Development and Evaluation of the Women's Sexual Interest Diagnostic Interview (WSID): A Structured Interview to Diagnose Hypoactive Sexual Desire Disorder (HSDD) in Standardized Patients

Abstract

Introduction Female sexual dysfunction (FSD) is a common disorder in postmenopausal women. Currently, there is no clear “gold standard” for the diagnosis of FSD. Aim The aim of this study was to evaluate the interrater reliability of the Women's Sexual Interest Diagnostic Interview (WSID), a new structured clinical interview designed to diagnose hypoactive sexual desire disorder (HSDD). The reliability of additional interview questions focused on the diagnosis of other types of FSD was also evaluated. Main Outcome Measures The main outcome measure was the level of agreement in the diagnosis of FSD among clinical experts, between clinical experts and study coordinators, and between clinical experts and patients' self-reported interactive voice response system (IVRS) version of the WSID. Methods Two versions of WSID were developed based on current diagnostic criteria: a clinician-administered version using a structured interview guide, and a patient self-report version using an IVRS. Three sexual medicine experts developed 20 clinical scenarios portraying cases and noncases of HSDD and other FSD diagnostic subtypes. Ten actresses with experience in standardized patient interviewing rehearsed these scenarios and performed the scripted patient roles in a standardized clinical interview with clinical experts (not the author of the script) and study coordinators, on a one-on-one basis, using the WSID interview format. In addition, all actresses completed the IVRS version of the WSID. Interviews were videotaped and viewed by the expert panel. In each instance, the diagnosis that the interview was scripted to portray was considered as the “gold standard.” Kappa (κ) coefficients were utilized to assess the level of agreement among experts, between study coordinators and the “gold standard”, and between the IVRS version of the WSID and the “gold standard”. Results All experts agreed with the gold standard diagnosis provided by the author of the script (κ = 1.0). Similarly, there was perfect agreement among the experts on the presence of depressive symptomatology (κ = 1.0). On the related diagnoses of arousal disorder, orgasmic disorder, and sexual pain disorder, kappas of 0.894, 0.966, and 0.946 were observed (P < 0.0001 for all comparisons). When study coordinator's WSID diagnoses were compared with the “gold standard,” kappa for HSDD was 0.851; sensitivity was 0.864, and specificity and positive predictive value (PPV) were 1.00 (P < 0.001 for all comparisons). When diagnoses obtained via IVRS interviews were compared with the “gold standard”, kappa for HSDD was 0.802, sensitivity was 0.818, and specificity and PPV were 1.00 (P < 0.001 for all comparisons). Conclusions Agreement as estimated by kappa coefficients was consistently high in both clinician-administered and patient self-reported IVRS versions in the diagnosis of HSDD.

Low Sexual Desire — Is it All in Her Head? Pathophysiology, Diagnosis, and Treatment of Hypoactive Sexual Desire Disorder

“…A number of well-validated self-and clinician-administered questionnaires are available, including the Female Sexual Function Index (FSFI), a 19-item self-report measure of FSD that scores on 6 domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain), as well as a total score, 32 and has been validated in women with HSDD; 33 the PFSF, a 37-item instrument, measures the loss of sexual desire and related aspects of sexual function in menopausal women with HSDD; 28,34 the Sexual Interest and Desire Inventory-Female Version (SIDI-F), a clinicianadministered tool to quantify the severity of symptoms in women with HSDD, 35,36 and the validated Women's Sexual Interest Diagnostic Interview (WSID), an assessment tool designed to help clinicians identify HSDD in postmenopausal women. [36][37][38] Shorter questionnaires have also been developed and validated for use in busy clinical practice, including the brief version of the PFSF, developed using items from the PFSF and the PDS and validated in HSDD, 39 a 4-item HSDD screener, which can be paired with a face-to-face interview by the primary care clinician to reliably screen for HSDD in postmenopausal women, 26 and the Decreased Sexual Desire Screener (DSDS), a 5-item questionnaire developed for practicing clinicians who are neither trained nor specialized in managing FSD. These brief diagnostic screening tools are designed to assist clinicians in making an accurate diagnosis of generalized acquired HSDD.…”

Critiques and Challenges to Old and Recently Proposed American Psychiatric Association's Website DSM 5 Diagnostic Criteria for Sexual Dysfunctions

“…On the other hand, if there are two naturally occurring distinct conditions present, with unique characteristics which show phenomenological overlap at the symptom level, the risks of merging them in DSM 5 may be substantial in terms of clinical practice and research. In the DeRogatis paper, Goldstein & Goldstein emphasizes the significance of protecting the women from having their problems lumped in a way that makes providing treatments more difficult (25). Therefore, it is expected that there will be further discussions and debates regarding whether this lumping is based on evidence or expert opinions.…”

“…Although the idea of merging the two disorders together is still mainly based on clinical judgement rather than sufficient empirical evidence, the suggestion has been welcomed by many professionals and is regarded as one of the most important propositions to be considered in DSM 5. Some authors (24) state that HSDD and FSAD share commonalities at the symptom level but data exists showing that they are distinguishable from each other (25). In a review made by DeRogatis in 2010, Goldstein and Goldstein suggest 3 categories such as HSDD, FSAD and FSIAD, as some women may have both desire and arousal problems while others clearly have only one (24).…”

What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder

“…Other measurements were rejected because published discriminant validation was lacking30, 31 or because the validation was limited to accuracy in use of the instrument to diagnose rather than measure low desire (Decreased Sexual Desire Screener, 32 Women’s Sexual Interest Diagnostic, 33 the Sexual Complaints Screener for Women, 34 and a structured diagnostic method to enable diagnosis of FSD in postmenopausal women) 21 . Other measurements were rejected because they covered sexual desire only in a single, generic item (the Arizona Sexual Experiences Scale, 35 the Massachusetts General Hospital Sexual Function Questionnaire, 36 and an unnamed measurement) 37 .…”