J 2011;34(2):33-38 pissn 2234-3180 / eissn 2234-2591 The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction Seong Ju Lee, Woo Sik Chung, Hana Yoon Department

More information

10/24/2014. Definitions and Epidemiology Physiology of Female Sexual Response Female Sexual Dysfunction

10/24/2014. Definitions and Epidemiology Physiology of Female Sexual Response Female Sexual Dysfunction None to report Tami Serene Rowen, M.D. M.S. Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco October 24, 2014 Definitions and Epidemiology Physiology

More information

Sex Cells The effect of hormones on peri- and post- menopausal female sexuality Dr. Cathy Caron November 24, 2011

Sex Cells The effect of hormones on peri- and post- menopausal female sexuality Dr. Cathy Caron November 24, 2011 Sex Cells The effect of hormones on peri- and post- menopausal female sexuality Dr. Cathy Caron November 24, 2011 Is sex over at menopause? Older adults are having sex 51% of women ages 50 to 59 report

More information

Female sexual dysfunction: Definition, classification, and debates

Female sexual dysfunction: Definition, classification, and debates Available online at www.sciencedirect.com Taiwanese Journal of Obstetrics & Gynecology 52 (2013) 3e7 Review Article Female sexual dysfunction: Definition, classification, and debates Ching-Hui Chen a,b,c,

More information

Flibanserin and Female Sexual Desire

Flibanserin and Female Sexual Desire Rx Photo Pixland / thinkstockphotos.com E Editor s note: The Rx column is intended to objectively inform and report on new developments in pharmacologic treatments and medical devices. Because in many

More information

Innovations in the Management of Dyspareunia

Innovations in the Management of Dyspareunia Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including

More information

Menopause and Sexuality

Menopause and Sexuality Menopause and Sexuality Bheemsain Tekkalaki, Swati Ravindran Department of Psychiatry, KLE University's J.N Medical College, Belagavi, Karnataka, India ABSTRACT Menopause heralds the end of the female

More information

Hypoactive Sexual Desire Disorder (HSDD)

Hypoactive Sexual Desire Disorder (HSDD) Hypoactive Sexual Desire Disorder (HSDD) Sharon J. Parish, MD Professor of Medicine in Clinical Psychiatry; Professor of Clinical Medicine 10/07/17 shp9079@med.cornell.edu 1 Conflict Of Interest Disclosure

More information

Postpartum Complications

Postpartum Complications ACOG Postpartum Toolkit Postpartum Complications Introduction The effects of pregnancy on many organ systems begin to resolve spontaneously after birth of the infant and delivery of the placenta. The timeline

More information

Renewing Intimacy & Sexuality after Gynecologic Cancer

Renewing Intimacy & Sexuality after Gynecologic Cancer Renewing Intimacy & Sexuality after Gynecologic Cancer foundationforwomenscancer.org Over 90,000 women are diagnosed with a gynecologic cancer each year. The challenge for a woman with cancer and her healthcare

More information

Sexual Disorders and Gender Identity Disorder

Sexual Disorders and Gender Identity Disorder Sexual Disorders and Gender Identity Disorder Chapter 13 Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Comer, Abnormal Psychology, 8e Sexual Disorders and Gender Identity

More information

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive

More information

ACTIVITY DISCLAIMER DISCLOSURE. Associated Session(s) Learning Objectives. Female Sexual Dysfunction: Demystifying the Secret Garden

ACTIVITY DISCLAIMER DISCLOSURE. Associated Session(s) Learning Objectives. Female Sexual Dysfunction: Demystifying the Secret Garden ACTIVITY DISCLAIMER Female Sexual Dysfunction: Demystifying the Secret Garden Phyllis MacGilvray, MD, FAAFP The material presented here is being made available by the American Academy of Family Physicians

More information

Flibanserin for Hypoactive Sexual Desire Disorder: Can We Bring Back that Loving Feeling?

Flibanserin for Hypoactive Sexual Desire Disorder: Can We Bring Back that Loving Feeling? Flibanserin for Hypoactive Sexual Desire Disorder: Can We Bring Back that Loving Feeling? Lori D. Watkins, Pharm.D PGY1 Pharmacy Practice Resident Methodist Hospital, San Antonio, Texas Division of Pharmacotherapy,

More information

Men s Sexual Health. Bell curve distribution. What is a normal libido? Everyone is different! Confused society. Hypoactive Sexual Desire Disorder

Men s Sexual Health. Bell curve distribution. What is a normal libido? Everyone is different! Confused society. Hypoactive Sexual Desire Disorder Men s Sexual Health 1. Too little or loss of libido 2. Too much of a good thing Bell curve distribution Dr Margaret Redelman Medical sex therapist Sydney Men s Health Bondi Junction Society of Australian

More information

Chapter 13. Sexual Variants, Abuse, and Dysfunctions. Sexual Abuse. Sexual and Gender Variants

Chapter 13. Sexual Variants, Abuse, and Dysfunctions. Sexual Abuse. Sexual and Gender Variants Chapter 13 Sexual Variants, Abuse, and Dysfunctions This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including

More information

Moving Beyond Cancer To A New Normal in Intimacy For Men & Their Partners. Presented by Mary Ellen West, RN, MN, CNM AASECT Certified Sex Counselor

Moving Beyond Cancer To A New Normal in Intimacy For Men & Their Partners. Presented by Mary Ellen West, RN, MN, CNM AASECT Certified Sex Counselor Moving Beyond Cancer To A New Normal in Intimacy For Men & Their Partners Presented by Mary Ellen West, RN, MN, CNM AASECT Certified Sex Counselor WHO Definition of Sexuality Central aspect of being human

More information

Sexual dysfunction in Multiple Sclerosis.

Sexual dysfunction in Multiple Sclerosis. Sexual dysfunction in Multiple Sclerosis. Moira Tzitzika MSc, BTEC, EFT, ΕCPS, MSMC Psychologist, Psychotherapist, Clinical. Sexologist First Vice President Hellenic Federation of Persons with MS Why such

More information

Female Sexual Dysfunction How Can Gynaecologists Help?

Female Sexual Dysfunction How Can Gynaecologists Help? SST LO Female Sexual Dysfunction How Can Gynaecologists Help? Sue ST LO MBBS, MD, FRCOG, PDipCommPsyMed The Family Planning Association of Hong Kong, Hong Kong Sexual dysfunction in women is common; gynaecologists

More information

Sexual Function and Dysfunction

Sexual Function and Dysfunction Sexual Function and Dysfunction Angie Rantell Lead Nurse / Nurse Cystoscopist Kings College Hospital, London, UK In the real world Sexual practices are changing! Sexual identities and behaviours change

More information

ASSESSING & MANAGING. Female sexual 2.0 CONTACT HOURS The Nurse Practitioner Vol. 34, No. 1

ASSESSING & MANAGING. Female sexual 2.0 CONTACT HOURS The Nurse Practitioner Vol. 34, No. 1 ASSESSING & MANAGING Female sexual 2.0 CONTACT HOURS 42 The Nurse Practitioner Vol. 34, No. 1 www.tnpj.com dysfunction Clair Kaplan, RN/MSN, APRN (WHNP), MHS, MT (ASCP) T he prevalence of female sexual

More information

Managing the Patient with Erectile Dysfunction: What Would You Do?

Managing the Patient with Erectile Dysfunction: What Would You Do? Managing the Patient with Erectile Dysfunction: What Would You Do? Florida A & M University College of Pharmacy and Pharmaceutical Sciences 42 nd Annual Clinical Symposium Wayne A. Sampson, M.D. Cross

More information

Psychopathology Sexual and Gender Identity Disorders

Psychopathology Sexual and Gender Identity Disorders Psychopathology Sexual and Gender Identity Disorders What you should know when you finish studying Chapter 10: 1. Stages of Sexual Responding desire, arousal, and/or orgasm 2. Sexual Dysfunctions that

More information

Topics in Human Sexuality: Sexual Disorders and Sex Therapy

Topics in Human Sexuality: Sexual Disorders and Sex Therapy Most people print off a copy of the post test and circle the answers as they read through the materials. Then, you can log in, go to "My Account" and under "Courses I Need to Take" click on the blue "Enter

More information

Atiwut Kamudhamas, MD, DHS, Ph.D., RTCOG, ACS

Atiwut Kamudhamas, MD, DHS, Ph.D., RTCOG, ACS Atiwut Kamudhamas, MD, DHS, Ph.D., RTCOG, ACS Biography 1985-1991 - Doctor of Medicine (First Class Honor) 1991-1992 - Post-graduate certificate in clinical medical science 1992-1995 - Diplomate Thai Board

More information

Sexuality and Bone Marrow Failure Diseases: A Conversation

Sexuality and Bone Marrow Failure Diseases: A Conversation Sexuality and Bone Marrow Failure Diseases: A Conversation Timothy Pearman, Ph.D. Director, Supportive Oncology Associate Professor Dept. of Medical Social Sciences Dept. of Psychiatry and Behavioral Sciences

More information

Menopause Matters. Equity Office Staff Seminar 14 November 2018

Menopause Matters. Equity Office Staff Seminar 14 November 2018 Menopause Matters Equity Office Staff Seminar 14 November 2018 1 What to expect at menopause How to manage symptoms Support at work Dr Janice Brown Medical lead, The University of Auckland NZ representative,

More information

Southern California Center for Sexual Health and Survivorship Medicine Inc, Newport Beach, CA 3

Southern California Center for Sexual Health and Survivorship Medicine Inc, Newport Beach, CA 3 The WISDOM survey: Physicians Level of Comfort Prescribing Treatment for Vulvar and Vaginal Atrophy (VVA) Symptoms in Women with a Predisposition or History of Breast Cancer Lisa Larkin, MD 1 ; Michael

More information

Outline. Clinic Visit: Mrs. Jones 3/10/2015

Outline. Clinic Visit: Mrs. Jones 3/10/2015 Outline Kim O Connor, MD, FACP Associate Professor University of Washington General Internal Medicine Sexual Response Cycle Categories of Female Sexual Dysfunction Biopsychosocial influences History Evaluation

More information

Vaginismus. get the facts

Vaginismus. get the facts get the facts Sexual Pain in Women: Some women can experience pain when trying to have sexual intercourse. Different kinds of pain have different causes. Sometimes the pain prevents intercourse from being

More information

Sexual Aversion. PP7501: Adult Psychopathology

Sexual Aversion. PP7501: Adult Psychopathology Sexual Aversion PP7501: Adult Psychopathology What is Sexual Aversion? The individual reports anxiety, fear, or disgust when confronted by sexual opportunity. What is Sexual Aversion NOT? Loss of desire

More information

BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC)

BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC) BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC) April 2014 Review April 2017 Bulletin 197: Dapoxetine for Premature Ejaculation JPC Recommendations: To support the East of England Priorities Advisory

More information

MENOPAUSAL HORMONE THERAPY 2016

MENOPAUSAL HORMONE THERAPY 2016 MENOPAUSAL HORMONE THERAPY 2016 Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA NICE provides the National Health Service advice on effective, good value healthcare.

More information

Using an FSDS-R Item to Screen for Sexually Related

Using an FSDS-R Item to Screen for Sexually Related Using an FSDS-R Item to Screen for Sexually Related Distress: A MsFLASH Analysis The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters

More information

FEMALE SEXUAL DYSFUNCTION

FEMALE SEXUAL DYSFUNCTION FEMALE SEXUAL DYSFUNCTION NM 1 FEMALE SEXUAL DYSFUNCTION: What women want? Navneet Magon MS (AFMC), FCCP Obstetrician, Gynecologist & Endoscopic Surgeon navneetmagon@gmail.com NM 3 Why talk about FSD???

More information

12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman

12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society

More information

Use of vaginal estrogen in Danish women: a nationwide cross-sectional study

Use of vaginal estrogen in Danish women: a nationwide cross-sectional study AOGS ORIGINAL RESEARCH ARTICLE Use of vaginal estrogen in Danish women: a nationwide cross-sectional study AMANI MEAIDI 1,, IRINA GOUKASIAN & OEJVIND LIDEGAARD 1 1 Department of Gynecology, Rigshospitalet

More information

Sexuality and Contraception. Prof. J. Bitzer Dep. Obstetrics and Gynecology University Hospitals Basel

Sexuality and Contraception. Prof. J. Bitzer Dep. Obstetrics and Gynecology University Hospitals Basel Sexuality and Contraception Prof. J. Bitzer Dep. Obstetrics and Gynecology University Hospitals Basel The motivation for poeple to become sexually active Sexual Activity Wish to become pregnant Feeling

More information

Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D.

Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D. Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D. Department of Andrology and Reproductive Endocrinology Medical University of Łódź, Poland SEXUALITY Sexuality

More information

Sexuality, Intimacy and Relationships in Survivorship: A Quality of Life Issue

Sexuality, Intimacy and Relationships in Survivorship: A Quality of Life Issue Sexuality, Intimacy and Relationships in Survivorship: A Quality of Life Issue Sage Bolte, PhD, LCSW, OSW-C Program Coordinator, Oncology Counselor Life with Cancer Inova Cancer Services Fairfax, VA sage.bolte@inova.org

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace

More information

When cancer joins you in the bedroom...sexuality and intimacy

When cancer joins you in the bedroom...sexuality and intimacy Meeting of the Waters 22/7/2017 When cancer joins you in the bedroom...sexuality and intimacy Gay Corbett Prostate Cancer Specialist nurse Continence Nurses Society Australia Vic Tas (CoNSAVT) Victorian

More information

Mental Health Nursing: Sexual Disorders. By Mary B. Knutson, RN, MS, FCP

Mental Health Nursing: Sexual Disorders. By Mary B. Knutson, RN, MS, FCP Mental Health Nursing: Sexual Disorders By Mary B. Knutson, RN, MS, FCP Definition of Sexuality A desire for contact, warmth, tenderness, and love Adaptive sexual behavior is consensual, free of force,

More information

OBSTETRICS & GYNECOLOGY

OBSTETRICS & GYNECOLOGY AUGUST 2011 NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING N ORLANDA VENUEP HARMACY. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: BHRT for Menopause

More information

5/3/2016 SEXUALITY: KNOWLEDGE OPENS THE DOOR OBJECTIVES DEFINITIONS CONT. DEFINITIONS

5/3/2016 SEXUALITY: KNOWLEDGE OPENS THE DOOR OBJECTIVES DEFINITIONS CONT. DEFINITIONS SEXUALITY: KNOWLEDGE OPENS THE DOOR TO COMMUNICATION JILL LIBBESMEIER BSN, RN, OCN OBJECTIVES Understand the differences between sexuality, intimacy, sexual health, and sexual dysfunction Identify how

More information

Testosterone therapy for sexual dysfunction in postmenopausal women

Testosterone therapy for sexual dysfunction in postmenopausal women CLIMACTERIC 2008;11:181 191 Testosterone therapy for sexual dysfunction in postmenopausal women Z. Hubayter* and J. A. Simon { *Division of Reproductive Endocrinology and Infertility, Department of Gynecology

More information

Menopause management NICE Implementation

Menopause management NICE Implementation Menopause management NICE Implementation Dr Paula Briggs Consultant in Sexual & Reproductive Health Southport and Ormskirk NHS Hospital Trust Why a NICE guideline (NG 23) Media reports about HRT have not

More information

Tadalafil once daily: Narrative review of a treatment option for female sexual dysfunctions (FSD) in midlife and older women

Tadalafil once daily: Narrative review of a treatment option for female sexual dysfunctions (FSD) in midlife and older women ORIGINAL PAPER DOI: 10.4081/aiua.2017.1.7 Tadalafil once daily: Narrative review of a treatment option for female sexual dysfunctions (FSD) in midlife and older women Chiara Borghi 1, Lucio Dell Atti 2

More information

85% 98% 6/12/2018. Disclosures. There is a need. There is a need and that need is unmet. Objectives. Barriers to meeting sexual health needs

85% 98% 6/12/2018. Disclosures. There is a need. There is a need and that need is unmet. Objectives. Barriers to meeting sexual health needs Disclosures No financial disclosures Addressing the Sexual Health Needs of Cancer Survivors: Applying Theory and Research to Practice Kristen M. Carpenter, Ph.D. June 11, 2018 There is a need There is

More information

The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women

The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women Arch Sex Behav (2010) 39:221 239 DOI 10.1007/s10508-009-9543-1 ORIGINAL PAPER The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women Lori A. Brotto Published online: 24 September 2009

More information

Chapter 11 Gender and Sexuality

Chapter 11 Gender and Sexuality Chapter 11 Gender and Sexuality Defining Some Terms Sex: Whether you are biologically male or female Gender: All the psychological and social characteristics associated with being male or female; defined

More information