The International Society for the Study of Women's Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women

Abstract

Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.

Mild traumatic brain injury/concussion and female sexuality, a scoping review of the literature

“…Because concussed patients are often discharged from the ED and not admitted, rigorous follow-up may be needed to ensure that these patients, females in particular, get adequate follow-up care to abate some of the long term consequences of the injury-sexual changes included. Providers should be trained to address sexual health after concussions with their patients in the outpatient setting, and prescribe the necessary behavioral and/or pharmacological therapies required to address the concerns raised by their head injured patients (Parish et al 2019;Deschênes et al 2019;Deschenes et al 2017). This is especially crucial given the higher prevalence of pituitary dysfunctions in concussed (16.8%) compared to moderately injured TBI (10.9%) patients.…”

“…Depression and other mood disorders could ensue; either as a direct consequence of the hormonal deficiencies, or as a result of the physiological and physical changes imposed by the condition; impacting the individuals' desire or ability to engage in sexual activity. These changes may inadvertently affect the person's relationship status, in the long run, impair fertility outcomes (Parish et al 2019;FertilityFactor.com 2016;Polyzos et al 2016;Ascoli and Cavagnini 2006;Bell and Pepping 2001). Infertility, defined as the inability to conceive after one or more years of trying (American Society for Reproductive Medicine 2016), is a direct consequence of both hypogonadism and sexual dysfunctions (FertilityFactor.com 2016;Polyzos et al 2016;Ascoli and Cavagnini 2006;Bell and Pepping 2001).…”

The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry.

“…Yet, addressing concerns about sexual health can be difficult for nurses [105,106], midwives [53,101], and physicians [37,107,108]. Although sexual health is avoided by clinicians [109,110], interactive postpartum sexual health education [111] was demonstrated in a randomized control trial of women in the postpartum (n = 250) to be an effective intervention to stimulate conversations and to advance knowledge development.…”

The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry.

“…Yet, addressing concerns about sexual health can be di cult for nurses [116,117], midwives [53,112], and physicians [36,118,119]. Although sexual health is avoided by clinicians [120,121], interactive postpartum sexual health education [122] was demonstrated in a randomized control trial of women in the postpartum period (n=250) to be an effective intervention to stimulate conversations and to advance knowledge development.…”